Re: GAG REFLEX

[Anonymous]

Gagging can be due to psychological factors, or physiological factors, or both. Gagging can also be a physical expression of panic, related to a feeling that some threat to breathing or swallowing is about to occur. This feeling of not being able to “catch your breath” may have its roots in the past – you may have had an experience where you actually suffocated, or were close to it.

Some people have such a bad gag reflex that it makes brushing their teeth almost impossible.
* Always have the patient breathe through their nose!”
* “Breathe. Breathe. Breathe. I say it 3 times because sometimes it is hard for me to breathe through my nose. I have to consciously force myself to take deep breaths and try not to get overwhelmed.”
* “To help with the gag reflex, I find that using a nasal decongestant before my appointment is very helpful in keeping the nasal passageways open to promote breathing through the nose.”

* A throat spray with numbing action, such as over-the-counter Vicks Ultra Chloraseptic Throat Spray, can relieve the gag reflex in gaggers or people with a cough or asthma. Dosage: 2 or 3 sprays right before treatment should last about an hour. This works really well for lots of people, so give it a try!
* “Desensitization can also work well. Give patients various dental tools such as a mouth mirror and small impression trays. They can then take these home and introduce these instruments into their mouths themselves. They should keep a diary of how long they feel comfortable by timing it. Doing this a few times in a row twice a day, you will become less sensitive to the gag reflex. As a dentist, you can ask the person to practice until, for example, they feel comfortable sitting with the tray in place for 5 minutes.”
* “One pretty bomb proof tip for handling gaggers is the use of table salt on the tip of the tongue..get the patient to dip their moist finger into a dampen dish of salt and get them to dab it onto the tip of their tongue. Works 95% of the time.”
* “Yes, the salt trick works great for a lot of gaggers. It’s definitely got some physiological basis because I’ve used it on a girl with severe brain damage and it worked, so not just a placebo effect. Sprinkle a little paper packet of it on the back of the tongue. The wee ones you get in canteens are about right, say 1-2g, dosage isn’t critical. If possible having the patient rinse round for a few minutes with some Normasol (0.9% saline) is even better.”
* “Gagging can be caused by fear, address your fear with your doctor and staff members in order to overcome it.”
* “For many people, there is a sense of loss of control in a dental chair during treatment and the tendency to gag is one representation of this. If you have this sense at all, then your dentist must reassure you that he or she will stop immediately if you want them to, whether it be to rinse, or just to catch your breath. If you have a trusting relationship, then your sense of control should increase. You may want to practice diaphragmatic breathing exercises through your nose to relax you in the chair. This info is readily available in any relaxation book.”
* “I find the most important factor in dealing with gagging problems is a calm manner – if you get stressed by not being able to take an impression, your patient is only going to gag more. Acknowledge the problem and show that you are not phased by it.”
* Let your dentist know what procedures or situations have triggered gagging in the past and see if alternative ones can be used.
* “Lift one foot up in the air to have them concentrate on that.”
* “Have the patient hum while the film is in their mouth – they can’t gag and hum at the same time. I tried it on a patient who hadn’t had x-rays for 2 years because she would gag on the bitewings. Worked great – we were both pleasantly surprised!”
* “For my patients that are gaggers, I put a little topical lidocaine on a cotton tip applicator and put it on the palate and the back of the tongue and it works great, and patients like the taste, I use watermelon. This works really well for x-rays, so it should also help for impressions etc.”
* “When placing films (bitewings), you could place some topical anaesthetic on the film to try and prevent the gagging. I have tried this and it works.”
* “Try to find a good time of day for you. The mornings are when I gag the most when brushing my teeth. Now I try to schedule appointments for the afternoon.”
* “I have a lot of success when the patient takes a sip of very cold water prior to placing the x-ray film.” (probably not the best idea if you have sensitive teeth 😉 )
* “Listening to music – I am too busy trying not to gag that I simply do not have the mental energy to ‘imagine myself someplace else’ or ‘think positive thoughts’. I bring in my own headphones with my own music and simply try to focus on that.”
* Sitting up rather than lying down can also help with the gag reflex. “In some situations, unconventional measures may be required. I once had to take an impression with the patient standing up to help defeat the gag reflex.” Using super-fast setting impression material and letting the patient walk around while the mold is setting also help.
* If you cannot tolerate intra-oral x-rays, a panoramic x-ray which keeps the film outside the mouth can be used (provided your dentist has this equipment). However, it is usually necessary to take bitewing x-rays as well. The child-sized ones are often easier to tolerate.
* Providing treatment in short increments can also help.
* Hypnosis can also help with the gag reflex. Make sure you choose a qualified hypnotherapist.
* Nitrous oxide (laughing gas) is very effective in reducing the gag reflex. IV sedation is even more effective and almost always eliminates the gagging.
* Nitrous oxide combined with oral sedation can be even more effective than nitrous on its own (not available in UK/Europe).

You can use the list above as a starting point and think about what might help you. You can also try and ask yourself “Under which circumstances might the gag reflex not occur?”, and try and come up with ideas. For some people, a harmless incident in the past might have triggered the gag response, and finding out about this incident (for example by asking parents) can eliminate gagging).

A fear of gagging and throwing up is a common feature in emetophobia (the fear of vomiting). Emetophobia, coupled with a bad gag reflex, is not much fun! Try the tips above, and check out websites about emetophobia.

Physiological causes which can predispose or cause a person to gag include not being able to breathe through your nose properly, catarrh, sinusitis, nasal polyps, mucus in the upper respiratory tract, a dry mouth, and medications that cause nausea as a side effect. Certain medical conditions (gastrointestinal diseases) can also contribute to gagging.

Gagging can be worse in the morning for some people. If this is the case for you, try and schedule appointments for the afternoon.

A severe gag reflex can be big obstacle for some people who need dentures. Here are some tips:

* the gag reflex can be triggered by a denture that extends too far into the palate – oftentimes it’s possible to trim it enough to make it comfortable
* sheer wanting will can help
* hypnosis can also help
* desensitization can work for some people – a bleaching shim with the palate included is worn as much as possible to see if you can be desensitized
* if finances allow, implant-retained dentures or implants may be an option