UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2023.e3628
1
Braz Dent Sci 2023 Apr/Jun;26 (2): e3628
The possible association between the types of soft palate and gag
reflex: a preliminary study
A possível associação entre os tipos de palato mole e o reflexo de vômito: um estudo preliminar
Esam HALBOUB
1,2
, Boshra Ahmed SAYED
3
, Sarah Abdu JAAFARI
3
, Ghadah Khalid ABUTALEB
3
,
Tahani Mohammed ARISHI
3
, Ahmed Hassan KHADHI
3
, Bandar Mohammed AL-MAKRAMANI
4
, Mohammed Nasser ALHAJJ
5
1 - Jazan University, College of Dentistry, Department of Maxillofacial Surgery and Diagnostic Sciences. Jazan, Saudi Arabia.
2 - Sana’a University, Faculty of Dentistry, Department of Oral Medicine, Oral Pathology and Oral Radiology. Sana’a, Yemen.
3 - Jazan University, College of Dentistry, Internship Program. Jazan, Saudi Arabia.
4 - Jazan University, College of Dentistry, Department of Prosthetic Dental Science. Jazan, Saudi Arabia.
5 - Thamar University, Faculty of Dentistry, Department of Prosthodontics. Dhamar, Yemen.
How to cite: Halboub E, Sayed BA, Jaafari SA, Abutaleb GK, Arishi TM, Khadhi AH, et al. The possible association between the types of
soft palate and gag reex: a preliminary study. Braz Dent Sci. 2023;26(2):e3628. https://doi.org/10.4322/bds.2023.e3628
ABSTRACT
Objective: whether gag reex, a common problem encountered during dental procedures, is associated with
the different types of the soft palate has not been addressed so far. This preliminary study sought to assess the
potential association between the different types of soft palate and gag reex. Material and Methods: one
hundred dental patients were recruited. The type of soft palate was determined. Subjective (self-reported) gag
reex was recorded based on many questions and past experience and on a 0-6 VAS. Objective assessment of
gag reex was done using different maneuvers where the posterior part of the tongue and the soft palate were
touched by dental mirror, and by taking impression for the upper arch. The association between the types of
soft palate and the subjective and objective recorded gag reex were statistically tested. Results: there were 53
(53%), 33 (33%) and 14 (14%) of the participants with class I, class II and class III soft palate, respectively. A
signicant association was found between the type of the soft palate and gag reex in response to one of the
subjective items (P= 0.039), more prominent among females (P= 0.009). Concerning the objective assessment,
no signicant associations were found among males. Meanwhile more females with class II and class III suffered
gag reex and/or actual gagging upon taking the impression (P = 0.001). Conclusion: this study illustrated
an association between the type of soft palate and gag reex, and its severity in females (more specically soft
palate types II and III) more than in males.
KEYWORDS
Gag reex; Soft palate; Dental materials; Prosthodontics; Restorative dentistry.
RESUMO
Objetivo: o reexo de vômito, um problema comum encontrado durante procedimentos odontológicos, está ou
não associado aos diferentes tipos de palato mole, não foi ainda abordado até o momento. Este estudo preliminar
procurou avaliar a possível associação entre os diferentes tipos de palato mole e o reexo de vômito. Material
e Métodos: cem pacientes odontológicos foram recrutados. O tipo de palato mole foi determinado. O reexo
de vômito subjetivo (auto-relatado) foi registrado com base em muitas perguntas e experiências anteriores e
em um VAS de 0-6. A avaliação objetiva do reexo de vômito foi feita por meio de diferentes manobras onde a
parte posterior da língua e o palato mole foram tocados por espelho dental e por meio de moldagem da arcada
superior. A associação entre os tipos de palato mole e o reexo de vômito subjetivo e objetivo registrado foi
testada estatisticamente. Resultados: houve 53 (53%), 33 (33%) e 14 (14%) participantes com palato mole
classe I, classe II e classe III, respectivamente. Foi encontrada associação signicativa entre o tipo de palato mole
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3628
Halboub E et al.
