Prosthetic rehabilitation of the gagging patient using acrylic training plates

Abstract

Patients with a hyper-responsive gag reflex pose dentists with a challenging problem. The gag reflex of some patients may be so severe that patients (and operating clinician) may favour extraction of any painful, infected teeth as opposed to more lengthy and complicated procedures such as root canal therapy. However, consistently adopting this approach may render the gagging patient completely edentulous. Such patients may then present to the dental surgeon requesting tooth replacement with some form of denture. This in itself can be a challenging task given the difficulties one may experience whilst taking impressions in this cohort of patients. This article will discuss the prosthetic management of the maxillary arch in edentulous patients with a severe gag reflex. There will be particular emphasis on the aetiology and physiology of the gag reflex, impression-taking techniques to allow the construction of an acrylic training plate (as an interim measure), principles of training plate design and construction of the definitive removable denture. Clinical Relevance: Removable training plates can be used as an interim measure to desensitize edentulous gagging patients before providing them with a definitive removable denture.

A Revolutionary Strategy for Managing Severe Labial Undercut and Residual Canines in a Patient with a Hyper-Gag Reflex- A Case Report

“…9 This problem was solved in the patient by desensitizing her to external stimuli employing acrylic training plates and using a modified Krols technique while registering the impression. 10,11 Cu-sil dentures were designed to preserve the remaining natural teeth and have a good influence on denture retention and stability. 12 The patient's proclined anterior maxillary ridge and anterior undercut was leveraged for our advantage, using flangeless denture and resilient liners.…”

Prescribed Treatment Options for Gag Reflex

“…31 This approach highlights the need for individualized management of patients with severe gag reflexes, with a focus on customized interventions to improve prosthesis acceptance and patient well-being. 26…”

Gagging and its management—A review

“…The posterior extension is quite subjective, and it mainly depends on the intensity of the gag that the patient presents with. [13][14][15] In an article by Ali et al, it has been recommended to scribe multiple post dam areas in the master cast or a duplicate of the cast. Furthermore, they found that the denture bases were retentive in the oral cavity without the use of adhesives in spite of the extension being short.…”

“…The extension of the training denture base must be to the full functional sulcus depth and extend as much as possible posteriorly. The posterior extension is quite subjective, and it mainly depends on the intensity of the gag that the patient presents with 13–15 . In an article by Ali et al, it has been recommended to scribe multiple post dam areas in the master cast or a duplicate of the cast.…”