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Why patients gag during dental visits – Israeli study

In a recent study, researchers found that excessive gagging during visits to the dentist is closely related to dental anxiety and emetophobia (fear of vomiting), and suggested that smells in dentists' offices also play a larger role in this issue than previously estimated.

More than 50% of the study participants reported unpleasant memories related to vomiting or gagging, and 10% to 17% claimed smells could induce the syndrome.

Previous physical health concerns like respiratory distress, a history of vomiting in the family, and psychological discomfort could also affect adults, said authors of the study, which was published in International Dental Journal.

They said that 25% of the study participants were mouth breathers, with a high percentage of individuals undergoing tonsillectomies.

The cross-sectional study, led by Tel Aviv University School of Dental Medicine, investigated the potential link between self-reported emetophobia, excessive gagging and anxiety at the dental office.

Dental anxiety is a well-studied behavioural barrier to dental care, while the unpleasant stimuli-triggered overactive gag reflex is less studied but concerning. The gagging reflex can impair dental treatment and has been associated with sexual penetration issues and a prior history of abuse in women.

Self-assessment techniques such as the Gagging Problem Assessment Tool (GPAR) and Gagging Assessment Scale (GAS) assess gagging. Emetophobia, a specialised phobia of vomiting, is less explored but may be connected.

Emetophobic sufferers experience intense dread, panic symptoms, avoidance, safety measures, and a higher likelihood of depression, anxiety disorders, and eating disorders.

For the online survey-based study, questions included whether the individual had excessive gagging; the severity of the reflex; and how it affected everyday living. They were also asked about mouth breathing, tonsillectomy, and relatives’ gagging.

Included were questions about unpleasant recollections of vomiting, experiences with nausea in non-dental treatment scenarios, and the level of gagging in specific situations such as eating certain meals, having dental x-rays, and smelling dental office odours.

In total, 186 people answered the questionnaire, with 164 (88%) completing it (88% female; average age 34 years).

Nearly 33% reported that their gagging reflex considerably interfered with routine activities; 6% had undergone a tonsillectomy, and 24% documented mouth breathing. A total of 58% reported having unfavourable recollections related to choking or vomiting, whereas 7% remembered vomiting in dental offices. Among the participants, 13% said that odours in dental offices frequently caused gagging, while 20% reported that smells unrelated to dental treatment might induce a similar response.

Overall, the study findings showed that excessive gagging in the dental office is associated with dental anxiety and emetophobia.

The findings indicated that smells in dental offices play a more robust role in dental anxiety and the gag reflex than previously estimated, and confirms prior reports that excess gagging in dental offices is closely related to dental anxiety.

Study details

Excessive gag reflex, dental anxiety, and phobia of vomiting in dental care

Nir Uziel, Efrat Gilon, Idan Bar, Naftaly Edri, Ilana Eli.

Published in the International Dental Journal on 16 January 2024


The most known and commonly studied behavioural obstacle to dental care is dental anxiety. An obstacle that is less studied though no less problematic is excessive gag reflex, which can severely impede dental treatment. Another understudied and possibly related syndrome is emetophobia (a specific phobia of vomiting).

The aim of this study was to examine possible comorbidity amongst self-reported emetophobia, dental anxiety, and excessive gagging in the dental office.

A cross-sectional online survey was conducted using the following self-report questionnaires: Dental Anxiety Scale, Gagging Problem Assessment, Gagging Assessment Scale (GAS), and Specific Phobia of Vomiting Inventory (SPOVI).

In all, 164 participants fully completed the questionnaires (87.8% female; mean age, 34 ± 11.07 years). Positive correlations were found among all variables (P < .001). High gagging (GAS > 6) was associated with a 7.29 times (P < .000) greater risk of positive emetophobia (SPOVI ≥ 10). Linear regression analyses revealed that the intensity of the reflex and the experience of gagging upon encountering odours in the dental office as well as dental anxiety and vomiting phobia significantly predicted participants’ gagging scores as evaluated by GAS (R2 = 0.59; F = 21.16; P < .001).

The study shows that excessive gagging reflex in the dental office is closely related both to dental anxiety and to emetophobia.


International Dental Journal article – Excessive Gag Reflex, Dental Anxiety, and Phobia of Vomiting in Dental Care (Creative Commons Licence)


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