Abstract
We herein report a dental treatment for a patient with primary lateral sclerosis and hyperactive gagging reflex. A 73-year-old female was referred to our department with the chief complaints of pain and swelling of the gingiva in the left premolar region of the mandible and mobility of a maxillary bridge. She had been aware of dysbasia, dysarthria and dysphagia for approximately 25 years and was diagnosed as having primary lateral sclerosis. Since she was experiencing fear and anxiety for dental treatment and hyperactive gagging reflex, intravenous sedation with midazolam was performed for removal of the bridge and extraction of two teeth. The dental treatment was uneventful and the gagging reflex did not occur. In total, dental treatments were performed 7 times as planned. The administration of midazolam became unnecessary as dental treatment progressed. The hyperactive gagging reflex in this case was due to fear and anxiety about dental treatment, and not due to primary lateral sclerosis.
As for dental treatment of patients with primary lateral sclerosis, it is necessary to administer an adequate amount of midazolam and to prepare sufficient instruments for suction to prevent respiratory depression and aspiration.
