How can I stop gagging?
Unlike the happy customer to the right (or above, if you’re on a mobile device), quite a few people have a sensitive gag reflex. Find out how to reduce gagging at the dentist’s or when trying to brush your teeth!
Tips for Dentists and Patients: Handling the Gag Reflex
- Let your dentist know what procedures or situations have triggered gagging in the past and see if alternative ones can be used.
- Focus on breathing through your nose. Take deep, even breaths in and out through your nose. This can lessen the gag reflex and also makes you feel more relaxed. You can find instructions for breathing techniques here.
- Try using a nasal decongestant spray (e.g. Sudafed) before the appointment. This keeps the nasal passageways open and makes breathing through the nose easier. Snore relief throat sprays and nasal strips have the same effect.
- Use a spray with numbing action to numb the throat, tongue and/or palate. Simply spray the entire rear of the mouth, hold it for a few moments, and then swallow. The numbness varies should last 15-30 minutes. Repeat as needed throughout the appointment. Over-the-counter Ultra Chloraseptic Throat Spray (active ingredient: benzocaine) is easy to get hold of. 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)
- Providing treatment in short increments can help.
- Using a rubber dam: “I have many anxious patients and patients with strong gag reflexes, who actually prefer to have treatment with rubber dam in place.”
- Nitrous oxide (laughing gas) is very effective in reducing the gag reflex. IV sedation is even more effective and almost always eliminates it.
- Try to 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.”
- Use distraction techniques. For example, listening to your own music on headphones can help take the focus away from trying not to gag. Another perennial favourite is lifting one foot up in the air and concentrating on that. You can find lots more distraction ideas here.
- 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.
Additional tips for specific gag reflex inducing situations
Some people have such a bad gag reflex that it makes brushing their teeth almost impossible. You can find more info here: Problems with Brushing Teeth.
Swallowing and/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 and will help hugely.” (Mike Gow, BDS)
- Child size x-ray film holders: these are easier to tolerate than adult-sized ones.
- Humming: “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 are 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.”
- 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!”
- “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.
- Ask your dentist if a smaller, child-sized impression tray can be used.
- “Desensitization 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.”
- “By explaining your fear of impressions, we can warm up the impression so that it sets much 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, no matter how hard I tried. My dentist suggested trying to put it in while my mind was very busy doing something else, to take my mind off the issue, but that didn’t work either. I decided to google solutions to gag issues, and 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.”
- 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
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 desensitized 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: It is a good idea to practice while you are relaxing, for example whilst 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.
Communication and psychological factors:
- “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.”
What causes a hypersensitive gag reflex?
- Physiological factors: not being able to breathe through your nose easily, medications which cause nausea, dry mouth (to name but a few)
- Psychological factors: gagging can be an expression of anxiety or panic, and may be related to a feeling that a threat to breathing or swallowing is about to occur. Some people have had a past experience where they nearly drowned. A fear of severe gagging and being sick is also common in survivors of sexual abuse.
- No real reason: you may simply have an easily provoked gag reflex.
A fear of gagging and throwing up is a common feature in emetophobia (the fear of vomiting). Emetophobia, coupled with a bad gag reflex, is not much fun! Try the tips above, and read more about emetophobia here: Emetophobia: The Fear of Vomiting.
Impression techniques and desensitisation techniques for dentures (British Dental Journal, November 2018)
Combating the hypersensitive gag reflex (PDF) – by Mike Gow and Jamie Newlands
Ask a Dentist: “I have a terrible gag reflex. Is there anything to make visits easier?”
Tips for the Management of the gagging patient (PDF) (Dental Fears Research Clinic, Washington)