Many people have a heightened gag reflex due to many different reasons, making dental treatment difficult. For those “easy gaggers” and others, the thought of having Dental Impressions of the teeth is stressful because it can stimulate the gag reflex. This reflex is called Arnolds Reflex, named after Freidrich Arnold, an anatomy physician in Germany in the 1800’s.
The reflex arises from the auricular branch of the glossopharyngeal nerve and the vagus nerve which are part of a larger group of nerves that giving sensation and motor control to the throat muscles, among other functions.
In researching this reflex, it’s said that in man and animals a cough can only be induced by stimulation of a structure innervated by the vagus nerve or one of its branches. The auricular branch of the vagus nerve (Arnold’s nerve) gives sensation to the ear canal mainly the front, lower part. Some people with this heightened reflex may stimulate a “throat tickle or cough” when cleaning the ear canal.
Arnolds reflex is said to be present in about 1/3rd of a small sample and is nearly 4 times more common in women than men. In most areas of our skin, stimulation of the cutaneous nerves (such as with clothing, jewelry, watches) rapidly declines so that we aren’t irritated all day by it. The ear canal isn’t, so the sensory signal maintains its strength as a protective reflex as long as the stimulus is present.
In some people with a sensitive gag reflex, gentle stimulation of the ear canal (forward lower part) can be used to block the gag reflex during impression taking. This article suggests use of soft earplugs during impression taking. I have also had success with patients placing their pinky fingers in their ears (pads forward) during impressions. The added stimulus through Arnolds nerve (branch) can decrease the gag reflex in some patients during dental impression. It’s not a “guarantee” due to the complex nature of the neurology, but it’s an easy technique to try!
Forsch Komplementmed. 2014;21(2):94-8. doi: 10.1159/000362140. Epub 2014 Mar 28.
An earplug technique to reduce the gag reflex during dental procedures.
Cakmak YO1, Ozdogmus O, Günay Y, Gürbüzer B, Tezulaş E, Kaspar EC, Hacıoglu H.
