PURPOSE: To assess removable prosthetic restoration tolerance according to the patient section of the short form of the Gagging Problem Assessment Questionnaire (GPA-pa SF) and the influence of gender, education level and prosthesis type and denture-related mucosal irritation on the GPA-pa SF scores before treatment and over a period of two months after prosthesis insertion. MATERIALS AND METHODS: 130 participants who required removable prosthesis were surveyed with a standard form that included questions regarding age, gender, education level, dental attendance, and prosthetic restoration type. Participants answered the GPA-pa SF before restoration (T0) and 1 day (T1), 2 days (T2), 15 days (T3), 1 month (T4), and 2 months (T5) after prosthesis insertion. RESULTS: Of the 130 participants, 110 participants completed the prosthetic restoration procedure, but only 93 of these were able to use the prosthesis over the two-month period. The mean GPA-pa SF score obtained at T0 was higher than the scores obtained at the other periods in the total of the sample. Significant difference was present between mean scores obtained at T0-T1 and T2-T3 than scores obtained at other periods (P<.05). Female participants and participants with denture-related mucosal irritation had higher GPA-pa SF scores at all time points analysed. Significant difference was present between mean GPA-pa SF scores obtained at T2-T3 than scores obtained at other periods for females and participants with denture-related mucosal irritation (P<.05). Education level and prosthesis type did not significantly influence the GPA-pa SF score at any time point analysed (P>.05). CONCLUSION: GPA-pa SF scores were higher before the restoration procedure began, and decreased over time with the use of prosthesis. Gender and denture-related mucosal irritation affected the GPA-pa SF scores.
Education ; Female ; Gagging* ; Humans ; Prostheses and Implants ; Prosthodontics ; Reflex* ; Surveys and Questionnaires

Patients with severe gag reflex (SGR) have difficulty getting the treatment they require in local clinics, and many tend to postpone the start of their treatment. To address this problem, dentists have used behavioral techniques and/or pharmacological techniques for treatment. Among the pharmacological methods available, propofol IV sedation is preferred over general anesthesia because it is a simpler procedure. Propofol in combination with remifentanil is characterized by stable sedative effects and quick recovery, leading to a deep sedation. Remifentanil acts to reduce the pain caused by lipid-soluble propofol on injection. The synergistic effects of propofol-remifentanil include reduction in the total amount of drug required to achieve a desired sedation level and anti-emetic effects. In this case report, we outline how the use of propofol-remifentanil IV sedation enabled us to successfully complete a wide range of dental treatments in a patient with SGR.
Anesthesia, General ; Antiemetics ; Deep Sedation ; Dental Care ; Dentists ; Gagging ; Humans ; Hypnotics and Sedatives ; Propofol ; Reflex*

Spontaneous bleeding from a short gastric artery in the absence of pre-disposing trauma is reported very rarely. To the best of our knowledge, the published literature includes only 14 cases. Young men comprise almost all of the patients, and were induced by vomiting or gagging. The patients usually required emergent surgery. Our patient, a 32-year-old man, was diagnosed with spontaneous hemoperitoneum due to short gastric artery tearing after a few instances of vomiting. We managed him conservatively including fluid, vitamin K and antifibrinolytic agent without surgery.
Adult ; Arteries* ; Gagging ; Hemoperitoneum ; Hemorrhage* ; Humans ; Male ; Splenic Artery ; Tears ; Vitamin K ; Vomiting*

The Purpose of this article is to present a clinical case report for palateless complete denture. Despite the contravacy of palatal uncoverage in upper complete denture, palateless complete denture has some merits for upper edentulous patient. Following the uncovering of the palatal portion, the patient became easy to talk and restored the lost good tastes. He is happy despite of the decrease of the retention of the upper complete denture. Palateless complete denture is a compatible alternative for upper edentulous patients in cases of gagging, large palatal torus and restoring the lost good tastes. The clinical points are as follows : 1. The remaning alveolar ridge should be ovoid and have enough width and height for the support and retention. 2. The patient must have strong wish to the palateless complete denture. 3. Palatal beading made on the palatal peripheral border give good border sealing of the palatal flange and minimaized the prominence of the denture flange. 4. The peripheral border of the palatal flange should be reduced as thin as possible for more comfort. 5. Upper artificial posterior teeth should be arranged over the alveolar ridge crest and inner incline of the buccal cusp relieved for denture stability while chewing. 6. For stability of palateless complete denture, bilateral balanced occlusion should be sttained. Palateless complete denture will restore the lost good tastes and more comfortable and physiologic to upper edentulous patients and a good alternative to full palatal coverage complete denture in the properly selected cases.
Alveolar Process ; Denture Retention ; Denture, Complete* ; Dentures ; Gagging ; Humans ; Mastication ; Tooth

