POSIBILITĂŢI DE CONTROL AL REFLEXULUI GAG ÎN STOMATOLOGIE

Abstract

Introducere. Reflexul gag este unul defensiv, cu scop de a elimina obiecte străine din cavitatea bucală prin contracţia bazei limbii şi a vălului palatin. Hiperexcitabilitatea sa poate compromite realizarea manoperelor stomatologice, însă nu există un consens privind selecţia optimă a metodelor de control a acestuia. Scop. Evaluarea impactului metodelor non-farmacologice (presopunctură VC24, stimulare tran-scraniană directă cu curent continuu - tDCS, placebo-tDCS) asupra indicilor reflexului gag. Material şi metode. Studiul controlat cu placebo a inclus 25 de voluntari sănătoşi (bărbaţi, 20-40 ani), sub condiţii experimentale similare (presopunctură în punctul VC24; placebo-tDCS; tDCS -anod C4, catod F7, 20 min, 2 mA), cu comparaţii intra-su-biect (Wilcoxon) ale indicilor reflexului gag (prag de declanşare; intensitatea percepută; câmpul receptor - GTPI). Rezultate. tDCS şi presopunctura VC24 au determinat o reducere semnificativă a reflexului gag (prag: p < 0.001/p < 0.001; intensitate: p < 0.001/p = 0.007; GTPI: p = 0.006/p < 0.001), faţă de placebo (prag: p = 0.051; intensitate: p = 0.003; GTPI: p = 0.233). Compararea metodelor a relevat următoarele ierarhii ale eficienţei de control a reflexului gag: prag (presopunctură > tDCS); intensitate (tDCS); câmpul receptor (presopunctura). Proba placebo-tDCS a demonstrat efect minim, susţinând validitatea fiziologică a celor 2 intervenţii de control a reflexului gag (presopunctura, stimularea transcraniană directă cu curent continuu). Concluzii. Presopunctura VC24 a influenţat mai marcant pragul şi localizarea reflexului gag, iar stimularea transcraniană directă cu curent continuu a redus predominant disconfortul perceput asociat cu reflexul gag, validitatea fiind confirmată prin rezultatele aplicării placebo-tDCS.

Introduction. The gag reflex is a defensive reflex, aimed at eliminating foreign objects from the oral cavity by contracting the base of the tongue and the soft palate. Its hyperexcitability can compromise the performance of dental procedures, but there is no consensus on the optimal selection of methods for its control. Objective. Evaluation of the impact of gag control non-pharmacological methods (VC24 acupressure, transcranial direct current stimulation - tDCS, placebo-tDCS) on gag reflex indices. Material and methods. The placebo-controlled study included 25 healthy volunteers (males, 20-40 years old), under similar experimental conditions (acupressure at the VC24 point; placebo-tDCS; tDCS - anode C4, cathode F7, 20 min, 2 mA), with intra-subject comparisons (Wilcoxon) of gag reflex indices (triggering threshold; perceived intensity; receptive field - GTPI). Results. tDCS and VC24 acupressure resulted in a significant reduction in the gag reflex (threshold: p < 0.001/p < 0.001; intensity: p < 0.001/p = 0.007; GTPI: p = 0.006/p < 0.001), compared to placebo (threshold: p = 0.051; intensity: p = 0.003; GTPI: p = 0.233). The comparison of methods revealed the following hierarchies of gag reflex control efficiency: threshold (acupressure > tDCS); intensity (tDCS); receptive field (acupressure). The pla-cebo-tDCS demonstrated a minimal effect, supporting the physiological validity of the two control interventions for gag reflex (acupressure, transcranial direct current stimulation). Conclusion. VC24 acupressure had a more significantly influence on the gag reflex threshold and localization, the transcranial direct current stimulation predominantly reduced the perceived discomfort associated with the gag reflex, their validity being confirmed by the results of the placebo-tDCS application.