Preventing Gagging

If the patient is a gagger tell them it is quite alright to gag. It doesn't bother you one bit. I find this makes the patient relax.

I try to divert their attention by giving them something to do. I practice taking the impression using an empty tray and ask them to hold up the ends of the bib. Some will ask them to lift one leg.

You can also spray or swab the throat with a topical anesthetic, or have the patient gargle with it. Remember it doesn't taste good. Note: the school does not stock topical anesthetic spray.

Surprisingly enough putting salt on the patient's tongue also works. The brain concentrates on the salt and not on the gagging messages. First check if they have a blood pressure problem.

You can use your thumb to press on acupuncture points on the hand and the wrist that will create a feeling of soreness and distention. This feeling is known as "Suan Zhang." I guess this relies on the extinction phenomenon caused by simultaneous stimulation.
(You can't use this "soreness and distention" procedure on Temple Dental patients. I would only use this on selected patients in your private practice.)

See 22. Addendum, click on References and look for the 2nd section labelled "gag reflex."

I always stand in front of the patient when taking an impression. I am able to watch the throat to see if any impression material is flowing down. If the impression material is bothering (gagging) the patient, I use a mouth mirror as a miniature shovel to quickly pull the material to the front of the mouth. Using a thin layer of rubber base will reduce the excess material and produce a better impression.

(Some people will not gag even when material starts to run out the back of the tray. Some will gag when the tray is 12 inches out of the mouth.

Patients with a hyperactive gag reflex cannot wear complete dentures. Treatment usually involves sessions of repeated stimulation of the gag reflex over a period of days. The goal is decreased sensitivity which will allow the patient to perform the usual oral activities while wearing dentures. This is not the sort of patient a dental student should be expected to treat.)

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©1999 by Julius Rosen, D.D.S.