The possible association between the types of soft palate and gag reflex: a preliminary study
Halboub E et al.
The possible association between the types of soft palate and
gag reflex: a preliminary study
INTRODUCTION
The gag reex, also known as the pharyngeal
reex, is a reex contraction of the muscles of
the posterior pharynx after stimulation of the
posterior pharyngeal wall, tonsillar area, or base
of the tongue. It is believed to be an involuntary
defense mechanism to protect the pharynx and
throat from unwanted objects and prevent the
aspiration of solid food particles [1,2]. Gagging
is a common problem experienced during dental
procedures. Dentist routinely faces patients
with gag reflex in daily practice who need
extra management maneuvers in order to avoid
exacerbating of such a situation [2].
Individuals with severe gag reflex have
poor oral health status. That is because they
have difculty in brushing their posterior teeth.
Thus, these teeth are more susceptible to dental
caries and gingival bleeding. Moreover, it has
been reported that individuals with gag reex
had higher number of missing teeth than those
without a severe gag reex [3]. It is necessary for
dentists to identify the gag reex of their patients
before starting any diagnostic or therapeutic
dental procedures. This will allow the dentist to
manage the problem correctly and effectively.
Although the prevalence of gag reex is not exactly
well known, van Houtem et al. [3] reported a
prevalence of 8.2% of self-reported gag reex.
The actual or problematic gagging was found
to be 10-25% in another study carried out by
Sewerin [4] during intra-oral radiographic
procedures. Randall et al. [5], however, reported
a prevalence of 7.5% of high frequent problematic
gagging during dental procedures in the dental
clinics.
The soft palate is considered one of the
trigger points of gag reex. It is a mobile muscular
fold suspended from the posterior border of the
hard palate, sloping down and back between the
oral and nasal parts of the pharynx. Unlike the
hard palate, the soft palate doesn’t contain a bony
framework. Rather, it consists of the aponeurotic
and muscular tissue. Moreover, the soft palate
contains neurovascular structures and many
mucous glands that lubricate the oral cavity [1,6].
The function of the soft palate is to facilitate
speech, breathing and swallowing by making
sure that the proper communication channels
between the oral, pharyngeal and nasal cavities
are open or closed during each of these processes.
The soft palate is an important part in the oral
cavity that should be taken into consideration
in the daily dental practice, particularly when
dealing with dentures and dental impressions.
It forms the posterior palatal seal of the denture.
Any extension beyond this resilient tissue will
result in dislodgement of the denture, speech
difculty, inammation of the extension area,
or gag reex.
To the best of our knowledge, there has not
a single study so far linked specic types of soft
palate to the occurrence of gag reex. Therefore,
this preliminary study sought to assess the
potential association between the different types
of soft palate and gag reex among a sample of
Saudi dental patients.
MATERIAL AND METHODS
This preliminary cross-sectional study
was conducted at College of Dentistry, Jazan
University, Jazan, Saudi Arabia. It was approved
by the Standing Committee for Scientic Research
Ethics, Jazan University (REC41/1-005). It was
also conducted in strict compliance with the
Helsinki Declaration on medical research
involving human subjects. Study’s potential risks
and benets were explained to all participants
and written informed consents were obtained
accordingly.
As this study was preliminary and exploratory,
the sample size was not prior-calculated. Rather, a
e o reexo de vômito em resposta a um dos itens subjetivos (P= 0,039), mais proeminente no sexo feminino
(P= 0,009). Em relação à avaliação objetiva, não foram encontradas associações signicativas entre os homens.
Enquanto isso, mais mulheres com classe II e classe III sofreram reexo de vômito e/ou engasgo real ao receber a
impressão (P = 0,001). Conclusão: este estudo ilustrou uma associação entre o tipo de palato mole e reexo de
vômito e sua gravidade em mulheres (mais especicamente palato mole tipos II e III) mais do que em homens.
PALAVRAS-CHAVE
Ânsia de vômito; Palato mole; Materiais dentários; Prótese dentária; Dentística.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3628
Halboub E et al.
