Question

I (female, 65) urgently need to go to the dentist, but I can't make it any more. When the X-ray plates are placed in my mouth, I am seized with an uncontrollable nausea and have seizures. An acquaintance told me about an all-round X-ray that he survived without any problems. But my dentist doesn't want to know anything about it. So I keep putting off going to the dentist. How can I tackle my fear of gagging and therefore of the dentist? R. F. in E. 

Short answer

The easiest way to combat nausea at the dentist is to concentrate fully on keeping your tongue still. This is because patients with nausea unconsciously try to push foreign objects (such as the x-ray film) out of their mouth with their tongue, which is unsuccessful - and can lead to stress, anxiety and nausea. 

In the dental practice, there are several methods to prevent nausea and the resulting anxiety. The most important point is personal trust in the dentist. There are many aspects to this, including pain-free and calm treatment: there are now methods of administering local anesthesia, the injection of which is hardly or not at all noticeable. In many cases, patients largely lose their fear and can relax more during treatment, which greatly reduces nausea. During dental treatment, isolation with a rubber dam can be very helpful. This is a latex film that is stretched around the tooth to be treated with a special clamp and serves as a barrier to the inside of the mouth. This gives the dentist ideal access to the tooth, but never has to touch critical areas such as the tongue or palate. 

X-ray without gag reflex 

Anesthetic lozenges (Sedagul®) or sprays are available as a direct aid against the gag reflex during X-rays and are very effective. Hypnosis methods can also be used, but require appropriate knowledge on the part of the practitioner (more information and addresses on hypnosis in dentistry at: www.smsh.ch). Nitrous oxide is also a good option. 

The latest X-ray machines for all-round radiographs (OPT) are very detailed, but are not ideal for detecting caries. This requires oral x-rays, which are also available in small sizes. 

Simplest method 

Anyone suffering from nausea should concentrate on consciously keeping their tongue absolutely still. Patients with nausea unconsciously try to push the X-ray film out of their mouth with their tongue, for example. This is known to be unsuccessful, and so the nausea, stress and anxiety are triggered. The method of "holding the tongue still" can be used for all treatments in the dental practice. It is simple, has no side effects and is successful in 99 percent of cases. In practice, however, it requires conscious coaching by the dentist and a few exercises with the patient. Personally, I have had the best experiences with it. 

Author: Dr. med. dent. Jürg Eppenberger
Published in: Neue Luzerner Zeitung on July 09, 2012