{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T12:23:37Z","timestamp":1787833417052,"version":"build-2784847793"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004048","name":"Kashan University of Medical Sciences","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004048","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Saudi Dent. J."],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    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.\n                    <jats:italic>Quercus persica<\/jats:italic>\n                    (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\u2009=\u200940 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\u2009\u00b1\u20092.26 to 1.38\u2009\u00b1\u20091.72; p\u2009=\u20090.001), in the placebo group (from 5.83\u2009\u00b1\u20092.01 to 5.10\u2009\u00b1\u20092.10; p\u2009=\u20090.002). Between-group comparison confirmed a significantly greater reduction in the intervention group (p\u2009&lt;\u20090.001). 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\u2009&lt;\u20090.001). 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.\n                  <\/jats:p>","DOI":"10.1007\/s44445-026-00207-2","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T12:40:25Z","timestamp":1784551225000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quercus persica lozenges versus placebo for reducing gag reflex severity in adult dental patients: a randomized double-blind controlled trial"],"prefix":"10.1007","volume":"38","author":[{"given":"Atefeh","family":"Mohammadi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohsen","family":"Taghizadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Hosseiniara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossien","family":"Akbari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameneh","family":"Taghdisi Kashani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"207_CR1","doi-asserted-by":"publisher","unstructured":"Akram E, Masoud K (2012) Evaluation of the antibacterial and wound healing activity of quercus persica. J Basic Appl Sci 8. https:\/\/doi.org\/10.6000\/1927-5129.2012.08.01.18","DOI":"10.6000\/1927-5129.2012.08.01.18"},{"key":"207_CR2","doi-asserted-by":"publisher","DOI":"10.1016\/J.INDCROP.2019.05.008","author":"C Anlas","year":"2019","unstructured":"Anlas C, Bakirel T, Ustun-Alkan F et al (2019) In vitro evaluation of the therapeutic potential of Anatolian kermes oak (Quercus coccifera L.) as an alternative wound healing agent. Ind Crops Prod. https:\/\/doi.org\/10.1016\/J.INDCROP.2019.05.008","journal-title":"Ind Crops Prod"},{"key":"207_CR3","doi-asserted-by":"publisher","first-page":"967","DOI":"10.22037\/IJPR.2014.1532","volume":"13","author":"S Azizi","year":"2014","unstructured":"Azizi S, Pirbalouti G, Amirmohammadi M (2014) Effect of Hydro-alcoholic Extract of Persian Oak (Quercus brantii) in Experimentally Gastric Ulcer. Iran J Pharm Research: IJPR 13:967\u2013974. https:\/\/doi.org\/10.22037\/IJPR.2014.1532","journal-title":"Iran J Pharm Research: IJPR"},{"key":"207_CR4","doi-asserted-by":"publisher","unstructured":"Banc R, Rusu ME, Filip L et al (2023) Phytochemical profiling and biological activities of quercus sp. galls (Oak Galls): a systematic review of studies published in the last 5 years. Plants 12. https:\/\/doi.org\/10.3390\/plants12223873","DOI":"10.3390\/plants12223873"},{"key":"207_CR5","doi-asserted-by":"publisher","unstructured":"Basri D, Tan LS, Shafiei Z et al (2011) In vitro antibacterial activity of galls of quercus infectoria olivier against oral pathogens. Evidence-based Complementary and Alternative Medicine: eCAM. 2012. https:\/\/doi.org\/10.1155\/2012\/632796","DOI":"10.1155\/2012\/632796"},{"key":"207_CR6","doi-asserted-by":"publisher","unstructured":"Castillo-Mendoza E, Zamilpa A, Gonz\u00e1lez-Cort\u00e1zar et al (2022) Chemical constituents and their production in Mexican Oaks (Q. Rugosa, Q. Glabrescens and Q. Obtusata). Plants 11 https:\/\/doi.org\/10.3390\/plants11192610","DOI":"10.3390\/plants11192610"},{"key":"207_CR7","doi-asserted-by":"publisher","unstructured":"Coman N, Ber\u021ba L, Nicolae-Maranciuc A et al (2024) Green synthesis of platinum nanoparticles using aqueous bark extract of Quercus sp. for potential antioxidant and antimicrobial applications. BioResources