Exploring the Role of Amitriptyline in Modulating Gag Reflex Sensitivity

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.

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).

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.

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).

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.