QUESTION

I frequently gag during dental procedures and dread going even for a cleaning. What can I do to get past this?

ANSWER

Gagging during dental procedures is common. For some people, just having dental instruments anywhere in their mouths—not even at the backs of their throats—can set them off. The problem can lead to acute anxiety, dental phobia…and avoiding the dentist altogether. The good news is that taking care of your teeth doesn’t have to be a grim ordeal!

Normally, our gagging reflex is activated when the soft palate (upper back of the throat) is stimulated by an object such as a piece of food (or a dental instrument) touching it. Gagging helps keep the airway clear and can prevent choking. For some people, this reflex gets triggered too easily, a condition called hypersensitive (or hyperactive) gag reflex. For some hypersensitive gaggers, even thinking about something in their mouths can do it. Any experienced dentist has had many sufferers among his/her patients—and most dentists know strategies that can help. Ask your dentist about the following options…

Liquid lidocaine. Lidocaine is a local anesthetic that blocks nerve signals, and it can be used on the nerves in the soft palate that are hyperreacting. Gargling with liquid lidocaine (or spraying it into the back of the mouth) just before a dental procedure numbs the mouth and throat, which can help suppress the gag reflex.

Novocaine or other injected anesthetic. Your dentist may already be using injections of novocaine, lidocaine or mepivacaine somewhere in your mouth as an anesthetic for your dental procedure. Numbing the tongue and palate as well would help suppress the gag reflex.

Panoramic X-rays. Bitewing X-rays, which involve positioning uncomfortable dental film way back in your mouth, are notorious for causing patients to gag—even patients who don’t have a hyperactive reflex. Instead, your dentist may be able to get a good picture of what’s going on in your mouth with either panoramic or cone-beam computed tomography (CBCT) X-rays, which don’t require dental film to be in your mouth. Note: CBCT X-rays do emit more radiation than regular dental X-rays.

Sedation. In more extreme cases, systemic drugs are necessary. Oral tranquilizers such as triazolam (Halcion) or diazepam (Valium) can relax patients enough to suppress the gag reflex while allowing them to stay awake. Intravenously administered drugs—such as midazolam, propofol, ketamine­ or dexmedetomidine—provide deeper sedation but can have dangerous side effects.

If you choose intravenous sedation, be sure to ask whether your dentist has an active “IV-moderate sedation permit” from your state’s dental board. Although specific regulations differ from state to state, the basic requirements in all 50 states are rigorous—including 60 hours of pharmacological and physiological training, 20 hours of individual sedation cases, a review by the state dental board and an on-site inspection of the premises to ensure that the office is equipped to handle anesthesia-related emergencies.

Nitrous oxide. “Gas” (nitrous oxide) relaxes you while still leaving you awake and can be very helpful either on its own or in combination with injected anesthetic. But be aware that nitrous oxide can make some people nauseous—a concern for anyone who gags easily. With nitrous oxide, it’s best not to eat or drink for several hours before your dental procedure to avoid the danger of vomiting while you are not fully alert.

Find the right dentist. Although any unhurried, caring dental professional is likely to be able to deal with most patients who gag too easily, some patients—perhaps you included—need a dentist who is particularly good at dealing with dental phobias. I recommend calling several practices in your area and asking about the dentists’ experience in treating anxious patients, including any use of sedation. You might also want to arrange an initial consultation—with no work planned so that you won’t be too anxious—to discuss a care plan for future dental visits. Children with hyperactive gag reflex can benefit from going to a pediatric dental specialist. But keep in mind that many pediatric dental practices have noisy, chaotic waiting rooms. An already anxious child may do better in a quieter setting.

What you can do for yourself: Taking a deep breath from your diaphragm when you feel yourself about to gag helps suppress the gag reflex by relaxing the throat…and you can try distracting yourself if you feel you might gag, such as by focusing on lifting your foot only an inch or so. This works best during parts of the procedure when you don’t have to hold still. Enlisting your dentist (when it won’t interfere with what he is doing) to make it into a Simon Says game can really lighten the mood!