describe about gag reflex and it's etiology

1. G
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Presented By :Kaushal Goti
FINAL YEAR

2. Introduction
 One of the most puzzling clinical problems is gagging
and the patient is referred to as a ‘gagger’.
 The management of such dental patients can be an
embarrassing experience for the patient and a
distressing one for the doctor.
 Gagging may complicate prosthodontic treatment for
the edentulous patients either during the making of
the dentures or after they have been completed.

3. The Gag Reflex
 It is defined as the involuntary contraction of the
muscles of the soft palate or pharynx that results in
retching.
 It may lead to actual vomiting and is accompanied by
excessive lacrimation, salivation and sweating.
 It is a healthy defense mechanism and functions to
prevent the entry of foreign bodies into the larynx
or pharynx.

4. ETIOLOGY OF GAGGING
 Gagging is considered to have a multifactorial
etiology and a variety of precipitating or modifying
factors have been proposed.
 The literature identifies main categories of retching
patients :
a) The somatogenic group, in which gagging is
induced by physical stimuli, and
b)the psychogenic group, in which psychological
stimuli are thought to initiate gagging.

5. ETIOLOGY OF GAGGING
The 4 Factors That
Are Believed To Be
Important In The
Etiology Of Gagging
Include:
Local And
Systemic
Disorders
Anatomic
factors
Psychological
factors
Iatrogenic
factors.

6.  Nasal obstruction, sinusitis, nasal polyps, mucosal
congestion of the upper respiratory tract, a dry mouth,
and medications that cause nausea as a side effect are
thought to predispose to or cause gagging.
 Certain medical conditions such as chronic GIT
disease, peptic ulceration, and carcinoma of the
stomach, can lower the intraoral threshold for
excitation and contribute to gagging.
A. Local and Systemic Factors

7.  Physical factors such as anatomic abnormalities and
oropharyngeal sensitivities have been suggested as
predisposing factors to gagging.
B. Anatomic factors

8. Orofacial conditions that may have a strong
psychogenic component are temporomandibular pain
dysfunction syndrome, atypical facial pain, denture
intolerance, burning mouth syndrome, and the gag
reflex.
C. Psychological factors

9. An overloaded impression tray or an unstable or poorly retained
prosthesis may induce gagging.
Overextended borders of a prosthesis, can impinge on the
‘‘trigger zones’’ and produce gagging.
A smooth, highly polished surface which is coated with saliva
may produce a ‘‘slimy’’ sensation causes gagging in some patients.
D. Iatrogenic Factors

10. Intervention
 The aim of treatment is to allow the patient to receive
dental care, with a minimum of anxiety and stress.
 The management of the patient may be performed in
general dental practice.
 The objectives is to reduce anxiety and ‘‘unlearn’’ the
behaviors that provoke gagging.
 Relaxation, distraction, suggestion, and systematic
desensitization are all methods that can be employed,
singly or in combination.

11. Management of Gagging
Identify
Initiating
Event
• Choking
associated
with
swallowing of
impression
material.
• Non-dental
events such
as
suffocation.
Ascertain
Triggers To
Gagging
• Tactile
• Gustatory
• Olfactory
• Auditory
• Visual
Detailed
Dental History
• How has
previous
treatment
been
performed?
• Has
preventive
strategy
been
employed?

12. REFRENCES
 Wright SM. Medical history, social habits, and individual
experiences of patients who gag with dentures. J
Prosthet Dent
 Conny DJ, Tedesco LA. The gagging problem in
prosthodontic treatment-Part I: description and causes. J
Prosthet
 Meeker HG, Magalee R. The conservative management
of the gag reflex in full denture patients. N Y State Dent
J
 Logemann JA. Swallowing physiology and
pathophysiology. Otolaryngol Clin North Am
 Wright SM. An examination of factors associated with
retching in dental patients. J Dent