The gagging problem in prosthodontic
treatment. Description and causes.
Conny DJ, Tedesco LA.
JPD 1983:49:5:601-605.

www....
INDIAN DENTAL ACADEMY
Leader in continuing dental education

www.indiandentalacademy.com

www.indiandentalacademy.com
Contents:
Description and identification.
The nature of gagging.
Neural involvement in gagging.
Reflex characteristics of ...
GAG REFLEX


A beautiful protective mechanism
provided by nature to prevent
unwanted entry of any foreign
body to respira...
GAGGING
Constriction of the constrictor
muscles of the pharynx elicited by
the stimulation of the sensory
receptors on the...
OR
AN EJECTORY CONSTRICTION OF THE
MUSCLES OF THE PHARYNGEAL
SPHINCTER. IT IS A NORMAL
PROTECTIVE REFLEX DESIGNED TO
PROTE...
RANGE


Mild choking




Violent uncontrolled retching
may or may not be associated with vomiting

www.indiandentalacad...
Mechanism of gagging

www.indiandentalacademy.com
Stimulation on the soft palate or posterior part
of the tongue

afferent impulses

medulla oblongata

efferent impulses...
AFFERENT PATHWAY




9 [glossopharyngeal]



10 [vagus]

Area supplied





CN
5 [trigeminal]



Lips,buccal surface...
EFFERENT PATHWAY









Cn
5[trigeminal]



Area supplied



7[facial]
9,10,11[pharyngeal
plexus]
10[vagus]
12[h...
ABNORMALY GAG REFLEX

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CAUSES
Systemic
Psychologic
Physiologic
Iatrogenic

www.indiandentalacademy.com
SYSTEMIC
RESPIRATORY
G.I TRACT
ALCOHOLICS AND SMOKERS

www.indiandentalacademy.com
RESPIRATORY
DEVIATED NASAL SEPTUM
NASAL POLYPS
SINUSITIS &PHARYNGITIS

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G.I TRACT
CHRONIC GASTRITIS
CARCINOMA OF STOMACH
PEPTIC ULCER
CHOLECYSTITIS
DIAPHRAGMATIC HERNIA

www.indiandentalacademy....
PSYCHOLOGIC
ACTIVE

PASSIVE

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PHYSIOLOGIC
INTRA-ORAL

EXTRA-ORAL

www.indiandentalacademy.com
EXTRA-ORAL
Visual
Auditory
Olfactory stimuli

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Intra oral- trigger zones
Posterior part of palate
 Posterior 1/3 of tongue
( most effective trigger zones)


www.indian...
Intra oral--- dental causes
Impression making
 Over/under extended prosthesis like Complete
Dentures
 Aerosols
 Routine...
Iatrogenic factor


In the otherwise non gagging patient’s,
poor execution of intra oral procedures
may elicit gag reflex...
Management

www.indiandentalacademy.com






Psycho logic intervention
Pharmacological intervention
Surgical correction
Dental acupressure
Clinical chair si...
Psychologic intervention
(runs from gental manner to psychotherapy)




Relaxtaion
Distraction
Hypnosis

www.indiandent...
Relaxation


Try tensing muscles and then relax them
one muscle group at a time

www.indiandentalacademy.com
Distraction
Lift one leg in the air and keep it there
( as the patient muscles become incredibly fatigued more and
more co...
Pharmacological (offer only short term solution
especially for severe and chronic problems)



Peripherally acting drugs ...
Surgical correction


For the patients unable to tolerate complete
dentures.basis for this techenique stems from the
obse...
Dental accupressures
Ear acupressure selected because there is
specific,recognized anti gagging points on ear
and needles ...




It is thought that this form of acupressure
might work by causing the release of
chemicals that influence the functi...
Dental chairside management







Audible breathing
Flex forehead downwards
Swallow saliva
Rubber dam(a barrier that...







Cutting of the over extended borders of
prosthesis and orthodontic appliances
Avoid patient visits after meals
...






Apply lower dentures first for habituation
Use minimum amount of impression material
Mesial bend and direction o...
Thank you
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
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Gagging problem in prosthodontics /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


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Gagging problem in prosthodontics /certified fixed orthodontic courses by Indian dental academy

