The idea of wearing a lower bite splint is a challenge for patients with a significant gag reflex, particularly if their gag reflex is stimulated by anything touching the side of the tongue.
The Gag Reflex (or pharyngeal reflex) is a hypersensitivity to anything touching the muscles involved with swallowing – the soft palate, the uvula, and the walls of the pharynx itself. When a patient has a gag reflex that is stimulated by sensation on the tongue, imagine how difficult it is to wear a bite splint which touches the tongue and stimulates that gag reflex! The patient has likely used the tongue in a dysfunctional way for years, keeping the tongue low against the lower teeth as opposed to resting high against the inside of the upper palate. The effect this has on the developing bite is frequently an anterior open bite, wherein only the back teeth touch; the effect on the neck is an overly straightened neck with loss of the normal lordotic curve. If a bite splint can be fit for a patient with the gag reflex, it can be adjusted to improve tongue positioning, nasal breathing, and healthy jaw and neck function.
In Patrick McKeown’s charming book Butekyko Meets Dr. Mew, the correct position of the tongue is reviewed at length, in a way that is understandable by children and adults alike. Incorrect tongue position leads to oral breathing, abnormal growth and development, and other issues including gagging.
In this patient’s case, we were able to override the splint gag reflex by first having the patient practice humming. Humming creates a pleasant vibration in the tissues lining the oral airway, and can allow contact between the soft palate and the back of the tongue. This humming served to desensitize the gag reflex so that we could insert the lower bite splint. From there, we next found that by creating an anatomically scalloped shape, that matched the exact shape of his teeth as closely as we could and as thin as we dared, that we were able to completely override the remainder of the gag reflex!
To enjoy an easy read about proper tongue position, see below: