Margaret has practiced in multi-disciplined dental practices, perio and now has found her home in pediatrics. She enjoys spending time promoting dental hygiene and helping to bring quality continuing education to practicing hygienists.
My first “gagger” was my clinic partner in dental hygiene school. You couldn’t even get a mouth mirror in without her gagging and becoming nervous. The first time I performed an exam on her I thought I was going to throw up from all the gagging and noises, which made me wonder, “Was I really cut out for this job?”
Fast-forward to my current position as a pediatric dental hygienist, where the gags are free-flowing and the spit-up could be endless. When I first started in this position I already had years of experience with “gaggers,” but would my previously learned techniques work with the little ones?
The other hygienist in the office who had a few more years of pedo experience told me: Always keep a trash can by your feet so you can reach down and grab it quickly when your patient needs it.
After a few clean-ups, I decided it was time to test out the methods I’d used on adults.
Of course, there are the old standbys – a dash of salt on the tip of the tongue or holding one of their legs up while rendering treatment. These methods usually work great for x-rays, but then you have to get through the rest of the appointment! I thought back to the times where I’d encountered the worst fits of gagging in my life, and that’s when it hit me:
In my experience, the pain of childbirth can be quite nauseating, and after giving birth to five children, I remembered the breathing exercises and how they calmed me down. Perhaps those same methods could work for my gaggers?
Gagging is usually a defense mechanism – when someone becomes nervous, it tends to be their first resistance during an oral exam. Step one to combating this reaction is to relax the patient; ask them to take deep breaths through the nose or mouth, holding their breath for at least 3-5 seconds. Then instruct them to exhale forcefully through the mouth.
Do this exercise three or four times and it will usually placate them enough to listen. Afterwards, have the patient practice breathing through their nose while their mouth is open. I usually follow with a soft mantra: breathe in, breathe out, and continue this repetition throughout the appointment as necessary.
Slowly lean the patient back. If it helps, lightly touch their shoulder as you tilt them so they have contact with you. Let them know you’re going to tell them a secret and softly whisper, “breathe” into their ear. Remind them often to inhale and exhale, and not hold their breath! Give them frequent breaks and praise them for doing a great job (even adults like to know they’re gaining control of their gag). Holding something, like the saliva ejector or a Kleenex, gives them a sense of control.
After a few tries, most patients get the hang of breathing. If you’re using the cavitron or prophy jet, have them either turn toward you or away from you so the water pools on the side of their mouth rather than the back of their throat. For best results while using aerosols, have someone assist with suction. If no help is available, the Ivory® ReLeaf™ suction tip is a tremendous help because it retracts and suctions at the same time.
Remember: you are the clinician and your patients put their trust in you. Encouraging confidence in the patient helps with an easier appointment for them and a less stressful day for you. Gagging can be controlled if your patients remember to breathe!