Wright SM An examination of the personality of dental patients who complain of retching with dentures. Br Dent J. 1980; 148:211-213
Newton AV The psychosomatic component in prosthodontics. J Prosthet Dent. 1984; 52:871-874
Kramer RB, Braham RL The management of the chronic or hysterical gagger. ASDC J Dent Child. 1977; 44:(2)111-116
Landa J, 2nd edn. New York: Dental Items of Interest; 1954
Ramsay DS, Weinstein P, Milgrom P, Getz T Problematic gagging: principles of treatment. J Am Dent Assoc. 1987; 114:178-183
Krol AJ A new approach to the gagging problem. J Prosthet Dent. 1963; 13:611-616
Hoad-Reddick G Gagging: a chairside approach to control. Br Dent J. 1986; 161:174-176
Murphy WM A clinical survey of gagging patients. J Prosthet Dent. 1979; 42:145-148
Noble S The management of blood phobia and a hypersensitive gag reflex by hypnotherapy: a case report. Dent Update. 2002; 29:70-74
Chidiac JJ, Chamseddine L, Bellos G Gagging prevention using nitrous oxide or table salt: a comparative pilot study. Int J Prosthod. 2001; 14:364-366
Singer IL The marble technique: a method for treating the “hopeless gagger” for complete dentures. J Prosthet Dent. 1973; 29:146-150
Fiske J, Dickinson C The role of acupuncture in controlling the gagging reflex using a review of ten cases. Br Dent J. 2001; 190:611-613
Ren X Making an impression of a maxillary edentulous patient with gag reflex by pressing caves. J Prosthet Dent. 1997; 78
Vachiramon A, Wang WC Acupressure technique to control gag reflex during maxillary impression procedures. J Prosthet Dent. 2002; 88
Conny DJ, Tedesco LA The gagging problem in prosthodontic treatment. Part II: Patient management. J Prosthet Dent. 1983; 49:757-761
Farrier S, Pretty IA, Lynch CD, Addy LD Gagging during impression making: techniques for reduction. Dent Update. 2011; 38:171-176
Pavlov IPLondon: Oxford University Press; 1927
Dickinson CM, Fiske J A review of gagging problems in dentistry: 2. Clinical assessment and management. Dent Update. 2005; 32:74-80
Turner JW, Moazzez R, Banerjee A First impressions count. Dent Update. 2012; 39:455-471
Floystrand F, Karlsen K, Saxegaard E, Orstavik JS Effects on retention of reducing the palatal coverage of complete maxillary dentures. Acta Odont Scand. 1986; 44:77-83
Brill N, Tryde G, Cantor R The dynamic nature of the lower denture space. J Prosthet Dent. 1965; 15:401-418
Kayser AF Shortened dental arches and oral function. J Oral Rehab. 1981; 8:457-462
Alhanbali E, Kelleway JP, Howlett JA Acrylic denture distortion following double processing with microwaves or heat. J Dent. 1991; 19:176-180
Budtz-Jorgensen E, Bochet G Alternate framework designs for removable partial dentures. J Prosthet Dent. 1998; 80:58-66
Patients with a hyper-responsive gag reflex pose dentists with a challenging problem. The gag reflex of some patients may be so severe that patients (and operating clinician) may favour extraction of any painful, infected teeth as opposed to more lengthy and complicated procedures such as root canal therapy. However, consistently adopting this approach may render the gagging patient completely edentulous. Such patients may then present to the dental surgeon requesting tooth replacement with some form of denture. This in itself can be a challenging task given the difficulties one may experience whilst taking impressions in this cohort of patients. This article will discuss the prosthetic management of the maxillary arch in edentulous patients with a severe gag reflex. There will be particular emphasis on the aetiology and physiology of the gag reflex, impression-taking techniques to allow the construction of an acrylic training plate (as an interim measure), principles of training plate design and construction of the definitive removable denture.
Clinical Relevance: Removable training plates can be used as an interim measure to desensitize edentulous gagging patients before providing them with a definitive removable denture.
Article
Gagging is a normal protective mechanism which acts to maintain airway patency. It prevents foreign bodies from entering the trachea and can be evoked by stimulating numerous oral structures. In the literature the terms ‘gagging’ and ‘retching’ are often used interchangeably. However, they are two separate physiological processes. ‘Retching’ represents the initial process of eliminating noxious matter from the stomach. ‘Gagging’ refers to the protective mechanisms that prevent entry of unwanted substances into the mouth and oro-pharynx.1,2
The gag reflex is mediated by the autonomic nervous system via a series of cranial centres and nuclei in the medulla oblongata (Figure 1). The vomiting centre is functionally linked to the salivatory, vasomotor and respiratory centres.1,2 The close proximity of the salivatory nucleus to the vomiting centre explains why excessive salivation is observed in gagging patients. Tactile stimulation of the tongue/oro-pharyngeal regions with impression material will activate sensory afferent nerves of the trigeminal, glossopharyngeal and vagus nerves. These afferents synapse in the vomiting centre, from which efferent neurones are carried via the trigeminal, facial, vagus and hypoglossal nerves to the muscles of the tongue, pharynx and upper gastro-intestinal tract. Contraction of these muscles will eject any unwanted materials.3 Given that the vomiting centre also communicates with the muscles of the stomach and the diaphragm, gagging may be accompanied by vomiting. However, the reflex itself can also be initiated in a completely non-tactile fashion by the following:
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