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

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.