The gag reflex not only interferes with dental treatment, but also decreases quality of life in patients who have difficulty brushing their teeth or using dentures. We treated a case in which intravenous sedation with propofol was used in a patient with a severe gag reflex ; as a result of the dentures being made while using the lightest level of sedation that would not permit a gag reflex, the patient was able to wear the dentures for short periods of time.
The patient was a 64-year-old woman with a pretreatment gagging severity index of grade Ⅴ (most severe) ; psychological factors were strongly involved. Intravenous sedation was performed with conscious sedation, and the sedation level was adjusted while confirming with the patient as to whether treatment was possible. As a result, the Ce (estimated effect-site concentration) of treatable propofol decreased with repeated intravenous sedation. This finding suggested a gradual increase in the threshold at which the gag reflex appeared. Intravenous sedation with propofol may enable efficient desensitization. The repetition of sedation within a short period of time might also have had an additive effect.
