Quercus persica lozenges versus placebo for reducing gag reflex severity in adult dental patients: a randomized double-blind controlled trial

The gag reflex is a common challenge during dental procedures, often impairing clinical performance and causing patient discomfort. While pharmacological interventions are commonly employed, they can lead to adverse effects or be poorly tolerated. Herbal alternatives with local mucosal activity have gained increasing attention as potentially safer adjuncts. Quercus persica (Persian oak), rich in tannins, exhibits astringent and mucosal-desensitizing properties that may contribute to reducing gag reflex sensitivity. To evaluate the efficacy of a Quercus persica extract lozenge in reducing gag reflex severity in adult dental patients. In this randomized, double-blind, placebo-controlled clinical trial, 80 adult patients with a documented history of gag reflex were enrolled and equally allocated (1:1) into intervention and placebo groups (n = 40 each). Participants received either a 1-gram lozenge containing 200 mg of Quercus persica extract or an identical placebo. Gag reflex severity was assessed before and after intervention using a standardized 4-point ordinal scale across five intraoral regions. The primary outcome was the change in overall gag reflex score. Baseline demographic characteristics were comparable between the two groups. The Quercus persica group exhibited a significant reduction in overall gag reflex score (from 5.98 ± 2.26 to 1.38 ± 1.72; p = 0.001), in the placebo group (from 5.83 ± 2.01 to 5.10 ± 2.10; p = 0.002). Between-group comparison confirmed a significantly greater reduction in the intervention group (p < 0.001). Region-specific analysis revealed the greatest improvements in the soft palate and tonsillar regions, with mean reductions of 1.75 and 1.73 points, respectively (p < 0.001). Quercus persica lozenges were associated with a statistically significant reduction in gag reflex severity compared to placebo, particularly in highly sensitive intraoral regions. These findings suggest that Quercus persica may serve as a potential adjunctive approach for gag reflex management; however, conclusions should be interpreted with caution given the short-term assessment, and further studies are required to evaluate long-term efficacy, safety, and patient-reported outcomes.