Dentistry can be tough. But it doesn’t have to be. Most things with a little practice and repetition become quite easy. It’s often the modifying patient factors that really put a spin on your day.

This takes me back to uni.

I was making a set or partials for a lovely patient. He was great to treat however had warned me from day on, “I have a terrible gag reflex, last time I almost threw up!”

As a dental student this sent shivers down my spine. I needed to make a lower partial with bilateral distal end saddles – I needed a perfect impression!

The Gagger

A patient who gags can really make things difficult. Often their tongue is large, wandering and reactive. But don’t forget, it’s the patient who’s really struggling here. To help the patient get through these appointments there are a few ‘tricks’

Tricks for Managing the Gagger

  • Salt on the Tongue
  • Topical anaesthetic
  • Distraction
  • Nitrous oxide
  • Desensitise

Salt on the Tongue

Just sprinkle a bit on the tongue and you’ll be amazed

I believe I learnt this from a tutor in uni.

She suggests we sprinkle a small amount of salt on the back of the tongue.

It was explained to the patient that the salt activates the nerves in the tongue leading to inhibition of the sensory component which would otherwise trigger the gag reflex.

The result was incredible – i proceeded to fail at taking 3 lower bilateral DES impressions in a row, all without a gag at all!

I have no idea if this has a true physiological basis to it. There is suggestion that the sensitisation of the chorda tympani blocks the sensation of the gag reflex. Strange,as the reflex is often triggered by posterior tongue (glossopharyngeal) and soft palate (trigeminal). In fact, the best evidence I could find was that it is not significantly different to control. To be clear – this is NOT evidence based medicine, it’s a likely placebo based on my experience which i have seen work wonders for my patients!

Confidence

What I think really makes this work is distraction and your confidence. Letting them know you have a trick to help and being confident in that delivery gives them hope, and it seems to work.

Topical Anaesthetic

Numbing the back of the tongue and soft palate can help lower the sensitivity of these regions allowing you to work.

Personally, i’m yet to try this because the thought of a numb tongue makes me gag.

Distraction

It’s something most dentists almost intuitively say. “Focus your breathing”, “wiggle your toes”. All of these things help distract from the mouth and can help in the gagging situation. Although it’s arguable if it helps the patient or just helps us think we’re helping.

Nitrous Oxide

In the study that suggests salt isn’t particularly successful it also clearly shows that Nitrous Oxide is. This means that for complex situations and severe gaggers nitrous is going to be the number 1 option (short of sedation itself).

That is of course, if you have access..

Desensitise

I remember being told in university that one way to work past the gag reflex is to get your patients to systematically sensitise the area leading to a lowered response. I’m sure this works however feel asking my patients to force themselves to dry retch in the name of dentistry multiple times a day is a long shot.

Have you ever used salt? What has worked for your patients? Let us know on our facebook Group , Facebook Page or Instagram.

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David is a recent graduate dentist working in private practice in regional NSW, Australia. Read more at www.dentalheadstart.com/meet-david/

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