Gagging and Dentures. Testing Palatal and Gag Reflexes in Preparation for Denture Treatment.

dentures and Gagging Alexander Shor DmdPatients 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

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.

Trial Appliance

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.

palatal appliance alexander shor dental seattle prosthodontist
This top trial appliance was fabricated on the model of the patient’s jaw.

If you like this post you may also like reading What is a denture?,  How it’s Made- Avadent Digital Denture

Thank you for reading!

Dr. Alex Shor

Denture Gagging