Gagging / Swallowing
The gag reflex is a protective mechanism of the body that serves to clear the airway of obstruction. All patients have gag reflexes, some more sensitive than others. The gag reflex can be stimulated when the receptor contacts the soft palate, base of the tongue, or the posterior wall of the pharynx. When exposing a full mouth survey of radiographic images, it is recommended to begin in the anterior region of the mouth. An anterior placement is less likely to stimulate the gag reflex and will also help the patient become more accustomed and comfortable with the procedure.
To ensure a quick and smooth patient experience, prepare all equipment before the receptor is placed inside the mouth. The exposure settings should be set in advance, and the tubehead should be placed in the approximate area of exposure. It may help to encourage the patient to swallow once before the placement of the receptor. The patient can be instructed to release the biting pressure or remove the receptor as soon as the exposure is complete. Other recommended procedures to control gagging include deep breathing through the nose or mouth, anesthetizing the mouth with lozenges, mouthwash, topical anesthetic agents, or refocusing the patient's attention.11 Distraction techniques such as instructing the patient to raise one leg, bend the toes toward the body, etc. will focus attention on the task rather than on gagging. When a patient begins to gag, remove the receptor, be confident and reassuring, and try again. A panoramic radiographic image may be a useful supplement to intraoral radiographs when the molar areas are extremely difficult for the patient to tolerate or for the clinician to obtain.