How can I prevent gagging in the dentist’s chair?
Over the years, our readers and dentists have shared lots of tips for reducing the gag reflex.
On this page, we’ll share some top tips which you can pick and choose from. Then, we move on to tips for specific situations which can trigger the gag reflex, and ideas for desensitisation.
What causes gagging?
- Dental apprehension: Gagging can be an expression of dental anxiety. This can improve rapidly when you find dentist you trust and you feel in good hands. In many cases the gagging ceases completely.
- A sensitive gag reflex: Some people have a very active gag reflex. There are many tips on this page which can help, but for some, there will remain certain no-go areas in their mouths. Sedation or hypnosis can help if that is the case.
- Past experiences: A feeling that a threat to breathing or swallowing is about to occur is common in people who’ve had a past experience where they nearly drowned. The gag reflex may kick in as a protective mechanism. It can also be related to past sexual or physical abuse or torture experiences.
- Emetophobia (a fear of throwing up) often causes an intense fear of gagging, as gagging is perceived as a precursor to being sick. Ironically, trying not to gag may trigger the gag reflex (just like trying not to think of a pink elephant makes you think of… a pink elephant).
15 Top Tips for Dentists and Patients: How to Lessen The Gag Reflex
- Don’t be afraid to tell your dentist that you may gag during treatment and work out strategies together to help you cope!
- Focus on always breathing through your nose. Take deep, even breaths in and out through your nose. This greatly lessens the gag reflex. You can find instructions for breathing techniques on our relaxation page.
- If you have trouble breathing through your nose, try using a nasal decongestant spray (e.g. Sudafed) before the appointment. Snore relief throat sprays and nasal strips have a similar effect.
- Use a spray with numbing action to numb the throat, tongue and palate (unless you have a fear of feeling numb). Simply spray the entire rear of the mouth, hold it for a few moments, and then swallow. The numbness should last 15-30 minutes. Repeat as needed throughout the appointment. Over-the-counter Ultra Chloraseptic Anaesthetic Throat Spray (active ingredient: benzocaine) is easy to get hold of. It’s currently available in either Menthol or Blackcurrant flavour. Another option is Xylocaine (lidocaine) 10mg spray.
- Salt can work in a pinch (no pun intended):
The salt trick works great for a lot of people. It’s definitely got some physiological basis because I’ve used it on a girl with severe brain damage and it worked, so not just a placebo effect. Sprinkle a little paper packet of it on the back of the tongue. If possible having the patient rinse round for a few minutes with some Normasol (0.9% saline) is even better. – Gordon Laurie, BDS
- Use distraction techniques. For example, listening to your own music on headphones can help take the focus away from the gag reflex. A VR headset (not too large), which plays a favourite game or video, is excellent to distract you when having dental treatment. It’s also excellent for when having an injection.
- Another favourite is the leg trick: just before the x-ray or impression (or whatever else triggers your gag reflex) lift your left leg 6 inches off the chair and keep it there. This works great for lots of people.
Here’s another variation:
My tip to avoid the gag reflex is to lift your toes in the air, point your toes forward and flex your abdominal muscles. – from our message boards
And finally, a great tip from Douglas Miller BDS:
Ask your dentist to get you to do either leg lifting (alternate legs), arm folding or clasping hands, in a random fashion, as a series of tasks. This way you’ll never know what you’ll be asked to do next and you’ll be thinking about the next task set for you, during impression taking for example, rather than about having the impression itself.
- You can combine lifting your leg(s) with using acupressure: Simply press hard with your thumb on the acupuncture point CV24. It’s located at the centre of the groove directly below the lower lip:
I don’t know if this technique has to do with meridians, energy lines, or whether it’s a distraction technique, but what I can tell you for a 100% sure is that it reduces the gag reflex. – Mike Gow, BDS
There are other very effective acupressure points just in front of the ears either side:
You can decide whether you’ll go for CV24 or the left and right ear points by trying each out and deciding which works best for you1.
- Let your dentist know what procedures or situations have triggered gagging in the past and see if alternative ones can be used.
- Local anaesthetic injections can also be used to make the areas which trigger your gag reflex a bit numb, if you don’t mind the numb feeling too much. Some dentists may suggest using a block injection to freeze the palate and tongue, even when working on upper teeth.
