The KOJIMA Program for a Patient With a Severe Gag Reflex That Impeded Complete Denture Fabrication: A Case Report

A severe gag reflex can impair a patient’s ability to receive dental care. The KOJIMA program combines ultrasound-guided selective glossopharyngeal nerve blocks (UGSGNBs) and patient-led desensitization with swab palpation training to improve tolerance and reduce gagging. We utilized the KOJIMA program in the case of a patient with a severe gag reflex to allow successful fabrication and delivery of removable dental prostheses. The patient was a 61-year-old man with severe chronic obstructive pulmonary disease, asthma, intellectual disability, and a severe gag reflex (Grade V) in whom conventional intravenous (IV) moderate sedation with midazolam and propofol alone failed. Bilateral UGSGNBs enabled progressive treatment under IV moderate sedation with midazolam. Through the KOJIMA program, the patient demonstrated a reduction in his gag reflex severity and could successfully tolerate treatment. Consequently, occlusal registration and trial fitting of his dental prostheses became feasible while he was fully awake, enabling him to successfully complete the denture fabrication and delivery process. The KOJIMA program shows promise for the safe management of patients with a severe gag reflex undergoing prosthetic treatment. Future studies should assess its long-term efficacy and optimal protocols.