The possible association between the types of soft palate and gag reflex: a preliminary study
Halboub E et al.
The possible association between the types of soft palate and
gag reflex: a preliminary study
convenience sample of 100 participants (50 males
and 50 females) who t the inclusion criteria
was recruited. The participants were ordinary
attendants of the dental clinics. The subjects with
the following criteria were excluded: 1) cleft
lip/palate; 2) palatopharyngeal incompetency;
3) history of oral and/or maxillofacial trauma,
surgery or pathology; and 4) wearing removable
dentures or obturators.
The data collected were divided into two
parts: patient’s part (subjective/self-reported)
and dentist’s part (objective). In the “patient’s
part”, each participant was interviewed using
structured questionnaire including the following:
age, gender, occupation, in addition to certain
other questions about the participant’s past
experience regarding gag reflex (The asked
questions were included in Tables I-II for more
Table I - Self-reported gag reflex among all subjects by soft palate types
Variable
Whole sample
Type I Type II Type III P-value
Do you have a gag reflex?; yes responses 10 (34.5) 12 (41.4) 7 (24.1) 0.039
a
Have you ever had a negative incident with gag reflex?; yes responses 7 (41.2) 7 (41.2) 3 (17.6) 0.563
a
Have you ever had gagged at dentist’s office before?; yes responses 5 (31.3) 7 (43.7) 4 (25.0) 0.134
a
Have daily activities like brushing and flossing your teeth ever made you gag?; yes
responses
11 (40.7) 11 (40.7) 5 (18.5) 0.323
a
How do you feel when
you brush your back
teeth?
No nausea 36 (56.3) 19 (29.7) 9 (14.1)
0.552
a
Slight nausea 16 (48.5) 13 (39.4) 4 (12.1)
I am afraid I will vomit 0 (0.0) 1 (50.0) 1 (50.0)
I can’t do it because I immediately feel nauseated and
fell vomiting
1 (100.0) 0 (0.0) 0 (0.0)
How do you feel when
dentist is working on
your back teeth?
No nausea 40 (58.8) 20 (29.4) 8 (11.8)
0.565
a
Slight nausea 11 (40.7) 11 (40.7) 5 (18.5)
I am afraid I will vomit 2 (40.0) 2 (40.0) 1 (20.0)
Severity of gag reflex;
Mean±SD
1.57±1.62 1.97±1.99 2.86±2.48 0.075
b
a
Chi-squared test was used;
b
ANOVA test was used; P-value < 0.05 is considered significant.
Table II - Self-reported gag reflex among both genders by soft palate types
Variable
Males Females
Type I Type II Type III P-value Type I Type II Type III P-value
Do you have a gag reflex?;
yes
responses
4 (36.4) 4 (36.4) 3 (27.3) 0.619
a
6 (33.3) 8 (44.4) 4 (22.2) 0.009
a
Have you ever had a negative incident
with gag reflex?;
yes responses
3 (50.0) 3 (50.0) 0 (0.0) 0.444
a
4 (36.4) 4 (36.4) 3 (27.3) 0.058
a
Have you ever had gagged at dentist’s
office before? ;
yes responses
4 (40.0) 3 (30.0) 3 (30.0) 0.543
a
1 (16.7) 4 (66.7) 1 (16.7) 0.064
a
Have daily activities like brushing and
flossing your teeth ever made you
gag?;
yes responses
5 (41.7) 3 (25.0) 4 (33.3) 0.265
a
6 (40.0) 8 (53.3) 1 (6.7) 0.062
a
How do you feel
when you brush
your back teeth?
No nausea 16 (48.5) 12 (36.4) 5 (15.2)
0.658
a
20 (64.5) 7 (22.6) 4 (12.9)
0.476
a
Slight nausea 7 (46.7) 5 (33.3) 3 (20.0) 9 (50.0) 8 (44.4) 1 (5.6)
I am afraid I will
vomit
0 (0.0) 1 (50.0) 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0)
I can’t do it
because I
immediately feel
nauseated and
fell vomiting
0 (0.0) 0 (0.0) 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0)
How do you feel
when dentist is
working on your
back teeth?