  1. 1. The gagging problem in prosthodontic treatment. Description and causes. Conny DJ, Tedesco LA. JPD 1983:49:5:601-605. www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. Contents: Description and identification. The nature of gagging. Neural involvement in gagging. Reflex characteristics of gagging. Causes of gagging. Management of gagging www.indiandentalacademy.com
  4. 4. GAG REFLEX  A beautiful protective mechanism provided by nature to prevent unwanted entry of any foreign body to respiratory passage which will lead to choking. www.indiandentalacademy.com
  5. 5. GAGGING Constriction of the constrictor muscles of the pharynx elicited by the stimulation of the sensory receptors on the soft palate,by the psychic stimuli,or systemically by the drugs. www.indiandentalacademy.com
  6. 6. OR AN EJECTORY CONSTRICTION OF THE MUSCLES OF THE PHARYNGEAL SPHINCTER. IT IS A NORMAL PROTECTIVE REFLEX DESIGNED TO PROTECT THE AIRWAY AND REMOVAL OF THE IRRITANT MATERIAL FROM THE POSTERIOR OROPHARYNX. www.indiandentalacademy.com
  7. 7. RANGE  Mild choking   Violent uncontrolled retching may or may not be associated with vomiting www.indiandentalacademy.com
  8. 8. Mechanism of gagging www.indiandentalacademy.com
  9. 9. Stimulation on the soft palate or posterior part of the tongue  afferent impulses  medulla oblongata  efferent impulses  Spasmodic and uncontrolled movements of gagging www.indiandentalacademy.com
  10. 10. AFFERENT PATHWAY   9 [glossopharyngeal]  10 [vagus] Area supplied   CN 5 [trigeminal]  Lips,buccal surface of cheeks,anterior 2/3 of tongue,soft palate,sublingual region Posterior 1/3 of the tongue,posterior pharynx   Epiglottis,pharynx,larynx above vocal cords www.indiandentalacademy.com
  11. 11. EFFERENT PATHWAY       Cn 5[trigeminal]  Area supplied  7[facial] 9,10,11[pharyngeal plexus] 10[vagus] 12[hypoglosal]   Muscles of mastication,mylohyoid, tensor timpani Muscles of the lips Fauces , palate,pharynx  Larynx  tongue www.indiandentalacademy.com
  12. 12. ABNORMALY GAG REFLEX www.indiandentalacademy.com
  13. 13. CAUSES Systemic Psychologic Physiologic Iatrogenic www.indiandentalacademy.com
  14. 14. SYSTEMIC RESPIRATORY G.I TRACT ALCOHOLICS AND SMOKERS www.indiandentalacademy.com
  15. 15. RESPIRATORY DEVIATED NASAL SEPTUM NASAL POLYPS SINUSITIS &PHARYNGITIS www.indiandentalacademy.com
  16. 16. G.I TRACT CHRONIC GASTRITIS CARCINOMA OF STOMACH PEPTIC ULCER CHOLECYSTITIS DIAPHRAGMATIC HERNIA www.indiandentalacademy.com
  17. 17. PSYCHOLOGIC ACTIVE PASSIVE www.indiandentalacademy.com
  18. 18. PHYSIOLOGIC INTRA-ORAL EXTRA-ORAL www.indiandentalacademy.com
  19. 19. EXTRA-ORAL Visual Auditory Olfactory stimuli www.indiandentalacademy.com
  20. 20. Intra oral- trigger zones Posterior part of palate  Posterior 1/3 of tongue ( most effective trigger zones)  www.indiandentalacademy.com
  21. 21. Intra oral--- dental causes Impression making  Over/under extended prosthesis like Complete Dentures  Aerosols  Routine Intra oral examination and instrumentation  X- Rays (tactile stimulation of oral tissues inevitably occurs  www.indiandentalacademy.com
  22. 22. Iatrogenic factor  In the otherwise non gagging patient’s, poor execution of intra oral procedures may elicit gag reflex. Sensitive tissues may be stimulated as a result of rough or careless techniques and temperature extremes of instruments www.indiandentalacademy.com
  23. 23. Management www.indiandentalacademy.com
  24. 24.      Psycho logic intervention Pharmacological intervention Surgical correction Dental acupressure Clinical chair side management www.indiandentalacademy.com
  25. 25. Psychologic intervention (runs from gental manner to psychotherapy)    Relaxtaion Distraction Hypnosis www.indiandentalacademy.com
  26. 26. Relaxation  Try tensing muscles and then relax them one muscle group at a time www.indiandentalacademy.com
  27. 27. Distraction Lift one leg in the air and keep it there ( as the patient muscles become incredibly fatigued more and more conscious effort is required to hold the leg up)  Ask patient to breath audibly through the nose and at the same time rhythmically tap the right foot on the floor  Apnoea – prolong the expiratory effort at the expense of inspiration. This will produce a state of apnoea and discourage gagging.  Reverse counting  www.indiandentalacademy.com
  28. 28. Pharmacological (offer only short term solution especially for severe and chronic problems)  Peripherally acting drugs –topical & local anesthetics ( will numb the mouth and throat)—rational for the use of these drug is that if the afferent impulses from sensitive oral tissues are eliminated the reflex of gagging will not take place.   Centrally acting drugs – antihistaminic , sedatives , tranquillizers, parasympatholytics and CNS depressants Nitrous oxide www.indiandentalacademy.com
  29. 29. Surgical correction  For the patients unable to tolerate complete dentures.basis for this techenique stems from the observation that persistant gagging results from an atonic and relaxed soft palate found in nervous patients.to correct this situation,an operation to shorten and tighten the soft palate www.indiandentalacademy.com
  30. 30. Dental accupressures Ear acupressure selected because there is specific,recognized anti gagging points on ear and needles are not disturbed during access to the mouth.needles are out of patients line of vision. Technique involves the insertion of fine single use disposable needles of 7mm and inserting into an anti gagging point on each ear to a depth of 3mm.the needle is manipulated 3omin prior to carrying out the treatment www.indiandentalacademy.com
  31. 31.   It is thought that this form of acupressure might work by causing the release of chemicals that influence the functioning of the vagus nerve that controls swallowing and gagging. (has been used successfully to stop nausea and vomiting in the chemotherapy patients and pregnant women) www.indiandentalacademy.com
  32. 32. Dental chairside management      Audible breathing Flex forehead downwards Swallow saliva Rubber dam(a barrier that blocks fluids and other particles from entering the mouth) Use of super fast setting impression material www.indiandentalacademy.com
  33. 33.     Cutting of the over extended borders of prosthesis and orthodontic appliances Avoid patient visits after meals Make patient accustomed to instrumentation Use a few drops of lemon juice before insertion of dentures www.indiandentalacademy.com
  34. 34.     Apply lower dentures first for habituation Use minimum amount of impression material Mesial bend and direction of retentive tags in ortho appliances to prevent over extension ofn the palate A panaromic x-ray which keeps the film outside the mouth can be used for those who cannot tolerate intraoral films www.indiandentalacademy.com
  35. 35. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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