BACKGROUND: The timing principle uses a single bolus dose of nondepolarizing neuromuscular blocker followed by an induction drug to reduce airway patency secure time. If anesthetic depth is adequate, the laryngeal mask airway (LMA) can be inserted with or without a low dose nondepolarizing neuromuscular blocker. So we investigated the combined use of the timing principle and LMA to secure airway patency. METHODS: One hundred and two patients were randomly allocated into three groups. Group RP (n = 34) patients received rocuronium followed by propofol and then a LMA was inserted. Group PR (n = 36) patients received propofol followed by rocuronium and group PS (n = 31) patients received propofol followed by succinylcholine before LMA insertion. Accelerographic response to single twitch and train-of-four (TOF) stimulation were measured. LMA insertional conditions were measured using the degree of jaw relaxation, gagging, cough, and aeration. RESULTS: Single twitch and TOF ratio were lower in the RP group than in the PR group. The LMA insertional conditions were similar for the group RP and PS, but were poor for group PR. One patient in group PR recalled discomfort during LMA insertion. CONCLUSIONS: The combined use of the timing principle and LMA is effective at securing airway patency.
Cough ; Gagging ; Humans ; Jaw ; Laryngeal Masks ; Neuromuscular Blockade ; Propofol ; Relaxation ; Succinylcholine

Electrical stimulation is recently rising as a treatment protocol of dysphagia. The mechanism is known to induce the pharyngeal reflex to stimulate the sensory nerve around the neck. However, elevation of the hyoid and pharynx to stimulate the suprahyoid muscles (esp. mylohyoid muscle) is thought to be more beneficial. We presented 3 cases to improve the dysphagia after stimulation of the suprahyoid muscles to elevate the hyoid and pharynx similar to the normal swallowing during 4 weeks.
Clinical Protocols ; Deglutition ; Deglutition Disorders* ; Electric Stimulation ; Gagging ; Humans ; Muscles ; Neck ; Pharynx

OBJECTIVE: To compare the videofluoroscopic findings between the patients with lateral medullary infarct and middle cerebral artery infarct and to investigate specific findings relevant to lateral medullary infarct. METHOD: Among patients with stroke taking videofluoroscopic study for swallowing problems, thirteen patients had a lesion in lateral medulla in imaging study and twenty-six patients in middle cerebral arterial territory. The findings of videofluoroscopic study on two groups were analyzed and compared. RESULTS: In oral phase, the ability of mastication and bolus formation were better in lateral medullary group. In pharyngeal phase, lateral medullary group revealed significantly impaired triggering of pharyngeal reflex, impaired laryngeal elevation, larger amount of residual materials, repeated swallow, delayed pharyngeal transit time, weaker pharyngeal muscle contraction, and poorer upper esophageal sphincter relaxation. Inadequate relaxation of upper esophageal sphincter was most significant factor in indicating the possibility of lateral medullary infarct (positive predictability 90.0%). Inadequate triggering of pharyngeal swallow indicated least possibility of lateral medullary infarct (negative predictability 92.3%). CONCLUSION: Lateral medullary group has the characteristics of more impaired pharyngeal function and better oral function during swallowing than middle cerebral artery group in videofluoroscopic study. Inadequate upper esophageal relaxation and triggering of pharyngeal swallow are the most predictive for lateral medullary infarct.
Deglutition ; Esophageal Sphincter, Upper ; Gagging ; Humans ; Mastication ; Middle Cerebral Artery* ; Pharyngeal Muscles ; Relaxation ; Stroke

OBJECTIVE: The aim of this study was to illustrate the circumferential comfortable retainer (CCR) as a removable maxillary retainer with good potential patient compliance and to evaluate the discomfort of the retainers including distorted speech, gagging sensation and appliance discomfort. METHODS: Sixty-six orthodontic patients (male, 23; female, 43; mean age, 23.42 +/- 10.19 years) who received orthodontic treatment with fixed orthodontic appliances were randomly assigned to two groups after debonding, a conventional wraparound retainer (CWR) group that fully covers the palate with an acrylic plate and a highly polished surface, and a circumferential comfortable retainer (CCR) group which has a horseshoe shaped base plate with three folds on the anterior region. A questionnaire that had a visual analog scale (VAS) which consists of a 100-mm horizontal line with 2 end-points labeled "no discomfort" on the left and "worst discomfort" on the right, with regard to distorted speech, gagging sensation and discomfort, was administered to patients after 4 weeks of retainer wear. The Mann-Whitney test was used to test the hypothesis that there was no difference between the two retainers. RESULTS: Comparing distorted speech and discomfort, the CCR group significantly had lower values than the CWR group (p < 0.05). Comparing gagging sensation, the CCR group had lower values than the CWR group but there were no statistically significant differences between groups (p = 0.146). CONCLUSIONS: In conclusion, the results suggest that the circumferential comfortable retainer (CCR) might facilitate patient compliance and thereby improve the maintenance of the fixed orthodontic treatment outcome.
Female ; Gagging ; Humans ; Orthodontic Appliances ; Palate ; Patient Compliance ; Surveys and Questionnaires ; Sensation ; Treatment Outcome

