Gagging during impression making: techniques for reduction Sarah Farrier Iain A Pretty Christopher D Lynch Liam D Addy Dental Update 2024 38:3, 707-709.
Authors
SarahFarrier
BDS, MFDS RCS
Cardiff University Dental Hospital, Heath Park, Heath, Cardiff CF14 4XY
In everyday dental practice one encounters patients who either believe themselves, or subsequently prove themselves, to be gaggers. Gagging is most frequently experienced during impression making, but is also reported during the taking of radiographs, in the placement of restorations in posterior teeth and, in some individuals, the insertion of a finger for examination purposes. This paper describes some techniques that can easily be mastered by clinicians that may help both operator and patient avoid this unpleasant occurrence. Techniques such as acupressure, the adaptation of trays, or even the use of alternative impression materials and breathing techniques all have their place, and clinicians may have to try several of these, perhaps in conjunction, in order to assist their patients.
Clinical Relevance: A significant number of patients attend for dental treatment that require impressions, and for those with gagging problems it can be a horrendous experience. Being able to make the procedure less of an ordeal is better for all involved.
Article
The management of patients who gag is something all dentists have been faced with at some point in their career. It can be unpleasant for both clinician and patient. In some instances, gagging prevents procedures being performed or the acceptance of intra-oral appliances.
Identifying the cause for these reactions can be difficult. Patients who suffer from these problems have been loosely divided into two groups:
The gag reflex is a normal, healthy defence mechanism controlled primarily by the parasympathetic division of the autonomic system. Its function is to prevent foreign bodies from entering the trachea.2 Gagging includes a range of muscular actions. It may simply consist of muscular contractions of the tongue and soft palate but often involves contraction of the pharyngeal structures.3 The respiratory muscles may also become involved in the gag reflex. Spasmodic contractions of these muscles cause air to be forced from the lungs through the closed glottis. It is this action that causes the typical retching sound. Associated with this retching sound, chest muscles go into fixation and thoracic inlet muscles contract. This causes impediment of the venous return, dilating the veins of the head and neck, with flushing and congestion of the face.4 Vomiting can be the end point of a gagging episode and this is accompanied by lacrimation and salivation.5
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