1. Alaa Al-Otaibi
2. management technique
   1. BHAIVORAL
      1. behavioral modification
      2. distraction technique
         1. Conversation
         2. pt instructed to concentrate on breathing
         3. asking a patient to participate in activities that cause muscle fatigue
      3. Relaxation
      4. suggestion
      5. Systemic Desensitisation
         1. Training Bases
         2. Errorless learning
         3. cognitive behavioral therapy
         4. sensory flooding
         5. Teaching pt to swallow with their mouth open
   2. PHARMACOLOGICAL
      1. local anaesthesia
      2. conscious sedation
      3. general anaesthesia
   3. PROSTHETIC
      1. impression tech
      2. modification of maxillary custom tray to prevent gagging
      3. plateless dentures
      4. Gag reflex reduction in pt with maxillofacial prosthesis
      5. marble technique
   4. ACUPRESSURE
3. Etiology
   1. 1- local and systemic disorders.
      1. Nasal obstruction
      2. postnasal drip
      3. catarrh, sinusitis, nasal polyps
      4. mucosal congestion of the upper respiratory tract,
      5. a dry mouth
      6. and medications that cause nausea as a side effect
   2. 2- anatomic factors.
      1. 1- palatoglossal and palatopharyngeal folds
      2. 2- base of tongue
      3. 3- palate
      4. 4- uvula
      5. 5-posterior pharyngeal wall
   3. 3- psychological factors.
      1. a- classical conditioning.
      2. b- Operant conditioning.
   4. 4- and iatrogenic factors.
      1. a- overloaded impression tray.
      2. b- improper denture contour.
         1. i- thick rough or unevenly finished posterior border of maxillary denture.
         2. ii- underxtension of the distal aspect of maxillary denture.
         3. iii- overextension denture border
            1. the posterior aspect of the maxillary denture
            2. the posterior lingual region of the mandibular prosthesis
      3. c- inadequate maxillary retention:
      4. d- inadequate free way space.
      5. e- restricted tongue space.
      6. f- disharmonious occlusion. (increased vertical dimension of occlusion)
      7. g- A smooth, highly polished surface which is coated with saliva may produce a ‘‘slimy’’ sensation which is sufficient to cause gagging in some patients ( a matte finish has been advocated as more acceptable in this situation).
4. Gag reflex: is a normal healthy defense mechanism designed to prevent foreign bodies from entering the trachea.