Patients who consider denture treatment and have gagging problems should be carefully evaluated for the extent and severity of their palatal and gag reflexes.
Gagging- Palatal and Pharyngeal Reflexes
For clarification gagging is a layman’s term and what we are talking here are Palatal and Gag (also called Pharyngeal) Reflexes.
Almost all people react to the tactile (touch) stimulation on the palate and throat by contracting their palatal and throat muscles. The degree of muscle contraction can vary from minor to severe. In addition to muscle contractions some people may also react with retching, coughing, eye watering, excessive salivation and vomiting. When a person have these reactions we call it an exaggerated reflex.
Exaggerated reflex is very important consideration in denture treatment, especially with the top denture becasue it rests on the palatal tissues. In a sensitive person denture can be very uncomfortable and she or he will not be able to tolerate the denture if it extends into the sensitive area.
Over the years I have seen a number of patients who received denture treatment and could not use their dentures because of the exaggerated reflex. Some of these patients were unhappy because their gagging problem was not discovered at the beginning of the treatment.
I usually ask patients who consider denture treatment if they experienced any gagging problems. Patients with severe form of gagging are very aware of this problem. What we are more concerned are the patients with mild to moderate form of exaggerated reflex and who are not sure how severe is their gagging.
If there is any suspicion of the exaggerated reflex I will perform a tactile test and in many instances will fabricate a trial appliance. The purpose of the appliance is to simulate coverage of the oral tissues by the denture. I will ask patient to take it home and try to use it. Appliance can be adjusted so it gives us an idea on how much we can extend the denture. An appliance can also be used as a training device and help patient with adaptation to the denture. In some situations by using an appliance we may discover that the denture is contraindicated and patient should consider other treatment options.
Below is an example of palatal appliace for a patient with a suspected exaggerated reflex. This patient presented with hopeless teeth and was considering immediate full upper denture which rests on the palatal tissues. During interview patient confirmed history of gagging. The patient was given an upper appliance and was asked to use it several hours during the day. Patient was able to adjust to the appliance and we made a decision to proceed with immediate denture treatment.
Thank you for reading!
Dr. Alex Shor