# Role of photobiomodulation in controlling the gag reflex during posterior tooth extraction, a pilot case series

## TL;DR

This study explores using low-level laser therapy on specific points to reduce the gag reflex during tooth extraction, showing promising results.

## Contribution

The study introduces a novel application of photobiomodulation for managing gag reflex during dental procedures.

## Key findings

- LLLT significantly reduced gag reflex severity scores postoperatively.
- PGS scores correlated moderately with baseline GSI scores.
- LLLT was effective in facilitating posterior tooth extraction.

## Abstract

This pilot case series aimed to investigate the feasibility and preliminary efficacy of photobiomodulation (PBM; also known as low-level laser therapy [LLLT]) applied to specific acupuncture points (PC6 and CV24) in managing the gag reflex during posterior single-tooth extraction. Participants with moderate-to-severe gag reflex (n = 20) were selected based on Gagging Severity Index (GSI) scores ≥ 3 during clinical examination. Gag reflex severity was measured using both the GSI and the Predictive Gagging Survey (PGS) before and after the procedure. LLLT (976 nm diode laser, 100 mW, 4 J/cm² per point, continuous-wave, 20 s per point, 8-mm diameter tip [spot area ≈ 0.50 cm²]) was administered immediately prior to extraction. Preoperative GSI scores (3.3 ± 0.6) underwent a significant decrease postoperatively (1.3 ± 0.5; P < 0.001). Concurrently, PGS scores showed a moderate positive correlation with baseline GSI. LLLT was found to be an effective method of controlling the gag reflex during posterior tooth extraction, thereby facilitating the procedure. In this pilot study, LLLT was associated with reduced gag reflex during posterior tooth extraction. However, the absence of a control group should be acknowledged as a limitation, and the findings should be interpreted with caution. Controlled trials are needed to confirm these preliminary results.

The online version contains supplementary material available at 10.1007/s10103-026-04806-7.