No nausea 18 (51.4) 12 (34.3) 5 (14.3)
0.383
a
22 (66.7) 8 (24.2) 3 (9.1)
0.193
a
Slight nausea 3 (25.0) 5 (41.7) 4 (33.3) 8 (53.3) 6 (40.0) 1 (6.7)
I am afraid I will
vomit
2 (66.7) 1 (33.3) 0 (0.0) 0 (0.0) 1 (50.0) 1 (50.0)
Severity of gag reflex;
Mean±SD
1.00±1.65 1.11±1.71 2.33±2.55 0.179
b
2.00±1.49 3.00±1.85 3.80±2.28 0.039
b
a
Chi-squared test was used;
b
ANOVA test was used; P-value < 0.05 is considered significant.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3628
Halboub E et al.
The possible association between the types of soft palate and gag reflex: a preliminary study
Halboub E et al.
The possible association between the types of soft palate and
gag reflex: a preliminary study
details). The self-reported severity of gag reex
was scored on Analogue Visual Scale (AVS)
measuring 0 to 6, where zero means no gag reex
at all, and 6 means sever gag reex or even actual
gagging.
In the “dentist’s part”, the type of soft
palate was rst determined based on House’s
classication. On the basis of angular relationship
formed by soft palate with hard palate, soft palate
is classied as “type I”: broad and normal with
a band of 5-12 mm resilient tissue posterior to
the line between tuberosities which is almost
horizontal or turns down from the hard palate
gently at angle <10°; “type II”: about 3-5 mm
resilient tissue posterior to the line between
tuberosities which turns down from the hard
palate at angle 10-45°; and “type III”: about
2-3 mm resilient tissue anterior to the line
between tuberosities which turns down sharply
from the hard palate at angle >45° [7-9].
Figure 1 shows the different types of soft palate.
For this purpose, the examiners (BS, SJ, GA, TA,
and AK) were trained well and calibrated under the
supervision of a specialist in prosthodontics (BA).
The training was conducted on 30 volunteering
dental students and the specialist explained to the
trainees (examiners) the criteria of determining
each type of the soft palate. One week later, the
trainees examined these students again and a
consensus on the type of the soft palate was in
absolute agreement with the previous results.
For the purpose of the current study, each
participant was examined by two of the examining
authors, and the type of soft palate was decided by
agreement. The examiners assessed the gag reex
using different maneuvers: 1) Touching the soft
palate by a dental mirror while the participant is
opening his/her mouth in a relaxed position; 2)
Touching the soft palate by a dental mirror while
the participant is opening his/her mouth and say
‘AAAAAH’; 3) Touching the posterior part of the
tongue by a dental mirror while the participant is
opening his/her mouth in a relaxed position; and
4) Touching the posterior part of the tongue by
a dental mirror while the participant is opening
his/her mouth and say ‘AAAAAH.’
The examiners also assessed the gag reex
upon taking impression for the upper arch.
In brief, alginate impression (Cavex CA37,
The Netherland) was mixed according to the
manufacturer’s instructions and immediately
loaded into a plastic impression tray which
was then inserted into the patient’s mouth.
The reactions of the participants were recorded
as: no gag; gag reex or actual gagging.
Raw data were input into excel le from which
they were imported into SPSS for Windows version
25 (IBM, Armonk, NY, USA). The qualitative
variables were presented as frequencies and
proportions, while the quantitative variables were
presented as means and standard deviations.
The potential associations between any two of
the qualitative variables were tested using Chi-
square, while the potential differences in any
quantitative variables by gender were tested
using independent t-test. The differences in
quantutative variable by type of soft palate was
tested using ANOVA. A p value of < 0.05 was
considered signicant.
RESULTS
The mean age of the participants was
26.99±5.92 years. The males were signicantly
younger (25.58±2.65 vs. 28.4±7.73; P = 0.001).
Up to 44% of the participants were students, and
18% were housewives. There were 53 (53%),
33 (33%) and 14 (14%) of the participants with
type I, type II and type III soft palate, respectively,
with no significant difference distribution by
gender.
