Exploring the Role of Amitriptyline in Modulating Gag Reflex Sensitivity

Abstract

Background: The gag reflex serves as an essential protective airway mechanism but can significantly interfere with dental care, affecting up to 44% of patients and leading to treatment avoidance in severe cases. Objectives: To evaluate the effect of the topical application of an amitriptyline solution on reducing the gag reflex intensity, measured by the Gag Trigger Point Index (GTPI). Methods: In this randomized single-blind clinical trial, 48 participants with a GTPI score higher than two were divided into amitriptyline (treatment) and lidocaine (control) groups. In the amitriptyline group, 75 mg of amitriptyline tablets were dissolved in 5 milliliters of distilled water (15 mg/mL) and gargled for one minute by the participants. Then, the GTPI was examined after 10 minutes. In the lidocaine group, four puffs of 10% lidocaine spray were applied to the target areas of the oral mucosa, and the GTPI was measured five minutes later. The taste and smell of both medications were assessed using a self-report questionnaire to measure patient satisfaction. The data were analyzed using SPSS version 22. Results: In both the lidocaine and amitriptyline groups, GTPI levels demonstrated significant decreases. The lidocaine group showed a change from 4.46 to 2.42 (P < 0.001), and the amitriptyline group showed a change from 4.04 to 1.29 (P < 0.001). The reflex change rate was -2.75 in the amitriptyline group and -2.04 in the lidocaine group. When comparing the groups, no statistically significant differences were observed in the extent of gag reflex reduction or in participants’ perception of taste and smell (P > 0.05). Conclusions: Amitriptyline can be considered a potential alternative to lidocaine spray in gag reflex management, particularly in lidocaine-intolerant patients. Further studies are needed to confirm long-term safety and determine the local versus systemic pharmacological effects.