Patients with a severe gag reflex tend to avoid the dentist.
If you have a gag reflex, the last thing you want to do is have someone stick anything in your mouth. Of course the dentist had his/her team members are going to stick things in your mouth to make impressions, clean, fill teeth, take x-rays etc. Depending on the severity of the gag reflex, some patients gag even before anything is placed in the mouth.
Dentists have several ways overcome gagging including:
- Gradual desensitization
- Topical anesthetic
- Local anesthetic
- Nitrous Oxide (laughing gas)
- Oral sedatives
- Distraction with salt
- Breathing exercises
Gagging is a physical problem as well as a psychological one.
There is a strong psychological part with probable roots an early childhood incident involving near suffocation, choking, or some other traumatic event. The trigger is usually a sense of loss of control when another person is putting something in the patient’s mouth. The person can usually eat and brush their own teeth without a problem, but react when another person is controlling the event. There is a nerve trigger that comes into play also. Touching certain parts of the mouth trigger the gag reflex. Some patients even gag on their own toothbrush.
Shelly suffers with a gag reflex. It seems to be getting worse as she gets older. Shelly hates going to the dentist. She does not go every six months, and waits until something bothers her before scheduling.
I meet Shelly
I meet Shelly a few months ago after her husband had come in for an examination. He thought I could work with her. She explains that she has a severe gag reflex which is worse on the left side. I let Shelly know that I have successfully worked with many patients with a gag reflex. I have several techniques available and I will be patient with her. After talking with her, she allows me to check her mouth. True to form Shelly’s gag reflex is worse on the left side. We are able to get x-rays on the right side by spraying topical anesthetic on her tongue and the roof of her mouth. The left side is more sensitive and we can only get one x-ray. Shelly decides to have her teeth whitened and we are able to take impressions using topical again. Using topical anesthetic, we are also able to clean her teeth.
Shelly breaks her tooth and needs a crown
Shelly calls me a week later with a broken tooth. I have her stop in the office to check it out and sure enough, she had cracked her tooth which now needs a crown on the same side as her worst gag reflex. We scheduled the appointment. When she comes in to make the crown her gag reflex is much worse and her sinuses are draining so she cannot breathe through her nose. In addition Shelly has been delayed by traffic for her appointment and is very anxious.
Dealing with Shelly’s situation
I tell Shelly I cannot use the laughing gas since she cannot breath through her nose. In addition, since I was not aware of her anxious state until she arrived, I cannot give her an oral sedative (we were not scheduled for that type of appointment). I assured Shelly that I thought we could still overcome her gagging with topical and local anesthetic along with frequent breaks if needed. I slowly anesthetized her mouth with topical, and a special combination of local anesthetics. Since her reflex was quite severe, I anesthetized more of her mouth that I normally need to. The procedure went smoothly, and she was quite thankful that we accommodated her. Shelly now had a temporary crown
Shelly’s next visit
I told Shelly that I would prescribe oral sedative for her and make sure she used a decongestant in advance so she could have the gas (nitrous oxide) next time. Shelly will come back in tow weeks for the fit of her new crown. She is now confident that I can treat her successfully.
If you or someone you know suffer with a severe gag reflex, there are techniques that can help.
I love dentistry and I look forward to helping overcome their fears, improving their health and smile.
Phillip C. Neal DDS answers all of your questions about gag reflexes at Crystal Lake Dental Associates.
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