There are several other techniques that help to disengage the “gag” reflex and expand the working area. Have the patient press their thumb just below their lower lip and above the chin – while this creates a pain point, the success relates to the distraction away from the trigger to the “gag” reflex. Have the patient take their right hand and pinch the area between the thumb and index finger of their left hand.ģ. Have the patient squeeze their thumb by wrapping the four fingers of the same hand around the thumb – a fist with the thumb inside.Ģ. Making use of simple pressure points provides another alternative however, the technique and location of pressure points must be demonstrated in advance of the impression.ġ. Breathe through your nose and lift your feet off of the chair are simple and quick ways to distract the reflexive action, particularly if the first time the reflex becomes apparent is while making the impression. Bob Winter has written a great article, “ Tape Your Trays,” on this very topic.ĭistraction is a technique that helps to orient the focus away from the trigger to the “gag” reflex. The discussion helps the patient feel as though you have listened to their concern and more importantly with the demonstration that you understand their concern as well.
The important part is in helping the patient understand the cause of the “gag” reflex (back third of the tongue in contact with impression material), what you are doing to help manage the feeling (creating a barrier with wax or tape to limit the ooze of material), and what they can do during the impression process at the moment the patient feels uncomfortable (position their tongue to avoid contact). How is a full-arch impression a manageable “gag” reflex situation? Adding boxing wax (Figure 1) or scotch tape to form a barrier simply to inhibit the flow of impression material is a simple trick that makes a difference for our patients. It is easy to imagine the posterior third of the tongue glancing across what is an abrupt transition between the soft palate and either the impression material or the posterior extension of the denture base.
A complete denture where the patient is only able to tolerate the prosthesis for a specified period of time before they give up and remove their teeth out of frustration.
NO GAG REFLEX FULL
A full arch impression, alginate or silicone, with material oozing past the posterior extension of the tray and as soon as it hits the patient's tongue creating an uncomfortable cycle alternating between controlled breathing and the convulsion associated with a “gag” reflex.Ģ. The key factor separating patients with a manageable “gag” reflex relates to the sensitivity of the Glossopharyngeal Nerve (IX) with fibers in the posterior third of the tongue. It is rewarding to work through this challenge, although it is much more rewarding to reminisce with the patient after working through the challenge. How do you distinguish between a patient who you can work with in the office versus a patient that should be referred out for counseling and/or treatment? We all want to help the patient. The other end of the spectrum relates to people who have simply had a bad experience with impression material oozing to induce panic in an attempt to maintain an airway. At one end of the spectrum, is a patient who simply cannot tolerate anything in their mouth (toothbrush, mirror and explorer). The anxiety is palpable – the patient feels the tension as well as the dentist or the assistant about to make an impression.Ĭertainly, there is a range as to what triggers the patient's protective “gag” reflex.
Whatever your answer, 90 seconds or four minutes, the follow-up from the patient is typically some form of a deep breath and the explanation, “I am a gagger,” to help set the tone for what we are about to see. “How long does the impression have to stay in my mouth?”
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