Case Report of Difficult Dental Prosthesis Insertion Due to Severe Gag Reflex

Abstract

Susceptibility to the gag reflex may render insertion of removable dentures very difficult. The use of intravenous sedation in such cases allows for the fabrication of dentures with decreased discomfort to the patient. When the completed dentures are inserted, however, discomfort may still occur as the effects of the gag reflex will again be felt. We report a case of an edentulous maxillary patient who was unable to insert his dentures due to the gag reflex. A denture with a smaller than usual plate area was created so as to prevent anxiety occurring during insertion with subsequent triggering of the gag reflex. The dentures reached as far as the premolars. At first, long-term wear was difficult due to gagging at immediately after insertion. Full-time wear became possible, however, after approximately one and a half months. Hereafter, masticatory function will be enhanced through extension of the denture base and addition of artificial teeth in stages.

Is acupuncturing effective in controlling the gag reflex during dental procedures? A review of literature

“…In some patients, the gaging is only limited to the stimulation of the surrounding tissues of oropharynx, while others might show the gaging reflex with some other stimuli except physical ones such as the sight, taste, smell of certain objects. [ 1 4 ] It has been mentioned that the gag reflex occurs in 44% of individuals who wear dentures which highlights considerable importance compared to other situations. [ 1 ]…”

Managing Gag Reflex during Removable Partial Denture Treatment: A Review and a Clinical Report

“…Dental procedures such as obtaining impressions of maxillary and mandibular arches, mapping the posterior vibrating line for complete dentures, tooth preparations in posterior teeth, third molar extraction, endodontic treatment of posterior teeth, the taking of radiographs, and in some individuals, the insertion of a finger for examination purposes may cause an exaggerated gag reflex, which poses difficulty in performing the procedures successfully . Psychological factors include stress, phobia, alcoholism, fear, and visual and olfactory stimuli.…”

“…Most articles describe impression making as the most fearful and stressful dental procedure for patients with severe gag reflex . Some techniques have been used to reduce gag reflex during impression procedures .…”

“…6 Gagging is a common problem during dental treatment, and can make therapeutic procedures (e.g., tooth preparation, impressions, mapping posterior vibrating line) distressing, difficult, or even impossible to perform, with a higher incidence in female patients. [7][8][9][10][11] Exaggerated gag reflex may lead to problems during clinical stages of fabrication and during wearing of removable complete and partial prostheses. 12 An unusually active gag reflex upsets the patient and consequently may lead to avoidance of routine dental treatment, poor oral hygiene, and tooth loss.…”

“…[24][25][26] Most articles describe impression making as the most fearful and stressful dental procedure for patients with severe gag reflex. 2,3,5,[9][10][11][12]14,15,24 Some techniques have been used to reduce gag reflex during impression procedures. 3,8 Tray extension and adaptation, 8,15,24 or even the use of alternative impression materials, 8,15 altered consistency to avoid overflow, 15 breathing techniques, 8,15 acupressure, 8,16 acupuncture 27 or hand pressure point, 13,16,28 as well as nitrous oxide inhalation 14 are some of these techniques.…”