Dental anxiety and the gagging reflex
When talk turns to dental procedures, everyone has a story. Many of these stories relate a seemingly irrational fear of dentists, dental surgeries, and dental treatments, but also the related areas of dental prosthetics, like getting dentures. In forums on social media about dentures, people specifically ask for advice regarding the gag reflex when getting dentures. In this article, we attempt to shine a light on some of the triggers of dental anxiety and gagging, and how you might develop strategies to overcome them.
What is dental anxiety?
Dental anxiety is a common and well-documented condition presenting as anxiety, stress or fear related to having dental procedures1,2 like the acquisition of dentures. Dental anxiety differs from its related condition, dental phobia, by degrees of magnitude and increased severity of reactions.
What is the gagging reflex?
Related to dental anxiety and sometimes occurring as a consequence of undergoing dental treatment, is the unpleasant reflex of gagging (also known as pharyngeal contraction). There are two different stages in the process of getting dentures where the gag reflex may be a problem. Firstly, when having impressions done, and secondly, in the adjustment period while becoming accustomed to having a denture in one’s mouth.
Why am I anxious?
Have you ever asked yourself what triggers your dental anxiety? While a patient’s anxiety may be exacerbated by underlying mental conditions like PTSD, depression or by previous traumatic experience with dental treatments,1 among more common reasons for feeling anxious is fear of pain. Perhaps early dental experiences have initiated this fear along with horror stories people like to relate when talking about dental procedures and getting dentures.
Loss of control over a situation can also trigger your anxiety as you embark on the denture journey. Understandably, a change from your natural teeth to wearing a prosthetic device like a denture can be challenging, not only to how you see yourself but also how you navigate relearning to eat speak and smile again. Related to feelings of loss of control is how you might react physiologically. Anxiety can cause reactions like gagging, an autonomic response, something that happens automatically without your control, to having a foreign device in your mouth.
Signs of dental anxiety may include:
- Avoiding dental check-ups and treatment
- Palpitations or racing heart
- Low blood pressure and fainting
- Feeling panicky at the thought of treatment
- Shortness of breath or hyperventilation
- Crying or other forms of distress
- Excessive sweating in the clinical setting1
What causes gagging and why do I suffer with it?
Sensitivity to gagging is very individual. For some people, the gagging reflex is mild while for others it can be debilitating. Also known as the pharyngeal reflex, gagging is a reflexive response to something contacting the roof of your mouth, back of your throat or tongue or tonsil area causing your throat to contract. Gagging can also be triggered by other sensory stimuli like smells, sounds, tastes, and sight. The physiological purpose of gagging is to prevent choking or consuming harmful substances.5 You can imagine how having dental impressions done, involving the manipulation of unwieldy moulds with moulding compounds, could trigger such a response in some people.
Equally, learning to get used to a denture which at first may feel enormous and cumbersome until you gain some control over where it sits in your mouth, may also generate the gag reflex.
In some instances, an overactive gag reflex can be psychosomatic, arising from psychological stressors6 like past traumatic experiences. In this case, you may be referred to a psychotherapist for behavioural therapies like hypnosis for example.6
Dentures and the gagging issue
While those who have dental anxiety may fear procedures involving needles drilling or pain, for many denture patients it appears to be the gagging reflex they dread.9 When impressions are taken, moulds and moulding compounds must be accommodated in the limited space of a patient’s mouth. While decidedly uncomfortable for the brief time it takes the mould to set, for those with issues around gagging, that time can seem to be interminable. Coupled with the necessary manipulation by the prosthetist to get the mould in and out of the confined space of a mouth, patients often describe the experience as uncomfortable and claustrophobic. This can be overcome by modifying the tray used to take impressions to overcome excessive gagging response.8
In extremely sensitive cases, your prosthetist can also adjust the palatal length of your denture, thus decreasing palate overstimulation (the cause of gagging) by the denture.8 You should not attempt this adjustment yourself as destabilisation of your denture can result. For those sensitive to gagging, the anxiety induced by the very thought of it occurring, can further elevate their anxiety thus increasing the probability of more gagging.9
Gagging can be a challenge for some people when beginning the process of getting dentures. If you are prone to gagging, it may also arise again when you first have the denture fitted until you become accustomed to having the denture in your mouth. But all is not lost. There are ways to mitigate the gag response.
Tips to avoid anxiety and anxiety-induced gagging
- Discuss your anxiety concerns with your prosthetist. Armed with foreknowledge, your oral health provider can advise on strategies to use. Being aware of your anxiety ahead of treatment, they are better equipped to minimise discomfort or triggering of your gag reflex. Some practitioners use distraction methods or talk you through each phase of the procedure, so it doesn’t seem endless.
- Agreeing on a stop signal with your prosthetist when you need a breather, can also be helpful by giving you some control over the situation.
- Distracting yourself with relaxation techniques like using a headset to listen to music.
- Using a stress ball to squeeze redirects your attention from what’s going on in your mouth to your hand.4
- Use mindfulness techniques like counting your breaths by inhaling slowly for five counts, exhaling for five, then repeating.10
- In the case of becoming accustomed to new dentures, being reassured it is a phase through which you will eventually pass, can help.
- In extreme cases seeing your doctor beforehand for medication can help you relax.
- Psychosomatic sources of an overactive gag reflex can be treated with therapies like hypnosis or sedative medicines.6
- Additional interventions with varied degrees of proven effectiveness include herbal remedies, acupressure, acupuncture, behavioural therapies, laser, and prosthetic devices.7
The downside of dental anxiety
A major downside of failing to address dental anxiety is avoidance. When you avoid seeing your dental practitioner because of your anxiety you may be jeopardising your long-term wellbeing and oral health. If left unaddressed, small issues can become larger ones of more serious concern. For example, patients who fear the process of getting dentures may go without teeth and suffer gum and bone loss, not to mention a reduced quality of life. Over time the facial structure can collapse without teeth to provide the scaffolding to hold it in shape, thus making the person look older than their years. They may be unable to eat properly or enjoy social life, or they may miss employment opportunities because of lack of teeth.
Conclusion
Dental anxiety and gagging can be a problem when you are undertaking the process of getting dentures or undergoing necessary denture maintenance. If gagging and dental anxiety are problems for you, understanding why gagging happens and how it may be managed can give you some control over the anxiety induced by dental interventions. Failure to address dental care because of dental anxiety can have long term negative implications for your oral health and quality of life. You don’t have to deal with dental anxiety or the issue of gagging on your own. Your dental prosthetist has expertise managing these problems and is there to help you.
References
- https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dental-anxiety-and-phobia
- https://www.webmd.com/oral-health/easing-dental-fear-adults
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790493/
- https://www.health.harvard.edu/blog/drills-needles-and-pain-oh-my-coping-with-dental-anxiety-2019121818475
- https://www.healthline.com/health/how-to-get-rid-of-gag-reflex#how-to-stop
- [Psychic aspects of the overactive gag reflex (gagging) in connection with a clinical case] - PubMed (nih.gov)
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953338/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843452/
- https://pubmed.ncbi.nlm.nih.gov/24789238/
- https://www.mouthhealthy.org/en/az-topics/a/anxiety
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