Management of the Retching Patient Flashcards
What is retching?
Physiological mechanism- involuntary contraction of the muscles of the soft palate or pharynx.
What is the psychogenic form of retching?
Retching that is brought on by the sight, smell or sound of a dental surgery or the thought of a procedure.
What is the somatic form of retching?
Touching trigger zones- i.e. palatoglossal and palatopharyngeal folds, base of the tongue, palate, uvula and posterior pharyngeal wall.
What structures lie in between the palatoglossal and palatopharyngeal folds?
Palatine tonsils and tonsillar fauces.
What procedures may be difficult for a retching patient?
Impressions
Jaw registration
Tolerance of dentures
Denture retention (if you reduce the size of the palate).
What relaxation techniques can be used to aid treatment of a retching patient?
Dim lighting, music, avoid sight of dental instruments.
Controlled breathing.
What distractions techniques could be used?
Get patient to raise their legs- one leg and then the other.
Wiggle their toes.
Get patient to press and tap on their temple.
Salt on their tongue
Close their eyes.
What desensitisation techniques could be used in this case?
Tapping the back of the mouth with a toothbrush.
Tell patient to practise this at home.
Hypnosis, acupuncture, CBT.
What modifications can be made to the stock tray?
Lower trays in the upper arch.
Palatal reduction fo special trays.
Rapid setting impression material.
Modify the stock tray so that it does not go as far back in the mouth.
What modifications can be made to denture design?
Not prescribe a denture- presribe SDA instead.
Horseshoe connector.
Multiple post dams.
CoCr rather than acrylic.
No second molars on denture
Cusps on posterior teeth may need rounded so they do not stimulate the tongue.
