describe about how to manage gag reflex

1. MANAGEMENT OFMANAGEMENT OF
GAG REFLEXGAG REFLEX
Prepared By:Prepared By:
Kaushal GotiKaushal Goti
FINALYEARFINALYEAR

2. CONTENTSCONTENTS
Behaviour Technique
Systemic Desensitization
 Training Bases
Pharmacological Technique
Prosthodontic Management
Other Technique

3. BEHAVIOURAL TECHNIQUESBEHAVIOURAL TECHNIQUES
Behavior modificationBehavior modification
Behavior modification is one of the most successful longBehavior modification is one of the most successful long
term method of managing the gagging patient.term method of managing the gagging patient.
It reduces anxiety and helps “unlearn” the behaviourIt reduces anxiety and helps “unlearn” the behaviour
that provokes gagging.that provokes gagging.
During treatment , the patient’s mind is diverted toDuring treatment , the patient’s mind is diverted to
something pleasant experience like music, talking.etc.something pleasant experience like music, talking.etc.

4. RelaxationRelaxation
It may be helpful in reducing the gag reflex.It may be helpful in reducing the gag reflex.
An example of this is to ask the patient to tense or relaxAn example of this is to ask the patient to tense or relax
certain group of muscles starting with the legs andcertain group of muscles starting with the legs and
working upwards , while continuing providingworking upwards , while continuing providing
reassurance in a calm atmosphere.reassurance in a calm atmosphere.

5. SYSTEMATIC DESENSITIZATIONSYSTEMATIC DESENSITIZATION
This technique is also called asThis technique is also called as graduated exposuregraduated exposure
therapy.therapy.
The technique consists of the incremental exposure of theThe technique consists of the incremental exposure of the
patient to the feared stimulus.patient to the feared stimulus.
The intensity, duration and frequency of the noxiousThe intensity, duration and frequency of the noxious
stimulus are slowly increased, allowing the patient to dealstimulus are slowly increased, allowing the patient to deal
with the situation gradually.with the situation gradually.
It is important to use a step wise approach to prevent orIt is important to use a step wise approach to prevent or
minimize the patient’s gagging.minimize the patient’s gagging.

6. Many re-education techniques the patient is given anMany re-education techniques the patient is given an
object to place in the mouth for a longer period ofobject to place in the mouth for a longer period of
time.time.
The size of the object and the length of the time forThe size of the object and the length of the time for
which it is held in the mouth gradually increaseswhich it is held in the mouth gradually increases
until the patient is able to tolerate the dentaluntil the patient is able to tolerate the dental
procedures.procedures.

7. MARBLES TECHNIQUEMARBLES TECHNIQUE
SingerSinger described a technique where ordinarydescribed a technique where ordinary
glass marbles were used to re educate the patient priorglass marbles were used to re educate the patient prior
to the denture fabrication.to the denture fabrication.
Essentially for 1 week, marbles are sucked in theEssentially for 1 week, marbles are sucked in the
patient’s mouth for increasing periods of time whilepatient’s mouth for increasing periods of time while
awake.awake.
Once these are tolerated, maxillary and mandibleOnce these are tolerated, maxillary and mandible
denture record bases are made and later converted todenture record bases are made and later converted to
the conventional dentures.the conventional dentures.

8. TRAINING BASESTRAINING BASES
This is a further desensitization technique, whereby aThis is a further desensitization technique, whereby a
patient is progressively supplied with a series of smallpatient is progressively supplied with a series of small
to full sized denture bases. A thin acrylic denture base,to full sized denture bases. A thin acrylic denture base,
without teeth is fabricated and the patient is asked towithout teeth is fabricated and the patient is asked to
wear it at homewear it at home..

9. PHARMACOLOGICAL TECHNIQUESPHARMACOLOGICAL TECHNIQUES
Local Anaesthesia:Local Anaesthesia: The gagging can beThe gagging can be
minimized by adding hyaluronidase (1-3cc)minimized by adding hyaluronidase (1-3cc)
with 2% lidocaine HCL (1cc).with 2% lidocaine HCL (1cc).
One-third of this solution is injected into theOne-third of this solution is injected into the
area of each greater palatine foramen toarea of each greater palatine foramen to
prevent gagging.prevent gagging.

10. Consious sedation:Consious sedation:
Sedating agents reduce anxiety and maintainSedating agents reduce anxiety and maintain
reflexes that protect the airway.reflexes that protect the airway.
Nitrous oxideNitrous oxide is frequently used , the mechanismis frequently used , the mechanism
being an altered perception of the external stimulusbeing an altered perception of the external stimulus
which depresses the gag reflex.which depresses the gag reflex.

11. PROSTHODONTIC TECHNIQUESPROSTHODONTIC TECHNIQUES
Modification of edentulous maxillary customModification of edentulous maxillary custom
tray:tray: To prevent gagging, attach a disposableTo prevent gagging, attach a disposable
saliva ejector to the base plate wax in the midlinesaliva ejector to the base plate wax in the midline
of the tray.of the tray.
Impression Material to be used:Impression Material to be used: Low-fusing waxLow-fusing wax
has been advocated for gagging patients.has been advocated for gagging patients.

12. Modification of the prosthesis:Modification of the prosthesis:
Plateless denture, a cast metal denture base ofPlateless denture, a cast metal denture base of
aluminium or chrome nickel alloy isaluminium or chrome nickel alloy is
recommended.recommended.
TheThe advantagesadvantages areare intimate contactintimate contact ,, increasesincreases
the retentionthe retention of the prosthesis,of the prosthesis, provides rigidityprovides rigidity..

13. OTHER TECHNIQUES:OTHER TECHNIQUES:
Breathing exercises
Hypnosis
Praise patient
Pleasant environment
Acupuncture
Acupressure

14. REFERENCES:
 Amit Karla et al, Indian Journal of
Dental Sciences ,December 2012
Issue:5, Vol.:4
Shailendra Singh, Journal of
Evolution of Medical and Dental
Sciences/ Volume 2/ Issue 10/ March
11, 2013

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