https:\/\/doi.org\/10.15376\/biores.19.4.8621-8641","DOI":"10.15376\/biores.19.4.8621-8641"},{"key":"207_CR8","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/J.INDCROP.2012.12.011","volume":"45","author":"L Cust\u00f3dio","year":"2013","unstructured":"Cust\u00f3dio L, Patarra J, Albericio F et al (2013) Extracts from Quercus sp acorns exhibit in vitro neuroprotective features through inhibition of cholinesterase and protection of the human dopaminergic cell line SH-SY5Y from hydrogen peroxide-induced cytotoxicity. Ind Crops Prod 45:114\u2013120. https:\/\/doi.org\/10.1016\/J.INDCROP.2012.12.011","journal-title":"Ind Crops Prod"},{"key":"207_CR9","doi-asserted-by":"publisher","first-page":"618","DOI":"10.12968\/jowc.2021.30.8.618","volume":"30 8","author":"F Dardmah","year":"2021","unstructured":"Dardmah F, Farahpour M (2021) Quercus infectoria gall extract aids wound healing in a streptozocin-induced diabetic mouse model. J Wound Care 30 8:618\u2013625. https:\/\/doi.org\/10.12968\/jowc.2021.30.8.618","journal-title":"J Wound Care"},{"key":"207_CR10","doi-asserted-by":"publisher","first-page":"17093","DOI":"10.3390\/molecules200917093","volume":"20","author":"D Deryabin","year":"2015","unstructured":"Deryabin D, Tolmacheva A (2015) Antibacterial and Anti-Quorum Sensing Molecular Composition Derived from Quercus cortex (Oak bark) Extract. Molecules 20:17093\u201317108. https:\/\/doi.org\/10.3390\/molecules200917093","journal-title":"Molecules"},{"key":"207_CR11","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd011116","author":"P Eachempati","year":"2019","unstructured":"Eachempati P, Nagraj K, Krishanappa SKK et al (2019) Management of gag reflex for patients undergoing dental treatment. Cochrane Database Syst Rev. 2019 11 https:\/\/doi.org\/10.1002\/14651858.cd011116","journal-title":"Cochrane Database Syst Rev"},{"key":"207_CR12","doi-asserted-by":"publisher","unstructured":"Elham A, Arken M, Kalimanjan G et al (2020) A review of the phytochemical, pharmacological, pharmacokinetic, and toxicological evaluation of quercus infectoria galls. J Ethnopharmacol 113592. https:\/\/doi.org\/10.1016\/j.jep.2020.113592","DOI":"10.1016\/j.jep.2020.113592"},{"key":"207_CR13","first-page":"43","volume":"24","author":"E Hekmatian","year":"2012","unstructured":"Hekmatian E, Shadmehr E, Asghari G (2012) Effect of Elaeagnus angustifolia lozenge on gag reflex in dental patients. J Islamic Dent Association Iran 24:43\u201347","journal-title":"J Islamic Dent Association Iran"},{"key":"207_CR14","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.2165\/00003495-200565090-00005","volume":"65","author":"Z Hu","year":"2005","unstructured":"Hu Z, Yang X, Ho PCL et al (2005) Herb-drug interactions: a literature review. Drugs 65:1239\u20131282","journal-title":"Drugs"},{"key":"207_CR15","doi-asserted-by":"publisher","unstructured":"Kim S, Shin H-L, Son TH et al (2024) Quercus glauca acorn seed coat extract promotes wound re-epithelialization by facilitating fibroblast migration and inhibiting dermal inflammation. Biology 13. https:\/\/doi.org\/10.3390\/biology13100775","DOI":"10.3390\/biology13100775"},{"issue":"4","key":"207_CR16","first-page":"446","volume":"48","author":"D Lu","year":"2000","unstructured":"Lu D, Lu G, Rd J (2000) Acupuncture\/acupressure to treat gagging dental patients: a clinical study of anti-gagging effects. Gen Dent 48(4):446\u2013452","journal-title":"Gen Dent"},{"key":"207_CR17","doi-asserted-by":"publisher","first-page":"372","DOI":"10.30476\/dentjods.2022.96360.1934","volume":"24","author":"M Mehdizadeh","year":"2023","unstructured":"Mehdizadeh M, Mohammadbeigi A, Sharifinejad A (2023) An Overview about New Methods in Management of Gag Reflex during Dental Treatment: A Systematic Review. J Dent 24:372\u2013381. https:\/\/doi.org\/10.30476\/dentjods.2022.96360.1934","journal-title":"J Dent"},{"key":"207_CR18","first-page":"161","volume":"24","author":"M Mohammadi-Sichani","year":"2015","unstructured":"Mohammadi-Sichani M, Karbasizadeh V, Dokhaharani SC (2015) Effect of Oak Galls Extracts on Streptococcus mutans Growth and Biofilm Formation. J Mazandaran Univ Med Sci 24:161\u2013171","journal-title":"J Mazandaran Univ Med Sci"},{"key":"207_CR19","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.1186\/s12903-024-05248-9","volume":"24","author":"N