“What I see almost universally with patients that struggle with severe gag reflexes is underdeveloped airways and jaws.” Dr. Jordan Brenner
Their 8-year-old son had crowded teeth. And his parents were pretty sure he would need some kind of orthodontic treatment at some point. But crowding wasn’t his only issue. There were other issues going on that his parents were not considering or even thinking about.
One of his issues was a hypersensitive gag reflex. Every time he came in for a cleaning, he would gag really badly. It was always difficult for us to clean his teeth and it was always tough for him to get through it. I could already see there was an underlying problem here.
You see, our body naturally wants to force things out of our mouth when our mouth is our primary mode of breathing. It’s a protective measure. The most important thing we do is take our next breath. If your body feels like it can’t breathe, it’s going to fight to do it1.
We have some short-term techniques to help with gag reflex during appointments, but they don’t fix the underlying problem. Some of those techniques include salt on the tongue, numbing sprays, acupressure, and distraction.
It’s like the joke on The King of Queens TV show, when Kevin James is getting an impression at the dentist and he’s got that material in his mouth and he’s gagging constantly. The dentist just keeps saying, “It’s okay, just breathe through your nose.” For some people, when they’ve got that stuff in their mouth and they can’t breathe properly through their nose, it induces a panic. Kevin James does a great job of illustrating that on the show. And that’s what people with compromised airways feel like in real life.
With this boy’s case, and with a lot of similar cases, we also see chronic allergies or chronic stuffiness, so parents or patients will try decongestants or nasal sprays.
They often just assume that they have chronic allergies.
And they end up taking allergy medications all the time to reduce the symptoms. But it’s not going to get better if they keep breathing through their mouth because the nose is what filters the irritants out2. Without being able to breathe through the nose, those irritants will just keep causing inflammation.
When kids don’t get screened and treated for airway issues, we often get complaints of chronic allergies or stuffiness, hyperactivity or ADHD, and in this patient’s case, a severe gag reflex. And those are just some of the signs and symptoms that can be caused by an underdeveloped airway or mid-face.
And if these airway issues are allowed to continue into adulthood, we’re more likely to see TMJ issues or the effects of sleep apnea compounds. And we know that patients that have sleep apnea are three times more likely to have a heart attack or stroke. Blood pressure becomes harder to control. It’s more difficult for diabetics to control their blood sugar. And the risk of cancer goes up.
Some initial research is also showing that people who snore (a common symptom of sleep apnea) are three times more likely to die of COVID-19.
So the long-term health implications of airway issues are a cascade of effects that decrease the quality of life and increase the risk of life-threatening illnesses.
When I start an appointment like his, we always take photos and 3-D x-rays. I evaluate where everything is developing and we take measurements to answer the following questions:
- Are they developing where they’re supposed to be?
- Is there enough space between the teeth?
- Is there enough space for their airway?
- Do they have tongue ties and lip ties that need to be released?
- Do I see things that look like they’re constricted on the scan?
This 8-year-old patient’s 3-D x-ray clearly showed an underdeveloped and compromised airway.
For adults, we will also do a sleep study to confirm the patient’s airway issues. But for kids, I don’t jump into a sleep study unless we deem it necessary. Knowing that he had crowded teeth, we knew we needed to expand anyway, so with him, we could take it one step at a time.
For children, the treatment involves a removable appliance that they wear all day, every day.
- They learn how to chew and eat with it in.
- It helps promote forward growth of their jaws as well as proper positioning of their tongue.
- To hold the appliance in properly, they have to put their tongue in the right place, so it promotes proper swallow patterns and techniques as well.
This appliance looks a little odd at first, but when the patient puts it in, they adapt to it very quickly. We start this at a fairly young age and the feedback we get is that it’s very comfortable for the patient to wear. Very mild discomfort happens only when we’re adjusting it to help expand and grow.
For this particular patient, and for most patients, the appliance is worn for about eight months. After that eight months, we look to see if we need to do more. If so, we’ll look at some other options and other appliances that we fix in place. These also help with expansion. And they would wear these appliances until more of their adult teeth come in.
After wearing his removable appliance for eight months, he came to see us to start the next step. We took impressions and guess what? He didn’t gag at all. We took a new 3-D scan and he got through that with no issues too. His breathing was clearly easier and better. His new 3-D scan showed that his airway had enlarged and opened up.
A lot of times, we start to see airway related symptoms go away with just the removable appliance. For this 8-year-old boy, his hypersensitive gag reflex disappeared.
We were able to retrain him to properly breathe through his nose, and his body no longer had to fight to get things out of his mouth.
His parents knew we needed to correct the crowding, but they had no expectation that his gagging would suddenly go away. So when it did happen, it became a light bulb moment for both him and his parents. The revelation for them was that this kind of screening and treatment is more than just teeth. It was a life changer.
The heavy cloud of anxiety that always surrounded this young boy at every dental appointment just went away. Dental appointments are now much easier for his parents, the dental staff, and more importantly, him. The appointments are now “super easy”.
If you, or a family member, is struggling with a severe gag reflex, do not ignore it. Please come see us. We can start with a simple consultation — virtually over the computer or in person. If you come to the office, we can take a 3-D scan and a few pictures, and then we’ll have a casual chat about where your issues may lie.
So even though you may feel like you were getting by with your gag reflex, keep this in mind. A hypersensitive gag reflex is really just a symptom of a larger issue. Let’s find it and treat it properly.