Journal of Kerman University of Medical Sciences

Effect of Punica granatum Peel Extract Mouthwash on Gag Reflex During Dental Impression: A crossover Clinical Trial

Document Type : Original Article

Authors

Manouchehr Teymouri 1
Reza Taghizadeh 2
Masoumeh Taherpour 3
Sahereh Soltani 2
Samaneh Mollazadeh 1

1 Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran

2 School of Dentistry, North Khorasan University of Medical Sciences, Bojnurd, Iran

3 Department of Epidemiology and Biostatistics, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran

https://doi.org/10.34172/jkmu.3966
Abstract
Introduction: The primary aim was to diminish the gag reflex, quantified by the Gagging Severity Index (GSI), during orthodontic impression procedures. The goal was to enhance patient compliance by incorporating Punica granatum peel aqueous extract (P. granatum PAE) into a mouthwash solution used during the process.
Methods: This double-blind, longitudinal, controlled clinical trial was conducted on patients at a dental clinic. A total of 40 patients—21 females and 19 males, with average age of 29.3 ± 6.0 years—and GSI scores of 2 and 3 were included. The P. granatum PAE was prepared via freeze-drying and enriched with ascorbic acid, potassium sorbate, glycerin, and food coloring. A placebo mouthwash, devoid of P. granatum PAE, was also created. These mouthwashes, labeled ‘A’ and ‘B’, were administered randomly across two sessions, ensuring each patient received both types. The GSI was assessed before and after administration during the impression procedure.
Results: Statistical analysis using the Chi-squared test revealed that both mouthwash variants generally decreased GSI scores. However, the P. granatum PAE was notably more effective in reducing these scores (P < 0.005).
Conclusion: The study confirms that P. granatum PAE is a powerful antiemetic. Its inclusion in mouthwash formulations can significantly reduce GSI scores, thereby improving patient compliance with orthodontic procedures.

Keywords

Pomegranate
Antiemetics
Gagging
Dental clinics
Patient compliance
Subjects
  1. Prashanti E, Sumanth KN, Renjith George P, Karanth L, Soe HH. Management of gag reflex for patients undergoing dental treatment. Cochrane Database Syst Rev 2015(10):Cd011116. doi:10.1002/14651858.CD011116.pub2
  2. Mehdizadeh M, Mohammadbeigi A, Sharifinejad A. An Overview about New Methods in Management of Gag Reflex during Dental Treatment: A Systematic Review. J Dent (Shiraz) 2023;24(4):372–81. doi:10.30476/ dentjods.2022.96360.1934
  3. Agdal ML, Høyvik AC, Gudmundsen MH, Myran L. How to Deal with Gagging. InOral Health Psychology: Psychological Aspects Related to Dentistry 2022 Oct 8 (pp. 239-257). Cham: Springer International Publishing. doi:10.1007/978-3-031- 04248-5_16
  4. Seyed Khalil P, Amirhossein O, Negar E, Amir Pooya Z, Hamid Reza A, Mohammad Abedi F. Comparison of the Effect of Propofol Plus IV Lidocaine versus Propofol Plus Topical Lidocaine Spray on Decreasing Gag Reflex in Upper GI Endoscopy: A Clinical Trial. Archives of Anesthesiology and Critical Care 2019;6(1):27-32. doi:10.18502/aacc.v6i1.2046
  5. Mosannen Mozafari P, Aboutorabzadeh SM, Azizi H, Khorasanchi M, Lotfinia Z, Motaghi S. Is laser acupuncture effective in controlling gag reflex while taking dental impressions? A randomized double-blinded sham-controlled clinical trial. J Evid Based Dent Pract 2022;22(3):101733. doi:10.1016/j.jebdp.2022.101733
  6. Dulay MS, Dulay JS. Antiemetics: types, actions and uses. Br J Hosp Med (Lond) 2020;81(5):1–8. doi:10.12968/ hmed.2020.0050
  1. Balakrishnan B, Selvaraj S, Jayachandran D, Lenin MS. Herbal therapeutics in the management of gag reflex: A literature review. World Journal of Advanced Research and Reviews 2022;16(2):1072-1076. doi:10.30574/wjarr.2022.16.2.1274
  2. Naziri Z, Rajaian H, Firouzi R. Antibacterial effects of Iranian native sour and sweet pomegranate (Punica granatum) peel extracts against various pathogenic bacteria. Iranian Journal of Veterinary Research 2012;13:282–8.
  3. Kharchoufi S, Licciardello F, Siracusa L, Muratore G, Hamdi M, Restuccia C. Antimicrobial and antioxidant features of ‘Gabsiʼ pomegranate peel extracts. Industrial Crops and Products 2018;111:345–52. doi:10.1016/j.indcrop.2017.10.037
  4. Guerrero-Solano JA, Jaramillo-Morales OA, Velázquez- González C, De la OAM, Castañeda-Ovando A, Betanzos- Cabrera G, et al. Pomegranate as a Potential Alternative of Pain Management: A Review. Plants (Basel) 2020;9(4). doi:10.3390/plants9040419
  5. Dickinson CM, Fiske J. A review of gagging problems in dentistry: aetiology and classification. Sadj 2006;61(5):206, 8–10.
  6. De Veaux CK, Montagnese TA, Heima M, Aminoshariae A, Mickel A. The Effect of Various Concentrations of Nitrous Oxide and Oxygen on the Hypersensitive Gag Reflex. Anesth Prog 2016;63(4):181–4. doi:10.2344/15-00039.1
  7. Stanescu C, Forna DA, Forna NC, Vacaru-Carnaru M, Condratovici AP. Managing oral rehabilitation in patients with anxiety disorders under benzodiazepine therapy. Rom J Oral Rehabil. 2025;17(2):620-9. doi:10.62610/RJOR.2025.2.17.56
  8. Chi SI. Complications caused by nitrous oxide in dental sedation. J Dent Anesth Pain Med 2018;18(2):71–8. doi:10.17245/jdapm.2018.18.2.71
  9. Hekmatian E, Shadmehr E, Asghari G. Effect of pomegranate peel extract lozenge on gag reflex in dental patients. Journal of Isfahan Dental School 2011;7(3):229-235.
  10. Ishtiaq MZ, Abbas M. Assessment of antiemetic activity of methanolic peel extract of Punica granatum linn by chick emesis model. Healthc J Pharm Allied Sci 2018;1(1):38.
  11. Wang M, Septier C, Brignot H, Martin C, Canon F, Feron G. Astringency Sensitivity to Tannic Acid: Effect of Ageing and Saliva. Molecules 2022;27(5):1617. doi:10.3390/ molecules27051617
  12. Al-Khayri JM, Sahana GR, Nagella P, Joseph BV, Alessa FM, Al-Mssallem MQ. Flavonoids as Potential Anti-Inflammatory Molecules: A Review. Molecules 2022;27(9):2901. doi:10.3390/molecules27092901

 

 

Journal of Kerman University of Medical Sciences
Volume 33
Pages 1-5

Home

Editorial Board

Guide for Authors

Submit Manuscript

Guide for Reviewers

Contact Us