This article describes a technique to control gagging during impression making. When compared to those described in the literature, the proposed technique is simple, suitable for various gagging conditions and for different impression materials.

 As defined at present, gagging is an involuntary retching reflex that may be stimulated by some­ thing touching the sensitive parts of the oral cavity.1 Psychological problems which may have contri­ buted to the problem have also been reported.2,3 Conditions such as nasal polyps, sinusitis, deviated nasal septum, may also cause blockage of the nasal passages and precipitate a gagging reflex.4 Psychological problems may cause a deaf patient to elicit a spasm of gagging while viewing gagging of another patient.5 Other causes, such as inadequate free way space3 or extensive vagus nerve distribution,6 are also capable of acting as predisposing factors to gagging.
Different techniques to manage gagging have been reported in the literature. Leslie7 adopted a surgical technique; Singer8 placed five marbles in the mouth; Landa,2 Krol,3 and Kovats1 mentioned psychological approaches.
Psychotherapy hypnosis was applied by Shaw9 and Weyanat.10 Behavioral therapy was used by Appleby and Day.5 Pharmacological agents have also been used. Peripherally acting drugs, i.e. topi­ cal anaesthesia sprays, gels or lozenges, and injec­ tions, have been widely used in clinical techniques.11 On the other hand, centrally acting drugs, i.e. antihistamines, sedatives, tranquilizers, and CNS depressants, have also been used to treat the problem.12

Twenty-seven patients desiring treatment in the Department of Removable Prosthodontic Dental Sciences, College of Dentistry, King Saud Univer­ sity, Riyadh, Saudi Arabia, categorized as having a gagging reflex comprised the study group. Each patient displayed gagging either during intraoral examination or impression making. Upon further evaluation, patients were classified as severe, mod­ erate, or mild in their gagging reflex. The classification was based on the degree and susceptibility of the patient to gagging as evidenced by his/her response to treatment as shown in Table 1. The distribution of patients in relation to sex, type of prosthesis required and impression material(s) used is shown in Table 2.
The method described consists of asking the patient to participate in the impression making. Each patient was taught how to place, support, and remove the impression after setting by himself. The following steps were followed in each case:

It was noticed that fear of the patient was alleviated. Gagging was controlled and all patients were totally diverted from the gagging stimuli and successful impressions were made.

techniques are reported in the literature to overcome the problem of gagging during impres­ sion making. However, no single technique was found to be suitable for every patient.13 Psycholog­ ical approaches requiring prolonged procedures and highly cooperative patients to obtain good results were reported.1,2 Surgery was not highly recommended and was not suitable for all cases.7 The marble technique proposed by Singer8 required patient motivation. It appears that his approach presents definite medico-legal risks in the event of aspirating some of the marbles by the patient. Drugs, on the other hand, have limited effect on mild cases and seem to stimulate gagging for severe cases.13 Topical anaesthetic may actually increase nausea and vomiting.11 This is due to the sense of numbness produced in the sensitive palate and pharyngeal areas that may be subject to the vomiting reflex. Centrally acting drugs - antihis­ tamines, sedatives tranquilizers, parasympathetic and CNS depressants - offer only a short term solu­ tion, especially for some severe cases.12 For the more severe cases, other complicated techniques have been used. In some hysterical cases, hypnosis and behavioral therapy were utilized.14 The technique proposed in this paper is psychologically based and is similar to those of Landa2 and Kovats1. Distraction of the patient's attention from the stimuli is the base of the method. The technique is simple as compared to many of those discussed above. With the personal participation of the patient, the impression making process was smooth and effortless since it has given him the confidence and control over the situation. Such participation probably permits self-assurance that a disaster could be avoided. The technique has been shown to be accurate and valid irrespective of the severity of gagging reflex and the impression materials used. The completed prostheses (complete or partial) were clinically assessed and were found to be quite successful and satisfactorily fitted.

 

A simple technique to alleviate the problem of gagging during impression making has been described. In clinical trials, the method was quite helpful irrespective of the severity of the reflex and impression material. In extremely severe gagging reflex cases, the method reduced the severity to the point of becoming quite manageable.