During my dissertation research on children with PFD and gagging, I came across an interesting technique to treat gagging that was briefly mentioned in a few dental journals and one dental dissertation. It was referred to as the salting technique.
The Salting Technique
Friedman and Weintraub described this: The use of common table salt can temporarily minimize the gag reflex. The salt is placed for 5 seconds on the tip of the tongue, stimulating the taste buds detected in the anterior 2/3 part of the tongue, consequently triggering the chord tympani nerve, which in turn results in inhibition of gag reflex.(Friedman and Weintraub, 1995; Chidiac et al., 2001;Loo, 2022).
We don’t know exactly why this works:
The clinical findings described “do not appear to conform to neuroanatomic principles” (Friedman and Weintraub, 1995). According to the authors, “the glossopharyngeal nerve, generally regarded as the primary afferent limb of the gag reflex, innervates the posterior third of the tongue and upper pharynx. On the basis of observation, the gag reflex is extinguished by a superimposed simultaneous stimulation of the chorda tympani branches to the taste buds in the anterior two-thirds of the tongue. This mechanism appears to be an extinction phenomenon caused by simultaneous stimulation (Friedman and Weintraub, 1995, pg. 319).
Clinical application 3/3!
I was intrigued by this technique and decided to try it out.
- One of my grad students mentioned after class that she had a very limited diet and had trouble swallowing her pills due to gagging. I asked if she would try salting her tongue before swallowing a pill. She reported a few days later that she could swallow her pills for the first time!
- I presented my dissertation research at the Feeding Matters conference last year and a therapist approached me to talk about her hypersensitive gag reflex. She said she couldn’t brush her teeth without gagging. I suggested the salting technique and she reported after trying it that she was able to brush her teeth. She even (kindly) sent videos of brushing without salt which triggered a gag and emesis and brushing with the salt technique with success. That was 6 months ago and she reports that this continues to help her and now she only needs to use it a few times per week. She said this has transformed her life!
- I have tried this with one child, a 3 year old with a complex medical history. He has a hypersensitive gag requiring a g-tube. In full disclosure, we used medical and nutritional strategies with him to reduce his hypersensitivity but we also trialed the salt technique. He began asking for saltines to lick before eating in the morning and it appeared to help him.
Next Steps
We have a lot to learn!
There is a lot we do not know about using salt to inhibit a gag reflex – how much salt, the placement of salt, and the big question, why exactly this may help inhibit the gag and will it have a lasting effect. Needless to say, I am thrilled this has helped some people and plan to continue to study this with my mentor Dr. Donna Scarborough. A word of caution, we do not know how much salt is okay and would be particularly careful with children watching their sodium intake. If it does help, I would recommend talking with a dietitian or pediatrician about intake.
If you have questions, or try this and want to share your results, please email me at feedingnewsletter@gmail.com . I would very much like to hear if this helps or doesn’t help!
References
Chidiac, J. J., Chamseddine, L., & Bellos, G. (2001). Gagging prevention using nitrous oxide or table salt: a comparative pilot study. The International journal of prosthodontics, 14(4), 364–366.
Friedman MH, Weintraub MI. Temporary elimination of gag reflex for dental procedures. J prostate. Dent 1995;73:319.
Katsouda, M. (2021). Gag reflex and child’s dental care; a study of related factors. Doctoral Dissertation. Aristotle University of Thessaloniki, School of Dentistry.
Loo, P. Salty solution. Br Dent J 232, 133 (2022). https://doi.org/10.1038/s41415-022-3947-x
Mehdizadeh, M., Mohammadbeigi, A., & Sharifinejad, A. (2023). An Overview about New Methods in Management of Gag Reflex during Dental Treatment: A Systematic Review. Journal of dentistry (Shiraz, Iran), 24(4), 372–381. https://doi.org/10.30476/dentjods.2022.96360.1934
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