Gagging is a protective, natural reflex that stops entry of unwanted objects into the mouth and throat area. This reflex varies in intensity from one person to the next. Pronounced gag reflexes can compromise various aspects of dentistry, from diagnostic procedures of clinical examination and radiography to any form of treatment. In severe cases it could even lead to a patient avoiding care. There are many techniques in overcoming this condition and different strategies may be necessary in delivering dental treatment.
There are two basic classifications. One is called somatogenic which is induced by actual physical stimuli. The second is psychogenic in which psychological factors are thought to induce gagging without any physical stimulants.
Strategies for patient management fall under four categories.
First is psychological management via relaxation. This is accomplished through providing a comfortable and relaxing environment and/or breathing exercises like controlled rhythmic breathing and relaxed abdominal breathing.
Distraction techniques are also effective and thought to work by diverting attention away from the gagging problem long enough to carry out a procedure. Patients are asked to concentrate on a task or thought that will completely absorb their mind and prevent them from focusing on their gagging which increase their anxiety level.
Another technique is systematic desensitization and consists of incremental exposure to the feared stimulus which over a period of time will allow patients to become more used to certain stimuli.
Lastly there is the pharmacological option. A number of agents have been identified as effective against the gag reflex. Some topical anesthetics in forms of sprays or gels applied to the soft palate can be useful. Also some centrally acting drugs such as antihistamines and sedatives are helpful.
The attitude of the dentist toward the patient and his/her problem is ultimately very important. constant reassurance that the patient is alright will reduce embarrassment and anxiety.
