Bethany Clinical Hacks

Clinical Hacks: The gagging patient

Oct. 5, 2022
In this installment of Clinical Hacks, Bethany Montoya, RDH, focuses on the best ways (both tried-and-true and newer trends) to overcome patient gagging—whether you’re taking x-rays, impressions, or performing instrumentation.

It doesn’t matter what your clinical role is in the practice; we’ve all dealt with patients who, despite their best efforts, have an overactive gag reflex. While there are varying theories explaining why these patients struggle to fight the urge to violently cough, choke, and heave in the dental chair, we’ll save that discussion for another time. In this installment of Clinical Hacks, we will focus on the best ways to overcome patient gagging—whether you’re taking x-rays, impressions, or performing instrumentation. Some of these hacks are considered tried-and-true, while others are newer trends in the operatory.

Breathing techniques

One of the most traditional approaches for managing gagging is to coach the patient through focused breathing while we run to push the x-ray button or count down the minutes for the alginate to set during impressions. Telling patients to take long, deep diaphragmatic breaths in and out through the nose can help them from feeling like they are being suffocated while their mouth is full of dental equipment. One popular supplement to basic nasal breathing is instructing the patient to wiggle their toes while waiting for the procedure to end. For a significant number of patients, this simple method works well to calm fears and distract the mind. For others, however, it can have little-to-no effect.

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Salt on the tongue

Another old practice for managing a gagging patient is to place simple table salt on the patient’s tongue. Clinicians may either pour salt onto their gloved hand and sprinkle it over the tongue or use a cotton-tipped applicator to apply the salt. The flavor of the salt works to stimulate the patient’s taste receptors, which acts as a distraction for their gag reflex. While many clinicians are fans of this practice, it is important to remember that patients who are on a sodium-restricted diet for heart disease or high blood pressure are not ideal candidates. It’s always wise to check the patient’s health history for these conditions and verbally confirm that using salt is safe for the patient.

Topical anesthetic gel, spray, or mouthwash

Some patients respond well to the application of topical anesthetics on the tongue and in the throat. They may like being able to self-apply the anesthetic with a cotton-tipped applicator, so they feel in control of where and how the product is applied. It’s important to remember that depending on the type of anesthetic being used, the numbing effects may last anywhere from several seconds to several minutes. It’s best to choose the anesthetic based on how long the procedure is expected to last. Be sure to check the package insert and advise your patient on how long they can expect to feel numb once it’s applied.

Low-level laser therapy

A newer option available for gagging patients is the use of dental lasers! In a study performed with pediatric patients who were unable to tolerate bitewing x-rays due to overactive gag reflexes, laser stimulation was administered on the pericardium 6 (P6) acupuncture point on each wrist for 14 seconds, and patients were then able to successfully tolerate x-ray exposure.1 This method appeared to be very effective in controlling patients’ gag reflexes for the purpose of taking x-rays. In another study, it was explained that laser stimulation was able to lower anxiety levels, lower pulse rate, and increase oxygen saturation levels—physiological fear responses that tend to trigger the body’s gag reflex.2

Conscious sedation

Depending on the severity of the patient’s gag reflex and the nature of the appointment, some level of sedation may be the most appropriate option. Inhaled nitrous oxide is a fast, effective way to calm patients’ anxiety, which can in turn calm their overactive gag reflex. Conscious sedation can be administered only during procedures that may trigger gagging or may be continued throughout the appointment if the patient desires. For those with an extreme gag reflex requiring lengthy dental treatment, oral or intravenous sedation may be necessary for the patient to tolerate the tools and equipment required to properly treat their dental condition. For some patients, this option may be the only way they will willingly schedule treatment.

Patient gagging can be a true source of stress and frustration for any clinical team member in the dental practice. It can also keep affected patients from seeking routine preventive and restorative oral health care. Providing solutions for this common problem is important in ensuring patient compliance and a positive experience for all parties involved. Every patient is unique, and there’s no approach that is guaranteed to work for everyone. Having a variety of hacks available to manage overactive gagging will ultimately result in happier patients, as well as happier clinicians.

Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.

References

  1. Elbay M, Tak Ö, Şermet Elbay Ü, Kaya C, Eryılmaz K. The use of low-level laser therapy for controlling the gag reflex in children during intraoral radiography. Lasers Med Sci. 2016;31(2):355-361. doi:10.1007/s10103-016-1869-z
  2. Goel H, Mathur S, Sandhu M, Jhingan P, Sachdev V. Effect of low-level laser therapy on P6 acupoint to control gag reflex in children: a clinical trial. J Acupunct Meridian Stud. 2017;10(5):317-323. doi:10.1016/j.jams.2017.07.002