- Using a dental dam:
I have many anxious patients and patients with strong gag reflexes, who actually prefer to have treatment with rubber dam in place. – Mike Gow, BDS
The dental dam is excellent in controlling gagging (provided you are not claustrophobic). Not only does it protect the airway and prevent the possibility of items falling into the throat. It also gives you the impression of exterior-ising the tooth being worked on, so it appears that the dentist is working outside of the mouth.
- Find a good time of day for you:
The mornings are when I gag the most when brushing my teeth. Now I try to schedule appointments for the afternoon. – from our message board
- Wearing dark sunglasses and working with the room lights off may help create a soothing atmosphere.
- Hypnosis can be a powerful tool for reducing the gag reflex. Make sure you choose a qualified hypnotherapist.
- Some of our forum members have found nitrous oxide (laughing gas) really helpful for reducing the gag reflex. But it doesn’t work for everyone. IV sedation is extremely effective and almost always eliminates the gag reflex.
Additional tips for gag reflex inducing situations
- When the x-ray holder or sensor is in your mouth, don’t move any of the muscles in the mouth. This means breathing through your nose, and not moving the tongue, cheek, and palate muscles.
- Child size x-ray film holders: these are easier to tolerate than adult-sized ones.
The dentist should wet the X-ray sensor before putting it into the mouth. A dry one is more difficult. If your dentist is using a digital sensor (with a cable attached to it) it makes it more difficult for gaggers, so ask for an alternative. If nothing works out you can do a panoramic X-ray but this X-ray is a compromise, it is better to have the smaller bitewing X-rays.
Have the patient hum while the film is in their mouth – they can’t gag and hum at the same time. I tried it on a patient who hadn’t had x-rays for 2 years because she would gag on the bitewings. Worked great – we were both pleasantly surprised!
- Numbing agents:
For my patients that have problems with gagging, I put a little topical lidocaine on a cotton tip applicator and put it on the palate and the back of the tongue and it works great, and patients like the taste, I use watermelon. This works really well for x-rays, so it should also help for impressions etc.
When placing films (bitewings), you could place some topical anaesthetic on the film to try and prevent the gagging. I have tried this and it works.
In extreme cases, it is possible to use local anaesthesia to numb the sensitive spots in your mouth (usually the back part of the tongue and/or palate).
- Holding the film yourself:
When needing films, it seems that when the patient holds the film, they gag less.
- Digital CAD/CAM/intraoral scanners bypass the need for traditional impressions. These are wand-type instruments which take a digital 3D scan instead of using traditional impression material. When choosing a clinician, check if they have this equipment if you want to avoid physical impressions. Common brands include CEREC, iTero and TRIOS. These have become faster, more accurate and more affordable in recent years, and as a result, they are becoming more and more popular. If your dentist doesn’t have a scanner, they may know someone else in their area who can scan you.
- Sitting up rather than lying down helps with the gag reflex.
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.
- Leaning forward may work even better:
As soon as the tray was in, my dentist had me lean forward.. and that was the first time I did it first time around! So the leaning forward does work well! – from our message board
Trim a quadrant tray to be as minimal as possible, especially on the lingual. Make sure it’s closed tray impression in case quick removal is needed.
- Use a super-fast setting impression material, or make the mold a bit thicker so that it hardens quicker.
- Use a smaller impression tray.
- Desensitisation can also work well:
Give patients various dental tools such as a mouth mirror and small impression trays. They can then take these home and introduce these instruments into their mouths themselves. They should keep a diary of how long they feel comfortable by timing it. Doing this a few times in a row twice a day, you will become less sensitive to the gag reflex. As a dentist, you can ask the person to practice until, for example, they feel comfortable sitting with the tray in place for 5 minutes.
- Warm up the impression material so it sets more quickly.
- The gag reflex can be triggered by a denture that extends too far into the palate – oftentimes it’s possible to trim it enough to make it comfortable
- Desensitization can work well:
I always had a hypersensitive gag reflex too, and just couldn’t handle impression trays unless I was sedated, but for some odd reason, never thought that dentures would deliver a similar result. When I got my denture (upper), I just couldn’t keep it in for more than a second or two. My dentist suggested trying to put it in while my mind was very busy doing something else, but that didn’t work either.
