Working on patients with bad gag reflexes...How to help them?

[txlotusboys37]

So, I'll be starting dental school at UTHSCSA this July, whoop! When I was working for my dentist, he had a patient that had a pretty sensitive gag reflex, which of course made performing a procedure more challenging.

I wanted to know what current dental students and dentists do to deal with patients with "bad" gag reflexes? Are there any tricks you can give you patients to help combat the gag reflex? For instance, the patient I mentioned above would eat little bits of salt and that would help him, but he had to keep eating bits of salt throughout the procedure.

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[Neurocentric]

So, I'll be starting dental school at UTHSCSA this July, whoop! When I was working for my dentist, he had a patient that had a pretty sensitive gag reflex, which of course made performing a procedure more challenging.

I wanted to know what current dental students and dentists do to deal with patients with "bad" gag reflexes? Are there any tricks you can give you patients to help combat the gag reflex? For instance, the patient I mentioned above would eat little bits of salt and that would help him, but he had to keep eating bits of salt throughout the procedure.

Popping in, since I have this issue just as a patient.

My dentist told me to relax my tongue, and that helped a ton. Your first instinct is to move your tongue when they have to do something like have the pieces fit for x-rays, but I found if I kept my tongue still, I felt better.

 

[txlotusboys37]

That's another good point, for those of you who have problems with gagging, what do you do to keep youself from gagging/ gagging as much?

 

[mentlegen]

We just started taking alginate impressions on mannequins, but we were told that with certain patients with sensitive gag reflexes, we would be able to spray some topical anesthetic in back of the patient's throat to suppress the reflex.

 

[Decan]

I hear salt on the tongue helps (during impressions). Never tried it.

 

[PreDent08]

We just started taking alginate impressions on mannequins, but we were told that with certain patients with sensitive gag reflexes, we would be able to spray some topical anesthetic in back of the patient's throat to suppress the reflex.

sometimes the anesthetic spray makes it worse.

 

[DavesNotHere]

That's another good point, for those of you who have problems with gagging, what do you do to keep youself from gagging/ gagging as much?

The stupid tricks that seem to with my patients:

1. Tell patient to look down
2. Tell patient to Breathe through their nose
3. Tell pt to Lift their right leg up and suspend until done
4. Pet the patient's nose soothingly
5. Make sure alginate is not too liquidy

We had one that was so bad we ended up doing it under gen. Anesthesia

 

[Bereno]

The stupid tricks that seem to with my patients:

1. Tell patient to look down
2. Tell patient to Breathe through their nose
3. Tell pt to Lift their right leg up and suspend until done
4. Pet the patient's nose soothingly
5. Make sure alginate is not too liquidy

We had one that was so bad we ended up doing it under gen. Anesthesia

wait... you serious? lol

 

[DavesNotHere]

wait... you serious? lol

Heh i am i am. It's all distraction.

 

[Bereno]

Heh i am i am. It's all distraction.

Wow, noted

 

[Msmouth]

The stupid tricks that seem to with my patients:

1. Tell patient to look down
2. Tell patient to Breathe through their nose
3. Tell pt to Lift their right leg up and suspend until done
4. Pet the patient's nose soothingly
5. Make sure alginate is not too liquidy

We had one that was so bad we ended up doing it under gen. Anesthesia

I've seen this help many times! People tend to calm down when concentrating on something else, especially helps with children who tend to get overwhelmed with alginates. Often times I tell them to suspend their leg before I even put the alginate in.

Also Nitrous helps a lot of gaggers.
I use the topical spray for severe gaggers that have trouble with x-rays.

 

[DrJeff]

The stupid tricks that seem to with my patients:

1. Tell patient to look down
2. Tell patient to Breathe through their nose
3. Tell pt to Lift their right leg up and suspend until done
4. Pet the patient's nose soothingly
5. Make sure alginate is not too liquidy

We had one that was so bad we ended up doing it under gen. Anesthesia

wait... you serious? lol

Totally serious replies there. I use those, and also sometimes I'll even tap the patient over and over on their forehead. In addition I tend to be talking a mile a minute about random things when I've got to get an impression on a gagger. The more things you can do to distract them, the better!

