Mangement of the retching patient `

Question 1

what is retching?

Answer 1

physiological mechanism
involuntary contraction of the muscles of the soft palate or pharynx
= results in retching

Question 2

types of retching

Answer 2

psychogenic
- occur by sight, smell or sound of a dental surgery or thought of a.g. an impression
somatic
- touching “trigger zones”
- commonly palaoglossal and palatopharyngeal folds, base of tongue, palate, uvula, posterior pharyngeal wall

often a combination worsened by anxiety

Question 3

retching patients - management

Answer 3

identify problems
identify trigger zones
reduce anxiety
patience and empathy

Question 4

relaxation - examples

Answer 4

passive
- dim lighting
- music
- keep dental instruments out of sight
active.
- controlled rhythmic or abdominal breathing

Question 5

distraction techniques for impression taking

Answer 5

talking to patient
get patient to concentrate on keeping their leg raised/wiggle toes
get patient to press or tap on their temple
salt on patients tongue
ask patient to close eyes
rinse mouth with very cold water just before treatment

Question 6

desensitisation techniques

Answer 6

repeated brushing or stroking anterior palate or tongue with finger or toothbrush
“homework” of bushing/stroking for patient pre-treatment
swallowing with mouth open
hypnosis
CBT

Question 7

What is the MAGIC technique?

Answer 7

main amelioration of gagging indoctrination by communication
- patient fills their lungs completely with air
- sends a strong message form lung stretch receptors to medulla oblongata that there is plenty or air and no risk of choking
- psychogenic gag reflex is subverted

Question 8

impression. taking for retching patient

Answer 8

modify stroke trays
lower trays in upper arch
palatal reduction on special tray
rapid Rettung materioals
- e.g. alginate with warmer water = reduced exposure time