BACKGROUND: The aim of the study was to compare the laryngeal tube (LT) insertion conditions at 3.0 and 3.5microgram/ml effect site concentrations (ECs) during anesthesia induction using the target-controlled infusion (TCI) of propofol. METHODS: The forty patients were randomly divided into two groups. The patients received TCI of propofol with a 6.0 microgram/ml target plasma concentration (Cpt) and then an LT was inserted without the aid of a muscle relaxant when the predicted EC reached 3.0microgram/ml (group 1) or 3.5microgram/ml (group 2). The conditions of LT insertion, i.e., mouth opening, gagging, coughing, head or limb movement, laryngospasm, and overall ease, and hemodynamic responses were evaluated 3 min after midazolam injection, at loss of consciousness and eyelash reflex, and immediately before, immediately after, 1 min after, and 3 min after LT insertion. We also compared times required to insert LTs, cuff volumes, and incidences of blood staining and of postoperative sore throat. RESULTS: The conditions of LT insertion, except laryngospasm and overall ease, were not significantly different in the two groups. The incidence of laryngospasm in group 1 (25%) was significantly higher than in group 2 (0%) and group 2 was better than group 1 in terms of overall ease of insertion (P<0.05). No significant differences were observed between the two groups in terms of hemodynamic responses. Minimum cuff volume to 60 cmH2O was 64.0 +/- 8.3 ml in Group 1 and 63.9 +/- 6.5 ml in Group 2, and time required for LT insertion was 21.0 +/- 11.0 sec in Group 1 and 24.7 +/- 16.6 sec in Group 2. Postoperative sore throat and blood stain incidences were not significantly different in the two groups. CONCLUSIONS: After induction with 6microgram/ml of Cpt using propofol TCI for LT insertion, LT insertion at 3.5microgram/ml of EC provided a lower incidence of laryngospasm and better overall ease than insertion at 3.0microgram/ml of EC.
Anesthesia ; Blood Stains ; Cough ; Extremities ; Gagging ; Head ; Hemodynamics ; Humans ; Incidence ; Laryngismus ; Midazolam ; Mouth ; Pharyngitis ; Plasma ; Propofol* ; Reflex ; Unconsciousness

BACKGROUND: No study has been done to detect the aspiration using the videofluoroscopic swallowing study in the elderly patients. Elderly patients admitted to hospitals or long-term care facilities may intake the food orally without any evaluation of swallowing function and may be exposed to aspiration risk, which can be eliminated by some diet modification based on the fluoroscopic findings. METHODS: Sixty-three elderly patients who had an oral-feeding status were recruited in this study. They swallowed diverse food textures twice in the following order; liquid, Yoplait yogurt, pudding, soft-bland diet, and a regular diet. Swallowing parameters were checked as subglottic aspiration, supraglottic penetration, delayed pharyngeal reflex, and vallecular and pyriform sinus residues. RESULTS: Only 2 patients showed both aspiration signs and the subglottic aspiration in the fluoroscopic study. Six patients showed the subglottic aspiration in the fluoroscopic study without any clinical sign. Seven patients who complained of aspiration signs did not show the subglottic aspiration, but all of them presented the supraglottic penetration. Multivariate logistic regression analysis showed that no covariate was correlated with the subglottic aspiration whereas delayed pharyngeal reflex during liquid (p<0.001) or Yoplait (p=0.010) swallowing were correlated with aspiration plus penetration. CONCLUSION: This study demonstrates that a fluoroscopic swallowing study is important for the dysphagia diagnosis in elderly patients because of no significant correlation between the aspiration signs assessed clinically and the subglottic aspiration detected by the fluoroscopic swallowing study. Diet modifications, such as, liquid thickening will be necessary when patients demonstrate the evidence of subglottic aspiration during swallowing.
Aged ; Deglutition ; Deglutition Disorders ; Diet ; Fluoroscopy ; Food Habits ; Gagging ; Geriatrics ; Humans ; Logistic Models ; Long-Term Care ; Pyriform Sinus ; Yogurt