Eliminating the gag reflex with Happy Air (Relative analgesia)


A very common problem patients have is a sensitive gag reflex. This can present a serious challenge carrying out even simple treatment like taking X-rays or impressions.

There are some really great simple ways to help a lot of people, like salt on the tongue, topical anaesthetic on the soft palate, lifting one leg off the couch during treatment (my personal favourite) but these can be short lived.

This is where RA, Happy Air or Nitrous Oxide sedation can really help.

There have been two cases recently I’d love to share.

A middle aged chap needed a filling on a lower molar. He dreaded the idea of this and said that it was going to be unsuccessful because he had such a strong gag reflex, you could hear him downstairs in the waiting room.

Before we started, I tested his reflex by touching the side of his tongue next to the tooth we were going to treat. Sure enough, he made the usual incredible gag noise.

After 5 minutes of RA and then taking him off the gas, nothing. I did his injection at the back, nothing. Placed rubber dam and did a great white filling, nothing. The procedure took 30 minutes in total and as he said afterwards, there would have been no way he could have had that done otherwise.

And this is what we are finding. 5 mins or Happy Air is enough to knock out the strongest if gag reflexes for at least 30 minutes.

The second case was a youngish guy who sadly had to lose four upper front teeth due to a decayed bridge. He had a very strong gag reflex and was worried that he would not be able to cope with impressions for a denture.

Using the end of a mirror handle I mapped out where his reflex was and noted that we could safely make a horseshoe style denture for him without setting off his reflex.

5 minutes of happy air later, took very successful impressions without any hint of gagging.

Took the teeth out a week later and he has been successfully wearing the denture for 4 months.

Now it’s time for a decent chrome denture with more accurate impressions. We’ve had two sessions already with primary and secondary impressions, again after a few minutes of RA, not a hint of the gag reflex.

Again, someone who would have had real trouble getting to treatment he so needed.

RA is so straight forward for the patient, especially in these circumstances. Just takes a few minutes and the patient can safely drive back to work after a short recovery period. Makes a huge difference.

If you are a dentist and are keen to explore RA, may I recommend Dr Richard Charon to you who runs courses throughout the UK, including here at WDTI. He’s the UKs number one RA trainer.

Many thanks to Dr Richard Charon in Newbury for coining the phrase (Happy Air) and being my RA coach – genius!