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Friday, April 18, 2014
Gag reflex in cerebral palsy patient
Hello, I have cerebral palsy and a severe gag reflex. Currently, I am receiving dental treatment at a specialized facility operated by Tufts Dental School. Treatment includes IV conscious sedation, costing close to $1000 per visit. I have asked the anesthesiologist if lorazepam p.o. or some other oral medication would be useful and he thought not, due to the severity of my reflex. I`m a 59 year old male and have had dental work all of my life without sedation, although always compromised. The gag reflex seems to have become worse over time. Would a regular dentist be able to administer any sedating medication that would be effective but less costly? Are there particular drugs that would be better suited?
Thank you for your question. Certainly, the benzodiazepine group of medications, like lorazepam, are the safest and probably the most efficacious. I prefer triazolam (brand name: Halcion) for the quality of sedation and short duration of action. It is possible that this will help.
The addition of a topical anesthetic spray to the palate to "numb" it may help too but may make matters worse in your case. No doubt there are both central and peripheral nervous system inputs contributing to the gag reflex in your case.
I do not know the degree of your cerebral palsy and that may be an issue. Really, though, there is no way to know if any of this would work without trying!! If your dentist is amenable, that is what I would do.
The dose of drug is an issue as well. It may be that 0.5 mg or 0.25 mg may be too little ... or too much. You may already have some experience with sedatives and this will be a good guide. In some states, an additional dose can be given if enough time has elapsed from the initial dose. For safety concerns, I would not use more than two doses on a given treatment day. I hope this helps.
Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University