It’s the same scenario, you get to the dentist, sit in the chair and try and remain calm. But, as you look around at the various instruments all you can think is how each of them makes you want to throw up… literally. This brings me to today’s post: Dentistry and Gag Reflex. In dentistry there are various things that can stimulate a gag response. Most severe gagger’s are swarmed with anxiety before and during their appointment. Some is towards the actual dental procedure but, most is due to the fear that they will start to gag and be unable to control it. As a dentist we try and alleviate those fears and manage the response as best as possible. Gagging can be defined as a response ” In which the body attempts to eliminate instruments or agents from the oral cavity by muscle contraction at the base or the tongue and the pharyngeal wall”. Various things can cause this response whether it be from physical stimulation or psychological stimulation. With psychological stimulation certain sounds, smells and even thoughts can induce feelings of fear and stress thereby trigger a gag reflex. When I treat a patient with a sensitive gag reflex there are some methods I use to try and manage the symptoms.

• Initially, I focus on methods of desensitization combined with  relaxation. To do this a topical anesthetic is placed on the palate and back of the mouth. Then, I have the patient  find a focal point, such as a corner or a tile. Once a focal point is found breathing exercises are employed. We focus on keeping a steady pace of deep slow breaths while the procedure is completed.
• If this fails we move to a distraction technique. During the procedure the patient is instructed to lift one leg slowly up and then down. They are told to alternate their legs while focusing on breathing slow deep breaths. As silly as this seems,  it tends to work well with a mild gag reflex.
• If coping mechanisms do not work in conjunction with topical anesthetic then, pharmacological techniques will be offered if the patient is a candidate.  Nitrous oxide is the first pharmacological intervention that is used.  Nitrous is helpful for patients because it tends to distract as well as remove some of the anxiety of the dental procedure and the possibility of gagging. However, If the nitrous oxide is not effective then a different type of pharmacological treatment may be recommended such as Conscious Sedation. Conscious Sedation helps to reduce the anxiety associated with treatment as well as help to eliminate the physical reflex as well.
• Other therapies that are used by some practitioners are: acupressure and acupuncture

Gag Reflex: No More A Gag To A Dentist The Behavioral Techniques, Pharmacological Techniques, Acupressure and Acupuncture in Controlling the Gag Reflex – A Review Shriprasad S1, Shilpashree HS2

The use of relative analgesia in the prosthetic treatment of the ‘gagging’ patient.Packer ME, Joarder C, Lall BA.

Management of Exaggerated Gag Reflex Using Intravenous Sedation in Prosthodontic Treatment Harushi Yoshida¹⁾, Terumi Ayuse¹⁾, Satoru Ishizaka²⁾, Shingo Ishitobi¹⁾, Tomoyuki Nogami¹⁾, Kumiko Oi^{1) 2)}