The subjective (self-reported) gag reflex
is presented in Tables I-II. Concerning the
whole sample (Table I), signicant association
was found between the different types and
gag reflex in terms of response to “having
gag reflex” question (P= 0.039), with 41.4%
of type II participants reported having gag
reflex. Similarly, but insignificantly, higher Figure 1 - The different types of soft palate.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3628
Halboub E et al.
The possible association between the types of soft palate and gag reflex: a preliminary study
Halboub E et al.
The possible association between the types of soft palate and
gag reflex: a preliminary study
percentage among type II participants (P= 0.134)
reported positive responses concerning their
previous experience of gag reflex in dental
office. Although not statistically significant,
type III participants reported higher severity of
gag reex (2.86±2.48) than other classes did
(1.57±1.62 and 1.97±1.99 for types I and II soft
palate, respectively, P = 0.075; Figure 2).
Taking individual genders, no signicant
associations/differences were found in all
self-reported questions for male participants
(P > 0.05). Contrarily, higher proportions
of females with type II (44.4%) compared
to types I and III types of soft palate (34.5%
and 24.1%, respectively) reported having gag
reex (P= 0.009; Table II). Moreover, the self-
reported severity of gag reex was signicantly
higher for females with types III and II soft
palate (3.80±2.28 and 3.00±1.85, respectively)
compared to females with types I soft palate
(2.00±1.49, P= 0.039; Figure 2).
The results of the objective assessment of the
gag reex are presented in Tables III-IV. Concerning
the whole sample, no significant associations/
differences were found between the different classes
of soft palate and the recorded gag reex in terms
of all maneuvers applied (P > 0.05) despite that
participants with type II soft palate exhibited more
actual gagging than did the participants with other
types of soft palate (Table III).
Taking individual genders, 48% of females
with class II suffered gag reflex and 100% of
females with type III suffered actual gagging upon
taking the impression (P= 0.001). No signicant
associations were found among male participants
between the type of soft palate and objectively-
reported gag reex (Table IV).
DISCUSSION
Despite the advances in dentistry, gagging is
a common problem faced by dental practitioners
during dental procedures, which makes the
therapeutic procedures difficult or even
Table III - Gag reflex measurement methods among all subjects by soft palate classes
Variable
Whole sample
Class I Class II Class III P-value
Touching the soft palate by a mirror while the
subject is opening his/her mouth in a relaxed
position
No gag 39 (55.7) 20 (28.6) 11 (15.7)
0.513
a
Gag reflex 14 (46.7) 13 (43.3) 3 (10.0)
Actual gagging 0 (0.0) 0 (0.0) 0 (0.0)
Touching the soft palate by a mirror while
the subject is opening his/her mouth and say
‘AAAAAH’
No gag 36 (58.1) 17 (27.4) 9 (14.5)
0.307
a
Gag reflex 17 (44.7) 16 (42.1) 5 (13.2)
Actual gagging 0 (0.0) 0 (0.0) 0 (0.0)
Touching the posterior part of the tongue by
a mirror while the subject is opening his/her
mouth in a relaxed position
No gag 40 (54.8) 23 (31.5) 10 (13.7)
0.748
a
Gag reflex 12 (50.0) 8 (33.3) 4 (16.7)
Actual gagging 1 (33.3) 2 (66.7) 0 (0.0)
Touching the posterior part of the tongue by
a mirror while the subject is opening his/her
mouth and say ‘AAAAAH’
No gag 38 (57.6) 19 (28.8) 9 (13.6)
0.548
a
Gag reflex 14 (45.2) 12 (38.7) 5 (16.1)
Actual gagging 1 (33.3) 2 (66.7) 0 (0.0)
Gag reflex while taking impression
No gag 36 (65.5) 13 (23.6) 6 (10.9)
0.080
a
Gag reflex 16 (38.1) 19 (45.2) 7 (16.7)
Actual gagging 1 (33.3) 1 (33.3) 1 (33.3)
a
Chi-squared test was used; P-value < 0.05 is considered significant.
