How a dentist takes alginate impressions for a patient with an excessive gag reflex.

How does a dentist takes alginate impressions for a patient with an excessive gag reflex?

Here are a number of techniques which a dentist can use to take impressions for a patient with an excessive gag reflex.

1. The more relaxed and calm a patient is, the less the excessive gag reflex will be activated. There are a number of easy and quick techniques that you can quickly get a patient to relax. You can learn these from basic psychology books. There are ways under breathing, muscle relaxation, visualisation and acclimatization.
2. Always start off with the lower impression first. This is because the excessive gag reflex is mainly activated when sensation is transferred to the upper hard and soft palate. That tongue is also an area where the excessive gag reflex can be activated and this is more likely to be a problem in the upper arch and the reason why you should always start off with the lower impression first.
3. Needless to say, you should not overfill the impression tray. Most dentists and their dental nurses will overfill the impression tray and when the impression is seated in the mouth, the excessive material has to flow somewhere. The excessive material will overflow into the remaining areas of the mouth where the impression is not needed and this includes areas where the excessive gag reflex will be activated. If you are continually overfilling an impression tray, next time try to actually underfill the impression tray and you will find that most of the time you will have the right amount of alginate required.
4. Another way to prevent overfilling of the impression tray is to use wax borders which can prevent alginate going down the palate and on the lower arch into the retromolar areas causing the patient to feel sick.
5. Quite often with an excessive gag reflex patient, it is necessary to use a thicker mix of alginate..If you use a mixture which is too runny, it will simply run down the patient’s throat and on the tongue causing them to gip and become sick. Using aalginate mix which is slightly thicker will still record the detail of the patient’s mouth if it is mixed correctly without any air bubbles inside.
6. Distraction techniques are absolutely paramount when a dentist is trying to treat a patient with an excessive gag reflex. There are a number of different distraction techniques here that one can utilise.
7. It is important for the dentist and the dental nurse to be continually talking to the patient during the impression taking. This has two functions. It tends to reassure the patient and also tends to cause a distraction to the patient.
8. We often ask the patient to raise their right leg a few inches off the dental chair as soon as the impression is in their mouth. This is an excellent technique which acts as a distraction event.
9. You should also ask the patient to focus at a particular point on the ceiling. It helps if you have pictures of mobiles on the ceiling that the patient can gaze at.

There is a technique called the salt technique where you ask the patient to stick their tongue out and yoyu place few granules of salt on their tongue. It just seems to work and it has nothing to do with the salt but more to do with distraction.

7. Setting times. A dentist should be intimately familiar with the setting time of the particular alginate that they are using. Usually alginate comes in three settings. It can come as a slow set alginate, medium set alginate and a fast set of alginate.It should be obvious that for a patient who has an excessive gag reflex, you should always use the fast setting alginate.The setting characteristics of an alginate are not the only factor in its overall setting. It also depends on how long you mix the alginate for and also the temperature of the water relative to the temperature of the surroundings. Ideally, The alginate should be in the patient’s mouth for no more than 15 to 30 seconds. This is achieved by the dentist knowing in detail how long he should be mixing the alginate according to the setting property of that particular alginate and in relation to the water temperature compared to the surroundings. During cold temperatures in winter, it is usual to add warm water when mixing the alginate but in summer, you may have to cool the water down slightly especially if you are using a fast setting alginate.
8. Finally, when you know that the alginate in the mouth is starting to set, you should have a countdown mechanism which shows the patient that the procedure is nearly over. This also helps to relax the patient and induces a sense of timing.
   All the above factors can be used in combination to take alginate impressions for a patient with an excessive gag reflex