Gagging – bringing up an old problem part 2: management of the condition

Following on from the initial consultation (discussed in part one of the series), the clinician will have now established a good understanding of the patient's dental history and his/her overall expectations. Furthermore, the underlying aetiological factor(s) and an estimation of the severity of the gag reflex should have been properly evaluated. The clinician must now decide the most appropriate intervention(s) that will be implemented, in the first instance, with the aim of managing the gag reflex and achieving a successful outcome. The methods chosen will vary between different patients and, in most instances, a combination of different management approaches is normally recommended.

There are numerous treatment approaches which have been suggested in the literature and are categorized into the following methods: behavioural, pharmacological and non-pharmacological. Importantly, it should be mentioned at this stage that the evidence base for the management of the gag reflex is relatively poor and reliable conclusions cannot therefore be confidently drawn. The Cochrane Library¹ has reported that future studies are required in order to highlight the effects associated with each intervention and to provide evidence to inform clinical decisions better. Therefore, at the present time, it is recommended that clinicians have an overall awareness and understanding of all the available management options for gagging patients; from the author's experience, the clinical situation varies widely between different patients and there is no one approach that will be suitable (or appropriate) for all scenarios.