Figure 2 - Severity of gag reflex for the whole sample and according
to gender.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3628
Halboub E et al.
The possible association between the types of soft palate and gag reflex: a preliminary study
Halboub E et al.
The possible association between the types of soft palate and
gag reflex: a preliminary study
impossible to perform [10]. This preliminary
study aimed to investigate the relationship
between different types of soft palate and the
occurrence of gag reex by subjective method
(using interview questionnaire) and objective
method (through touching by dental mirror and
by taking impression).
In our study, the score of the severity of gag
reex reported by female patients was signicantly
higher than that of males and signicantly more
frequently in type II and III soft palate than in
type I. This can be ascribed to the higher tolerance
of gag reex by males despite the type of the
soft palate, and a lower tolerance of gag reex
by females which accentuated more in type III
followed by type II; females with type I revealed
lower frequency of gagging. Irrespective of the
type of soft palate, which has not been assessed so
far in relation to the gag reex, our results, higher
gag reex among females, agree with the results
of van Houtem et al. [3] study, but disagree
with the results reported by Karibe et al. [1] and
Akarslan and Bicer [11].
The sensitivity of different sites of the
oral cavity along with the ability of patients to
withstand intraoral stimuli varies greatly. There
are ve intraoral areas known as “trigger zones”
at which the gag reex is normally triggered,
namely: the palatoglossal and palatopharyngeal
folds, base of the tongue, soft palate, uvula, and
posterior pharyngeal wall [12]. We manipulated
two of these intraoral areas (base of the tongue
and soft palate) that are considered the most
excitable and accessible areas by different dental
procedures. The manipulation was carried
using dental mirror in two different physiologic
situations: while the participant was relaxed so
these areas are not contracted, and while the
subject saying “AAAAAH” so these structures
are in function (contracted). In addition to the
touching by the dental mirror, we took impression
for the upper arch. Indeed, among the dental
triggering that may cause gagging, taking
dental impressions of the upper arch is the most
problematic. Actually most of the participants
suffered difculties during this procedure [13].
Thus, the manipulations that we applied can
be trusted and be valid as objective assessment
procedures of gag reex.
Treating such a group of patients (who
frequently experience gag reex) can be stressful
and a time-consuming experience, both for the
dentist and the patient. Hence, this type of patient
need special considerations. Management of the
patient with gagging depends on the severity
of the problem. A dentist can perform dental
treatment of a patient with a mild to moderate gag
reex in his/her clinic in general dental practice.
Table IV - Gag reflex measurement methods among both genders by soft palate classes
Variable
Males Females
Class I Class II Class III P-value Class I Class II Class III P-value
Touching the soft palate by
a mirror while the subject
is opening his/her mouth
in a relaxed position
No gag 18 (46.2) 14 (35.9) 7 (17.9)
0.999
a
21 (67.7) 6 (19.4) 4 (12.9)
0.101
a
Gag reflex 5 (45.5) 4 (36.4) 2 (18.2) 9 (47.4) 9 (47.4) 1 (5.3)
Actual gagging 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
Touching the soft palate
by a mirror while the
subject is opening his/her
mouth and say ‘AAAAAH’
No gag 19 (47.5) 14 (35.0) 7 (17.5)
0.913
a
17 (77.3) 3 (13.6) 2 (9.1)
0.064
a
Gag reflex 4 (40.0) 4 (40.0) 2 (20.0) 13 (46.4) 12 (42.9) 3 (10.7)
Actual gagging 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
Touching the posterior
part of the tongue by a
mirror while the subject is
opening his/her mouth in
a relaxed position
No gag 16 (43.2) 14 (37.8) 7 (18.9)
0.609
a
24 (66.7) 9 (25.0) 3 (8.3)
0.304
a
Gag reflex 6 (60.0) 2 (20.0) 2 (20.0) 6 (42.9) 6 (42.9) 2 (14.3)
Actual gagging 1 (33.3) 2 (66.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
Touching the posterior
part of the tongue by a
mirror while the subject
is opening his/her mouth
and say ‘AAAAAH’
No gag 18 (46.2) 14 (35.9) 7 (17.9)
0.746
a
20 (74.1) 5 (18.5) 2 (7.4)
0.086
a
Gag reflex 4 (50.0) 2 (25.0) 2 (25.0) 10 (43.5) 10 (43.5) 3 (13.0)
Actual gagging 1 (33.3) 2 (66.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
Gag reflex while taking
impression
No gag 18 (54.5) 11 (33.3) 4 (21.1)
0.293
a
18 (81.8) 2 (9.1) 2 (9.1)
0.001
a
Gag reflex 4 (26.7) 6 (40.0) 5 (33.3) 12 (44.4) 13 (48.1) 2 (7.4)
Actual gagging 1 (50.0) 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100.0)
a
Chi-squared test was used; P-value < 0.05 is considered significant.
