Spend The Mornings Gagging? You're Not Alone - The Globe And Mail

Question: My husband has a problem with his gag reflex. It only happens when he brushes his teeth, but every time he puts the toothbrush past his lips it makes him gag. Any theories?

Answer: If you're someone who wakes up in the morning worried you're about to gag up a furball when you stick a toothbrush in your mouth, you are not alone. In fact, you're one of many people who suffer from an overactive gag reflex. You don't necessarily have to tolerate it, however.

Most of us understand gag reflex as what happens when the dentist sticks some futuristic whirling device in your mouth -- or when the doctor pops in a tongue depressor. In fact, it is relatively common for daily routines to be interrupted by the gag reflex. It's not abnormal: in fact, it's actually neurological; related to the nervous system.

The reaction does not necessarily occur because you are so disgusted that you feel like retching, although this is the common definition of gag and has been infused into North American slang, giving birth to clichéd expressions such as "gag gift" and "gag me."

The gag reflex is controlled by the brain stem, the part of the brain that prevents choking and aspiration, and ensures normal swallowing. Sometimes, however, the reflex is overactive or impaired.

When the palate is stimulated by an object such as that toothbrush, a sensory message travels to the brain stem where a motor neuron sends a message to raise the palate and cause the throat muscles to contract. This prevents food and drink from entering improper passageways such as the trachea or the nose.

An overactive gag reflex is not life-threatening, and it is possible to correct it or at least alleviate some of the discomfort. Certain individuals experience an overactive gag reflex, which can be attributed to many factors including an oversensitive palate, illness in general, or learned behaviour. In some cases, it is actually a response to fear.

To decrease the activity of a gag reflex, you can apply numbing spray or local anesthetic, available from your local pharmacy, to the back of the throat.

By contrast, an impaired gag reflex can be serious and must be investigated and the consequences addressed. Certain medical conditions can cause individuals to lose control of their motor skills, often making one more prone to a weak gag reflex. Disorders that can affect the gag reflex include stroke, Lou Gehrig's disease and Guillain-Barré syndrome.

As well, surgical patients and sedated individuals often have sluggish gag reflexes. They cannot protect their own trachea (the tube that connects your mouth and nose to your lungs), and as a result they often aspirate and choke. To compensate for the impaired gag reflex, in such instances, an air tube is inserted to protect the trachea.

Despite the gag reflex being controlled by the brain stem, some individuals can consciously manipulate the reflex -- either suppressing the action or inducing it. For example, sword swallowers learn how to suppress their gag reflex, allowing them to stick a sword down the esophagus toward the stomach. And individuals with bulimia, an eating disorder, may use the gag reflex to purge themselves. The more sensitive their palate, the more likely it is that they will be able to vomit intentionally.

The gag reflex performs an essential role in the body and it is important it works properly. If you think your gag reflex is unusual or abnormal, you should speak to your family doctor or dentist.

-- Dr. Allan Gordon, neurologist and director of Wasser Pain Management Centre at Mount Sinai Hospital

Ask The Doctor appears every other Tuesday. E-mail your questions to