I decided to google solutions to gag issues. One I came across sounded very logical, so I tried it. I brushed my tongue crosswise, as far back as the gag would tolerate for 15 seconds, twice a day, and kept trying to do that further and further each day. I didn’t try the denture in again for a full week of tongue brushing, and unbelievably, I put the denture in easily after that and haven’t gagged with it since! It’s certainly an easy solution, because I only had to tolerate brushing the tongue for 15 seconds at a time (and of course I felt really gaggy while doing that), and I believe that it is a very logical way of desensitizing one’s gag reflex. – from our message board
- Sheer wanting will and persistence can help
- Hypnosis can be helpful
- If finances allow, implant-retained dentures or bridges may be an option
- You can find more info on getting used to dentures here: FAQ: Dentures
Some people have such a bad gag reflex that it makes brushing their teeth almost impossible. You can find tips for reducing gagging when brushing here: Problems with Brushing Teeth.
The desensitisation strategy below may also help!
Unlearning the Gag Reflex (Desensitisation)
- Relax and breathe through your nose if physically possible.
- Using a small, very soft toothbrush, brush your tongue to right where the area that triggers your gag reflex begins (if you gag, you’ve gone too far). Spend about 15 seconds brushing that area, and then call it a night.
- Repeat the process over the next few days, at least once a day, in the exact same spot. Stop just short of the area where the gag reflex kicks in.
- When you are comfortable with this, move the brush slightly further back. Repeat the process as you did in the first spot.
- Continue moving the brush farther back. Each time you move the toothbrush back, your gag reflex has been desensitised in the previous spot. Keep moving it farther and farther back over the course of several weeks.
- Be persistent. The whole process may take a week to a month to complete.
I have an upper denture and was not able to put it in my mouth because it made me gag. I couldn’t even tolerate it for 10 seconds. I googled gag reflex issues, and discovered a really logical approach which I used with great success. The article I read said to brush your tongue sideways, back as far as you could without having a major gag and do so twice a day for 15 seconds. I did that for one full week, before trying to put the denture in again. It worked like a charm. – from our message board
Tip: do something relaxing while you’re practising, for example watching TV.
The same exercise can be used to desensitise your gag reflex in the palate area. Follow the same steps as above, but instead of brushing your tongue, gently massage your palate just behind your upper front teeth for a few minutes. When you are comfortable with this, move the brush slightly further backwards over your palate and carry on massaging. Practice this exercise until you’re comfortable massaging the front half of your palate.
Desensitisation exercise for swallowing or anything involving water
I teach my patients to practice swallowing with their mouths open in the run-up to the next appointment. Try this yourself at home. Once you have done this for a few days, you can progress to holding a small amount of water in your mouth (and keeping it there), while allowing the swallowing reflex to take place. Obviously the trick is not to swallow any of the water – just to allow the natural reflex within the throat to take place, keeping the water in the mouth. It is a very effective and useful thing to learn to do. – Mike Gow, BDS
Communication and psychological factors
Here is what people on our forum have said:
- “I apparently picked up the notion that gagging is a very effective way to get the dentist to stop work when I started to feel uncomfortable. I didn’t really know how to communicate with him without talking, so I just gagged.”
- “Talking with the dentist. This was probably the biggest thing that helped me. Establishing communication and letting him know my fears was a big step. For example, my dentist now places tools in my mouth at different angles than he did in the past. He lets his assistant know not to rest the sucking thing against my cheek. He also does not put so many things in my mouth at one time.”
- “For many people, there is a sense of loss of control in a dental chair during treatment and the tendency to gag is one representation of this. If you have this sense at all, then your dentist must reassure you that he or she will stop immediately if you want them to, whether it be to rinse, or just to catch your breath. If you have a trusting relationship, then your sense of control should increase.”
- “I find the most important factor in dealing with gagging problems is a calm manner – if you get stressed by not being able to take an impression, your patient is only going to gag more. Acknowledge the problem and show that you are not phased by it.”
Visit our support forum to get help with this and other fears, or to simply get things off your chest!
You may also like:
Impression techniques and desensitisation techniques for dentures (British Dental Journal, November 2018)
Combating the hypersensitive gag reflex (PDF) – by Mike Gow and Jamie Newlands
Tips for the Management of the gagging patient (PDF) (Dental Fears Research Clinic, Washington)
Sources of Information
Many thanks to (in alphabetical order) Daniel Finkelman, Douglas Miller, Gordon Laurie, Mike Gow, and all our forum members who have contributed their tips to this page!
- L. Cox and J. Brindley (2017). Exploring alternative methods of gag reflex control. Part 1: Acupressure. ; BDJ Team; London Vol. 4, Iss. 4: 17059, pages 7-11. DOI:10.1038/bdjteam.2017.59