Gagging: A review of the literature

Gagging commonly occurs during dental procedures, such as making a maxillary impression. Clinicians successfully treat many patients with mild gagging problems using only minor procedural modifications. For some patients, however, severe gagging can be elicited by the dentist’s fingers or instruments contacting the oral mucosa or even by nontactile stimuli, for example, patients seeing the dentist or remembering a previous dental experience. Providing dental treatment for this challenging group can be a stressful experience for both patients and clinicians. Anticipation of the distress induced by dentistry can often dissuade a patient with a gagging problem from seeking regular oral care. As a consequence, the severely affected patient tends not to seek routine dental treatment, presenting only when in pain, and may request treatment under general anesthesia. Patients with a longstanding history of problematic gagging may therefore have poor dental health, and require extensive treatment. The clinician may believe that the difficulties encountered in restoring dental health are insurmountable, and treatment planning therefore tends to be more radical, commonly resulting in exodontia. However, this may merely compound the problem if the patient is unable to tolerate a removable prosthesis. Edentulousness, the final outcome, may profoundly affect a patient’s social status, reducing self-esteem and quality of life. The purpose of this article is to outline the etiology of problematic gagging and review the management of patients with an exaggerated gag reflex.