Gagging is an upsetting problem that affects some patients during dental treatments. Gagging is the sensation of choking that causes the throat to spasm and makes swallowing and breathing difficult. Dental patients who are gaggers will often avoid dental care for long periods of time; becoming more susceptible to tooth decay, periodontal gum disease and other serious dental infections. Gagging may result from many routine dental procedures, but is most common during intra-oral (within the mouth) X-rays, impressions (taking molds) and for procedures that require the mouth to be held open for extended periods of time.
Most gagging problems are either mild or moderate and can be resolved if a few steps are taken. The first thing the dentist must do is to listen to the patient about their problem. A caring and concerned attitude by the dentist can often go a long way to allaying a patient's anxiety and can significantly reduce gagging. The dentist should then find out what procedures or situations have triggered gagging in the past and see if alternative ones can be used. I have found that several techniques are highly effective for helping gaggers. I will often use a topical anesthetic spray to numb the mouth and throat which acts to reduce the gag reflex. Other methods, including the use of super-fast setting impression materials, rubber dams (a barrier that blocks fluids and other particles from entering the mouth) and nitrous oxide gas can significantly control gagging in most patients.
Some gagging problems are severe and difficult to treat even by the most experienced dentists. These patients will often suffer from dental phobia and avoid dental treatment except when in severe pain. To treat a severe gagger, the dentist should first employ the same measures used for mild to moderate gaggers and also be extremely patient. The dentist may also consider having a patient lift his or her legs up off the dental chair, in short increments during dental treatment. For severe gaggers who cannot tolerate intra-oral X-rays, a panoramic X-ray, which keeps the film outside the mouth, can be used. In some situations, unconventional measures may be required. I once had to take an impression with the patient standing up to help defeat the gag reflex. As a last resort, severe gaggers can have dental treatment performed at a hospital under IV dental sedation or general anesthesia.
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