Message Boards
Today's Active Topics Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Handling the Gagging Population by Stephanie Aldrich, DDS

View Comments (6) More by this author (1)


So how do you handle these patients? The majority fall into three categories.
  1. Those who gag with impressions, but not X-rays
  2. Those who gag with impressions and X-rays
  3. Those who gag from just opening their mouths
We all laugh and joke about these people, but let's face it, when it's time to seat that crown on #2 and you need the patient's tongue out of the way, it can be a real challenge for you and your staff.

Here's some easy solutions that I've employed over the last 15 years that can help you and your staff with these patients.

Impression gagger
  1. If you're doing an alginate impression on either arch, make sure the tray you're using isn't too long. We use plastic trays so that we can easily trim them with a lab bur.
  2. Don't overload the tray. If you're doing an impression for whitening trays, obviously you don't need the palate, so why put any material there? If you put less material in the tray, that's less material that's going to ooze out the back and down the patient's throat.
  3. Sit the patient up fully and have him or her lean forward with several napkins in hand so the drool can flow on to the napkins.
  4. Talk to the patient about something (nothing too funny) during the set-up time as a distraction.
  5. Have the patient lift a leg up and down as a distraction from a mouth full of goo.
  6. Use fast-setting material. Make sure alginate is mixed with cold water so it will set up faster.
  7. If you're doing an impression for a crown and using a triple tray, usually the patient will gag. We use small quadrant trays and do separate impressions for the upper and lower quadrants, and then take a blue mousse bite for the lab to articulate the models.
X-ray gagger
  1. Sometimes you can't get the distal surfaces of the second molars with your bitewing sensors. If you have a pedo sensor, sometimes that can easily get back there.
  2. Use spray topical. Sometimes the patient's gag reflex won't be triggered if the tongue is numb. If you or your staff can spray a little topical on the side of the tongue, this will normally halt the reflex.
  3. If you have a digital pan, use the bitewing feature. Some of the new digital pans can take external bitewings like a Panorex film without even putting sensors in a patient's mouth. I'm currently looking at purchasing a digital pan for my patients who gag during X-rays.
  4. Sometimes distraction helps with these patients, too.
Complete gagger
  1. Schedule longer appointments. This is the No. 1 tip for these patients. If you allow some extra time, you won't get behind in your schedule and you won't become impatient with them as they struggle to complete their treatment.
  2. You may have to employ every tip that we've talked about so far to complete whatever procedure you're attempting.
  3. If you're seating an upper crown or doing an upper filling and their tongue falls into the back of their throat, sit them up and have them start singing "laaaaa." The higher their tone, the more the genioglossus and hyoglossus muscles pull down the tongue and open the airway. Sing with them and don't forget to take a breath with them.
  4. Take frequent swallow breaks. These patients tend to have prolonged swallow habits, sometimes swallowing more than once. They may even need to lick their lips too. Give them a break to reset their minds and their pesky tongues.
  5. If you employ a lower inferior alveolar nerve block, that will knock out the tongue and may suppress the reflex. Ultimately, you need to know your limits and those of your patients. Remember, most patients who have a strong gag reflex aren't trying to be problematic. Employing a bit of psychology and utilizing distraction techniques will help you cope effectively with the gagging—and your patients will appreciate your patience.


Dr. Stephanie Aldrich graduated from Case Western University School of Dental Medicine in 1999. She received a fellowship from the Academy of General Dentistry in 2007. Her general practice, Akron Dental Concepts, is in Akron, Ohio. You can reach her at docaldrich@gmail.com.


Sponsors
Site Menu
Message Boards Articles Continuing Education Podcasts Blogs Classifieds News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2024 Hygienetown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450