First start with the ABCs of dealing with this issue: The choice of trays that don't extend excessively; the choice of impression materials that don't easily flow backwards; and the choice of the right amount of this material so you dont end up with excess flowing backwards.

Then we move to the tricks that could be used, and I could mention a couple here: EITHER have the patient suck a candy made with the medical topical anesthetic tetracaine 1% until it begins to coat both the hard and soft palates, OR have the patient massage their hands with a chemical ice bag. The idea here is to keep the hypothalamus distracted and busy. As you know, the hypothalamus is the part of the brain that, besides other things, controls the gag reflex. So if you can keep this part busy with those "other things", then it will temporarily "forget" about the gag reflex.

Morning appointments are typically given for those anxious patients. To minimize the gag reflex, patients anxiety needs to be at a minimum. So anything that can be done to decrease the anxiety should be tried. Having a chair with heat and vibrating modes that the patient can control during the procedure also helps, since it provides a pleasing vibration meanwhile.

Nitrous oxide is a good way to calm the patient and their reactions to sensations during dental procedures.And finally, antianxiety elixir could be used.

My experiences:

The impression tray must fit optimal, so you should use an individual tray or ( and for making an individual tray ;) you must idividualize a tray with compound or silicone, so that no impression material  can touch the soft palate.

My experience is also: you should deflect the patient, his concentration shold be in in an other field. I tell him, he should lift his feet and keep them lifted. I made also good experience with acupuncture. I think the effect in this case is the same: deflection :)

Thanks Mr Rudolf,

But how do you combine acupunture in dentistry ? or how do you do it during the procedure ? This is something new I heard !

Thanks Mr Rudolf,

But how do you combine acupunture in dentistry ? or how do you do it during the procedure ? This is something new I heard !

There are two trackmarks, which are said to be good against gag reflex. The first is between bottom lip and gin in the median line, the second exact in the middle of the point, where triggerfinger and middlefinger first meet. The first is very uncomfortable if you want to make a dental impression, so I take the second one. I put in a needle after  disinfection and the patient has to watch that it will keep in place. Really, I believe, that this watching is the most important at all - nevertheless it works!

Well I recently had a patient in my practice and there was nothing I could do and I prescribed him training appliances (impression trays plastic which were modified) .... that didnt work. 

I am grateful for your advice, will try this out and hope that it works !

thanks

psycholgical handling of the patient is very important. usually we come to know about high gag reflex of the patient while history taking or when we check the size of the tray in the patient's mouth. If we realize that patient haz high gag reflex, then we should first counsel the patient. explain him/her about the procedure, about the material being used (as some patients dont like the smell or taste, or even the thought of an artifical material being put in their mouth), time the whole procedure will take etc. Along with this, correct size of the tray, minimal loading of impression material, placement of tray posteriorly and then anteriorly, first taking mandibular impression, use of fast set materials, empty stomach etc also help a lot.

By Dr. Scott Frey

Tips to Avoid Gagging

In the event that you may need an impression taken at the dentist or orthodontist and are concerned about gagging, here are a few different approaches you or your dentist can try to keep your gag reflex under control:

- Salt on the back 1/3 of the tongue. The nerves responsible for gagging and the nerves that provide taste to the back of the tongue are the same (glossopharyngeal nerve for those who are interested), and providing alternative stimuli to that nerve will often decrease the likelihood of you gagging. This really only works if something quick is being done.

- Wiggling your toes, breathing through your nose, lifting your legs, squeezing your thumb, etc. This helps you focus on something else and keeps your mind off weird sensations that might cause gagging.

- Chloroseptic spray to the back of the throat or rinsing with an anesthetic rinse prior to a procedure.  Many people may gag because of unexpected or strange sensations towards the back of the mouth during a procedure; numbing these areas can help sometimes.

- Hypnosis. As weird as it sounds, this can work well and some dentists are actually trained in hypnosis.

- Mild Sedation (i.e. putting you out or at least giving you an anxiolytic).  Gagging can be psychological more than anything, and being sedated or at least in a more relaxed state is one solution.

To the point and accurate adnan habib

Dear Rashid, 

distraction techniques can be used to prevent gaging and especially in children 

Diverting patients mind works well for most of the patients. While the  impression tray is in the mouth I tell patient to breathe deeply or instruct patient to raise their leg alternately. This excercise makes the patient busy and diverts his attention from impression making. Also minimum amount of material should be loaded on to tray to prevent  excess materail  flowing  backwards.

Well folks, I really try and use e.g. high viscosity alginates or putty for patients who have severe gag-reflex.

Plus, I have tried training appliances which do actually work for patients who are willing to use them

A technique that was taught to me about 25 years ago works well for all "gagging" patients.  Most Dentists are taught to place an impression from back to front, at least I was in the 1970's.  Then a restorative dentist teaching friend of mine said place the impression from front to back...It is the way we intake food/drink.  The nervous stimuli will not excite the gag reflex.  After all you don't gag eating dinner or drinking liquids, do you?  It is the normal physiological flow.  I have had many a patient say there is no way you will ever get an impression on me, I gag and throw up.  I explain the eating drinking process and take the impression.  It has always worked.

A technique that was taught to me about 25 years ago works well for all "gagging" patients.  Most Dentists are taught to place an impression from back to front, at least I was in the 1970's.  Then a restorative dentist teaching friend of mine said place the impression from front to back...It is the way we intake food/drink.  The nervous stimuli will not excite the gag reflex.  After all you don't gag eating dinner or drinking liquids, do you?  It is the normal physiological flow.  I have had many a patient say there is no way you will ever get an impression on me, I gag and throw up.  I explain the eating drinking process and take the impression.  It has always worked.

Dear Haroon Rashid ,

The following distraction techniques are used in chilren - asking the child to raise his finger or thumb as specified for example show me the right little finger or left thumb or right middle finger.

One simple method is to use fast-set polyvinylsiloxane impression materials in plastic mandibular impression trays.  Polyvinylsiloxane has a neutral taste, is not cold in temperature, and plastic trays are not cold like metal trays.  Set time can be as fast as 30 seconds to two minutes.  Also, try to avoid using full palatal coverage maxillary trays, but use mandibular trays for impressions.  Use small size or medium size mandibular trays that only cover the teeth and not soft tissue.  With maxilla, using a lower arch tray may capture enough of the soft tissue to make a retentive horse-shoe shaped partial denture.  

Instead of triple tray, which can trigger gag reflex, use two quarter arch trays.

Anesthesia of soft tissues that cause gag reflex can be used as last resort, either topical or injection or simple nitrous oxide. 

Avoid using alginate impressions with metal trays.  Cold and slimy texture triggers gag reflex and nausea, and cannot control flow of alginate impression material as much as with polyvinylsiloxane. 

Dear Rashid,

other distraction methods include asking the patient to breathe deeply.

Asking the patient to raise legs alternatively and point the toe towards roof.

Asking the patient to count within himself until 30 or 40 .

A small dab of alginate is placed over the child's thumb or finger and asked to raise the hand once the material sets.

Asking the child to lean forward and breathe through the mouth.

i guess all your doubts are clear. just in case kindly go through my article

i guess all your doubts are clear. just in case kindly go through my article