Unlike the happy customer to the right, quite a few people have a sensitive gag reflex. Gagging can be due to physiological factors, or psychological factors, or both.
Physiological factors include not being able to breathe through your nose properly, catarrh, sinusitis, nasal polyps, mucus in the upper respiratory tract, a dry mouth, and medications that cause nausea as a side effect. Certain medical conditions can also contribute to gagging.
Gagging can also be a physical expression of panic, related to a feeling that some threat to breathing or swallowing is about to occur. This can sometimes have its roots in the past – you may have had an experience where you actually suffocated, or were close to it.
Some people have such a bad gag reflex that it makes brushing their teeth almost impossible. You can find some tips here: Problems with Brushing Teeth.
A hyperactive gag reflex is so common that all dentists will have encountered this and should have developed ways of helping you cope. But to give you a greater choice, we’ve collected lots of tips from both dentists and people with a gag reflex here!
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.
- “Always have the patient breathe through their nose!”
- “Breathe. Breathe. Breathe. I say it 3 times because sometimes it is hard for me to breathe through my nose. I have to consciously force myself to take deep breaths and try not to get overwhelmed.”
- “To help with the gag reflex, I find that using a nasal decongestant (e.g. Sudafed) before my appointment is very helpful in keeping the nasal passageways open to promote breathing through the nose.”
- A throat spray with numbing action, such as over-the-counter Vicks Ultra Chloraseptic Throat Spray, can relieve the gag reflex in people who gag or people with a cough or asthma. Dosage: 2 or 3 sprays right before treatment should last about an hour.
- “I had a patient a few months ago who came in with a broken tooth which needed crowning, I cringed at the thought of doing this crown because of his severe gag reflex. He told me not to worry because he had a cure for his gagging problem. Astonished as to the cure, I inquired. He told me he had been using the snore relief spray from Breathe Right. We did the crown prep with no gag problems at all. I was amazed, so we have been using this on all patients with a gag reflex and I would say it works nearly 100% of the time.”
- “Numb the soft palate (and everything else in the back of the mouth/throat area while you’re there)! When an object touches the soft palate (i.e. your throat), it can easily trigger the gag reflex. Think swab throat culture taken by the nurse at your MD’s office when you suspect Strep throat. Not fun for most, and nearly impossible for some. Unlike the throat culture, dental work is not typically completed in a few seconds and rarely involves the soft palate. The long duration of many dental procedures, combined with lying on your back, combined with a dental provider placing instruments near the soft palate, is more than enough to cause repeated gagging in many patients. This is why I numb not only the soft palate but surrounding tissue as well. This can be accomplished by using either a topical gel or topical spray, typically composed of 20% Benzocaine. While both can be effective, I vastly prefer the spray because it covers more area with less product. Simply spray the entire rear of the mouth, have the patient hold it for a few moments, and then swallow. Duration of numbness varies from patient to patient but easily lasts 15-30 minutes with the spray that I use. Repeat as needed throughout the appointment and before you know it, the procedure is finished with everyone smiling!” (source: Eric G. Jackson DDS on Patch.com – Ask a Dentist)
- “One pretty bomb proof tip for handling gagging is the use of table salt on the tip of the tongue..get the patient to dip their moist finger into a dampen dish of salt and get them to dab it onto the tip of their tongue. Works 95% of the time.”
- “Yes, 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. The wee ones you get in canteens are about right, say 1-2g, dosage isn’t critical. If possible having the patient rinse round for a few minutes with some Normasol (0.9% saline) is even better.”
- “Lift one foot up in the air to have them concentrate on that.”
- “Listening to music – I am too busy trying not to gag that I simply do not have the mental energy to ‘imagine myself someplace else’ or ‘think positive thoughts’. I bring in my own headphones with my own music and simply try to focus on that.”
- 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.” (Mike Gow, BDS)
- Hypnosis can also help with the gag reflex. Make sure you choose a qualified hypnotherapist.
- Nitrous oxide (laughing gas) is very effective in reducing the gag reflex. IV sedation is even more effective and almost always eliminates the gagging.
- “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.”
- “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!”
- “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.”
- “I feel like most gagging occurs from airway problems or anxiety in the dental office. 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.
- Using a 20% benzocaine spray to numb the soft palate, pharynx, uvula, etc. can help a lot.
- “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!”
- “Nitrous oxide and spray topical usually work.”
- “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.”
- Sitting up rather than lying down can help 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.”
- 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.”
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. Try brushing 6 – 12mm (¼ to ½ inch) behind where your gag reflex used to begin. This is your new starting point. 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 month to complete. When the process is complete, you should be able to have a doctor swab the back of your throat without gagging. You might have to redo the process from time to time, as your reflex may return if you don’t.
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.”
- “I entered dental school late, as a mature student, after an inspirational dentist cured me of my fear with a gentle, almost cossetting approach. My personal worry was of choking on the instruments in my mouth, which resulted in an embarrassing tendency to retch, and many patients suffer from a fear of suffocating, or are frightened of ‘drowning’ on the water sprays we use to cool our instruments down. Most dentists are kittens deep down and if patients just explain to their clinician about their fears, we will keep the instruments at the front of the mouth so that the tongue and palate aren’t stimulated and the airway doesn’t feel like it has been violated.”
- “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. You may want to practice diaphragmatic breathing exercises through your nose to relax you in the chair. This info is readily available in any relaxation book.”
- “Just whatever dont show ANY sign of frustration. Just treat it like it’s nothing special and that will help the psychological factors.”
- “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.”
- “Another technique is to have the patient relax. Easier said than done…it IS a dental appointment right! The gag reflex cannot only be triggered by physiology, but psychology as well, and for some patients the latter plays the dominant role! Since dental anxiety can heighten the gag reflex, it needs to be controlled. Perhaps the patient had a traumatic dental experience in the past or perhaps they have an unspoken fear of losing control. These are both quite common sources of dental anxiety and the first step to reversing them is open and honest communication between dentists and patient. It is extremely important to me to have the patient in control of the appointment. For those of you who I’ve worked on, perhaps you remember me mentioning at the appointment to “raise your left hand if you need something. ” It doesn’t matter to me why a patient raises their left hand because all reasons are valid! From needing a bathroom break to an overabundance of water in their mouth to sensing a cough or sneeze coming on, each of these pauses in the action helps me provide a more pleasant dental appointment. I strongly rely on patient feedback to inform me about how to deliver better care. Additional anti-anxiety methods are also quite effective. Nitrous oxide (laughing gas), working with the room lights off, dark sunglasses, an IPod with soothing music, and even hypnosis are all good techniques that calm a patient and thereby diminish the likelihood of a gag reflex during the appointment.” (source: Eric G. Jackson DDS on Patch.com – Ask a Dentist)
- 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
More info on gagging
Some people gag because they have been abused in the past (see our page for abuse survivors and their dentists).
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 check out websites about emetophobia.
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)