Gag reflex is an undesirable reflex that can be problematic for dentists performing oral procedures. Glossopharyngeal nerve block provides reliable pharyngeal paralysis and has been used during tonsillectomy or fiberoptic intubation to both inhibit the gag reflex and provide pain relief. Intravenous sedation is an option for inhibiting the gag reflex during dental treatment, but it is insufficient for patients with a severe gag reflex. We report two patients with severe gag reflex who were successfully managed using a combination of intravenous sedation and glossopharyngeal nerve block. In both patients, the dental treatment was initially planned to be performed under intravenous sedation because of severe gag reflex and dental phobia. However, the gag reflex could not be sufficiently suppressed even with intravenous sedation and was obstructing the upper airway. Therefore, a combination of intravenous sedation and glossopharyngeal nerve block was planned for a subsequent dental treatment. The glossopharyngeal nerve block inhibited the gag reflex during dental treatment and allowed the dental treatments for the two patients with severe gag reflex to be completed. Although gag reflex is usually produced by mechanical stimulation at five intraoral trigger zones, intravenous sedation might be necessary because psychological factors, such as dental phobias, can also induce a gag reflex.