7
Braz Dent Sci 2023 Apr/Jun;26 (2): e3628
Halboub E et al.
The possible association between the types of soft palate and gag reflex: a preliminary study
Halboub E et al.
The possible association between the types of soft palate and
gag reflex: a preliminary study
However, the patients with severe gag reflex
should be referred to a special clinic or hospital
which has equipment required for the treatment.
Behavioral approaches, complementary medicine
therapies and pharmacological techniques are
used for the treatment of problematic gagging in
dentistry. The issue of managing dental patient
with gag reex has been extensively reviewed
elsewhere [2] and even different techniques
have been innovated in this context [14]. Digital
impression or the intra-oral scanning might be
the best option in this matter [15,16].
The study has cons and pros. One of the
strength points of this study was using the
same type and amount of impression materials
and the same water temperature, along with
the standardized position of the subjects while
applying the different testing procedures.
Furthermore, the study included equal numbers
of female and male patients.
One major limitation of the study is that
we didn’t assess the reliability of the objective
assessment of the types of soft palate. However,
we conrm that the examiners were trained well
under supervision of a specialist in prosthodontics,
in addition to the fact that all subjects were
assessed by two of the trained authors and the
assessment was thus recorded upon consensus.
Another limitation was the small sample size and
hence number of subjects with type III soft palate
was very small owing to the fact it is less prevalent
than types I and II soft palate. Also due to the
small sample size, the number of participants who
reported subjective gag reex, or who objectively
found to experience gag reex was small too.
Such a limitation may undermine the power of
the study to detect differences/associations and
limit the generalizability of the results. Therefore,
our results can be considered preliminary, and
thus further well-designed, large-scale studies
are highly encouraged.
CONCLUSION
This study illustrated an association between
the type of soft palate and the occurrence of gag
reex and its severity in females more than in
males. Females with type II and III soft palate are
more prone to gag reex than females with type
I soft palate, and even than males irrespective of
their type of soft palate. The dental practitioners
are required to take care of the various types of
the soft palate especially among females.
Author’s Contributions
EH, BMA: Designing the Study, Interpretation
of the Data, Drafting the Manuscript. BAS, SAJ,
GKA, TMA, AHK: Data Collection, Drafting the
Manuscript. MNA: Statistical Analysis, Drafting
the Manuscript. All authors read and approved
the nal manuscript.
Conict of Interest
No conicts of interest declared concerning
the publication of this article.
Funding
This work was funded by the Future Scientists
Program, Deanship of Scientic Research, Jazan
University, Jazan, Kingdom of Saudi Arabia
(Ref#: FS6).
Regulatory Statement
This study was conducted in accordance with
all the provisions of the local human subjects
oversight committee guidelines and policies
of: Standing Committee for Scientic Research
Ethics, Jazan University.
The approval code for this study is:
REC41/1-005.
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Mohammed Nasser Alhajj
(Corresponding address)
Thamar University, Faculty of Dentistry, Department of Prosthodontics, Dhamar,
Yemen.
Email: m.n.alhajj@hotmail.com
Date submitted: 2022 Sep 03
Accept submission: 2023 Feb 06