That being said, it's still a very good idea to have a bucket chairside, and stand BEHIND the patient, because sometimes, inspite of all your best efforts happens

 

[HBaller]

The stupid tricks that seem to with my patients:

1. Tell patient to look down
2. Tell patient to Breathe through their nose
3. Tell pt to Lift their right leg up and suspend until done
4. Pet the patient's nose soothingly
5. Make sure alginate is not too liquidy

We had one that was so bad we ended up doing it under gen. Anesthesia

I work in an orthodontic office so we are constantly taking impressions. Along with #3, with have them alternate lifting legs.

For the little ones, I put a little bit of alginate on the palm of one hand and have them put their finger in it and I tell them once it is white and hard then I can take the impression our of their mouth. They think it is the coolest thing ever and they aren't focused on whats going on in their mouth. We use Kromopan alginate so it starts off purple and then pink and then white when its set up...

 

[SayCheese123]

Lots of good tricks above. You may also want to book them for afternoon appointments, as the gag reflex is often worse in the morning.

 

[gryffindor]

I have a 12 year old gagger in our ortho practice. He's already puked twice on my assistant trying to place spacers and fit bands. The pediatric dentist told me she uses nitrous on him for prophies. We don't need any alginates on him yet, but my plan is to send him home with a disposable impression tray and have him practice getting it in his mouth. The patient clearly doesn't have a problem putting food in his mouth seeing as he's overweight so I'm sure he can practice and get an impression tray in his mouth too. It's all mental.

 

[Streetwolf]

I do most of the things noted already, especially leaning the head forward and lifting up the legs. I usually have them lift one leg for a few seconds, then the other leg a few seconds, etc just to keep them distracted.

For kids I'll sometimes play Simon Says. Seems to work well.

 

[johnburrows]

I saw this earlier this year

http://lifehacker.com/5858128/shut-off-your-gag-reflex-by-squeezing-your-left-thumb

 

[allstaryankee25]

I saw this earlier this year

http://lifehacker.com/5858128/shut-off-your-gag-reflex-by-squeezing-your-left-thumb

Was just about to post that - squeeze your left thumb with your left hand. It's like making a fist, but with the thumb inside. It really works - I use it when I'm cleaning my tongue

 

[DrReo]

The salt works really well for xrays.
Hurricane (benzocaine spray) has been very helpful for impressions.

 

[lemoncurry]

Had a patient who had multiple head injuries from motorcycle accidents and developed a horrible gag reflex. Just getting x-rays on this pt was a nightmare. Pt needed dentures and we couldn't get an impression without them gagging so loud it disturbed the whole clinic. This patient got referred to grad prosths and will need sedation just to get the darn impressions.

 

[johnburrows]

Was just about to post that - squeeze your left thumb with your left hand. It's like making a fist, but with the thumb inside. It really works - I use it when I'm cleaning my tongue

Yea, I use it when brushing really far back in my mouth... for some reason sometimes in the morning I have a bad gag reflex...

 

[DavesNotHere]

Yea, I use it when brushing really far back in my mouth... for some reason sometimes in the morning I have a bad gag reflex...

But not at night you old scallywag you!

 

[armorshell]

The power of placebo is strong in gag reflexes. Make sure before you try any technique (salt on the tongue, topical, "gag spray" (salt water)) reinforce with the patient how INCREDIBLY effective it is, how all your gag reflex patients love it, how it works so well.

I've also had a lot of luck with distraction techniques like having the patient clasp their hands together and pulling apart, mental math, foot raising and tapping and I've had good luck with pericardium 6 stimulation (acupressure point).

Nowadays I'd probably just sedate them though.

 

[johnburrows]

But not at night you old scallywag you!

Hahahaha you got me on that one Dave...

 

[txlotusboys37]

awsome...this is great info!

 

[michelanyc]

breathing through the nose has been the biggest asset for me - a tried & true gagger!