Nikkerdar","year":"2024","unstructured":"Nikkerdar N, Seyedi H, Mirzaeei S et al (2024) Comparative effects of three mucoadhesive gels containing lidocaine, zinc acetate, and tannic acid on the gag reflex of dental patients: a randomized double-blind clinical trial. BMC Oral Health 24:1442. https:\/\/doi.org\/10.1186\/s12903-024-05248-9","journal-title":"BMC Oral Health"},{"key":"207_CR20","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s12906-024-04334-3","volume":"24","author":"A Okamoto","year":"2024","unstructured":"Okamoto A, Karibe H, Tanaka S et al (2024) Effect of aromatherapy with peppermint essential oil on the gag reflex: a randomized, placebo-controlled, single-blind, crossover study. BMC Complement Med Ther 24:60. https:\/\/doi.org\/10.1186\/s12906-024-04334-3","journal-title":"BMC Complement Med Ther"},{"key":"207_CR21","doi-asserted-by":"publisher","DOI":"10.3892\/mmr.2023.13062","author":"P Oliveira","year":"2023","unstructured":"Oliveira P, Medeiros-Fonseca B, Vasconcelos-N\u00f3brega C et al (2023) Quercus spp. extract as a promising preventive or therapeutic strategy for cancer: A systematic review. Mol Med Rep. https:\/\/doi.org\/10.3892\/mmr.2023.13062. 28 3","journal-title":"Mol Med Rep"},{"key":"207_CR22","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1111\/j.1365-2125.2012.04350.x","volume":"75","author":"P Posadzki","year":"2013","unstructured":"Posadzki P, Watson L, Ernst E (2013) Herb\u2013drug interactions: an overview of systematic reviews. Br J Clin Pharmacol 75:603\u2013618","journal-title":"Br J Clin Pharmacol"},{"key":"207_CR23","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1007\/s11101-020-09707-3","volume":"19","author":"D \u015e\u00f6hreto\u011flu","year":"2020","unstructured":"\u015e\u00f6hreto\u011flu D, Renda G (2020) The polyphenolic profile of Oak (Quercus) species: a phytochemical and pharmacological overview. Phytochem Rev 19:1379\u20131426. https:\/\/doi.org\/10.1007\/s11101-020-09707-3","journal-title":"Phytochem Rev"},{"key":"207_CR24","doi-asserted-by":"publisher","first-page":"162","DOI":"10.30476\/dentjods.2023.97675.2032","volume":"25","author":"MM Torabi","year":"2024","unstructured":"Torabi MM, Shoorgashti R, Haji Fattahi F et al (2024) Evaluation of the Effect of Benzydamine Hydrochloride on the Intensity of Gag Reflex: A Randomized Single-Blind Clinical Trial. J Dent (Shiraz) 25:162\u2013168. https:\/\/doi.org\/10.30476\/dentjods.2023.97675.2032","journal-title":"J Dent (Shiraz)"},{"key":"207_CR25","doi-asserted-by":"publisher","unstructured":"Usichenko TI, M\u00fcller-Kozarez I, Knigge S et al (2020) Acupuncture for relief of gag reflex in patients undergoing transoesophageal echocardiography-a protocol for a randomized placebo-controlled trial. Med (Basel) 7. https:\/\/doi.org\/10.3390\/medicines7040017","DOI":"10.3390\/medicines7040017"}],"container-title":["The Saudi Dental Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s44445-026-00207-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s44445-026-00207-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s44445-026-00207-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T12:01:08Z","timestamp":1787832068000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s44445-026-00207-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":25,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["207"],"URL":"https:\/\/doi.org\/10.1007\/s44445-026-00207-2","relation":{},"ISSN":["1013-9052","2524-1702"],"issn-type":[{"value":"1013-9052","type":"print"},{"value":"2524-1702","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]},"assertion":[{"value":"11 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study protocol received approval from the Research Ethics Committee of Kashan University of Medical Sciences (IR.KAUMS.MEDNT.REC.1399.048) and adhered to the principles outlined in the Declaration of Helsinki and Good Clinical Practice (GCP) guidelines and also was registered in the Iranian Registry of Clinical Trials (IRCT20130211012438N33) prior to patient enrollment.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"By submitting this document, the authors declare their consent for the final accepted version of the manuscript to be considered for publication.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"101"}}