I have had a sensitive gag reflex since I was an infant. It is difficult for me to complete dental procedures. How can I prevent gagging when I go to the dentist?

A reflex is an automatic reaction to a stimulus, mediated by the spinal cord or lower brain. Some examples of reflexes common to children and adults include blinking, sneezing, coughing, yawning, and gagging. A gag reflex (also known as a laryngeal spasm) occurs when the throat or mouth is stimulated.

Reflex sensitivity varies among individuals. It is not uncommon to occasionally gag during a dental examination, throat culture or similar procedures.

Unfortunately, patients who are prone to gagging or retching may delay or avoid dental treatment (Clarke et al. 1988; Klepac et al. 1982). Breathing slowly and deeply through your nose is a simple way to prevent gagging. This method works well for most people. You might also ask your dentist to apply a small amount of topical anesthetic near the back of your mouth. Hurricaine® topical anesthetic produced by Beutlich Pharmaceuticals seems to work well in this regard.

Klepac et al., (1982) offers some additional ways to prevent a gag reflex:

Historically, dentists have tried to prevent gagging by using the following procedures: 1) distracting the patient; 2) hypnosis; 3) forced respiration; and 4) induced lagophthalmus. Morrish (1997) suggests that sensory stimulation of the cranial nerves of the superior laryngeal nerve branch would block the physiological gag response. These rather drastic measures may be employed when patients have a very sensitive gag reflex. General anesthesia is also a plausible approach in extreme cases.

You may want to share this article and the references with your dentist.

References:

Boersma-van der Meulen, "The extreme gag reflex in dental situations: Review of the literature," Nederlands Tijdschrift voor Tandheelkunde (1986) 93(5):169-172.

Clarke et al., "Hypnosis and concurrent denture construction for a patent with a hypersensitive gag reflex," American Journal of Clinical Hypnosis (1988) 30(4):285-288.

Davies et al., "Pharyngeal sensation and gag reflex in healthy subjects," Lancet (1995) 345(8948):487-488.

Klepac et al. "Treatment of an overactive gag reflex: 2 cases," Journal of Behavior Therapy and Experimental Psychiatry (1982) 13(2):141-144.

Morrish, "Suppression and prevention of the gag reflex with a TENS device during dental procedures" General Dentistry (1997) 45(5):498-501.

Selley, "A comment on videofluoroscopic evaluation of aspiration with visual examination of the gag reflex and velar movement" Dysphagia (1997) 12:21-23.