We’ve all had dental patients with hypersensitive gag reflexes who can’t sit through a single bitewing, lurch the moment your hand touches their lower incisors, or is so anxious that they can’t make it through a prophylaxis. As many as 10% to 15% of people have a hypersensitive gag reflex.1
Given that the trigeminal and glossopharyngeal nerves pass through the medulla oblongata ‒ which is close to the vomiting center of the brain ‒ oral stimulation during a dental procedure isn’t just a psychological trigger for gagging but a real physical issue.1 Talking your patient through the process may not be effective or even practical.
As someone who has seen a fair share of nauseating moments in the dental office (I worked in pediatrics for two years,) I’ve come up with a handful of tricks to try when my patients are unable to get through basic preventive care. While not all of these tips are clinically tested or proven, it certainly doesn’t hurt to try them.
Have Them Smile
Smiling is a natural gag suppressant; when we smile, it helps ward off bouts of nausea. Whether you’re sick in a public setting and trying to make your way to the restroom or have a patient struggling to get that periapical radiograph off of #2, remember the first key is to smile.
It helps to let the patient know that smiling is a natural gag suppressant. You might say something like, “Mrs. Jones, I know this sounds silly, but if you smile, it works certain muscles that fight against your gag reflex. When you open your mouth, I’d like you to start smiling, and as soon as I have you close down, go ahead and smile nice and wide for me.”
Chances are, smiling is the last thing anyone will want to do if they feel their gag reflex initiating. But it is proven to work simply because of human anatomy and the muscles in and around the mouth. Smiling through gagging is fast-acting, free, and you’ll know fairly quickly whether it works or not.
Sprinkle Salt on the Tip of the Tongue
Some patients and hygienists swear by this technique. Have the patient sprinkle a pinch of salt on the tip of their tongue right before they open wide or need a few radiographs taken. We know that salty foods (such as crackers) tend to be easy on the stomach for someone with nausea, and it might be tied back to the need to restore sodium or electrolyte levels. The best way to be sanitary about keeping salt in your operatory is to have a resealable bag with individual serving sizes of salt packets stored away.
You can also have your patient rinse and gargle with salt water just before the appointment. Remember that salt dilutes best in warm water, so you might give them a cup with a packet of salt and ask that they go rinse in the restroom just before you have them seated.
As a general disclaimer, be sure to clear your patient of any medical conditions or dietary restrictions, such as those who require a low-sodium diet, usually individuals with heart disease, kidney disease, or high blood pressure.
Distract Them
One of the most common things I did when I was taking radiographs on a patient with a sensitive gag reflex was to ask them to raise their right foot in the air. After a few seconds, I’d ask them to hold up three fingers on their left hand. Sometimes I’d have them switch their hands and feet or change the number of fingers involved. By the point we’d made it through two to three appendages, the radiograph was already taken.
Ask Them to Breathe Through the Nose
The gag reflex doesn’t tend to be as sensitive if the patient is breathing through the nose instead of the mouth. Physiologically speaking, nasal breathing is more effective than breathing through your mouth. But it also prevents air flow from tickling the soft palate and uvula, which might vibrate during mouth breathing and further irritate a sensitive gag reflex.
If your patient tends to have chronic sinus congestion or allergies, ask them to take a decongestant or antihistamine a few hours before their appointment to ensure their nasal passages are clear.
Use Throat Spray
The numbing spray people use for sore throats can also help desensitize their soft palate right before a dental appointment. The spray acts like a topical anesthetic. You might recommend that your patient bring some with them from home, or your office can keep some on hand as long as it’s used without any risk of cross-contamination.
Another option is to utilize topical anesthetic sprays that you purchase directly from your dental supplier, which typically contain stronger ingredients (like lidocaine) similar to topical anesthetic gel that is used before injections.
Schedule Appointments Later in the Day
Some people find that their gag reflex and corresponding nausea tend to be worse in the morning hours, including individuals who are experiencing morning sickness or gastroesophageal reflux disease. If that is the case, they may respond better to dental care scheduled toward the end of the afternoon rather than first thing in the morning.
When in Doubt, Recommend Nitrous Oxide
Nitrous oxide sedation may add a bit of time to your hygiene procedure, but so does a patient’s gag reflex. If you don’t have to worry about the patient feeling uncomfortable during a prophy, they’ll be more comfortable, and you’ll be able to work more efficiently. Nitrous oxide works well when it comes to managing gagging reflexes.
Be Patient and Have a Good Sense of Humor
Asking a patient to hum, smile, or hold up their fingers whenever they feel like gagging may not seem normal or even professional if it’s not something you’re used to doing. But when you approach the situation with a friendly demeanor and are understanding of the circumstances, I’ve found that most people will easily comply with these silly-sounding requests given the chance they might actually work. When they do, you’ve completely reframed how your patients view their dental care.
Thanks to techniques like these, it is still possible to provide preventative and basic dental care to patients in general care settings without the need for more complex services, such as deeper sedation or general anesthesia. The key is to be sensitive to patient needs and concerns rather than attempt to “power through” them, potentially causing the patient to avoid additional dental services in the future.
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Reference
- Sivakumar, S., Prabhu, A. Physiology, Gag Reflex. [Updated 2022 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK554502/
