Radek Mounajjed

The gag reflex is a physiological protective mechanism that, when exaggerated, represents one of the most challenging complications encountered in removable prosthodontics. Patients who receive a new maxillary complete denture — even when the prosthesis is technically well-made, stable, and retentive — may develop a hypersensitive gag reflex that significantly impairs their ability to wear and adapt to the appliance. This article provides a comprehensive, evidence-based overview of the etiology, classification, clinical assessment, and management of the gag reflex in this specific patient population. The literature distinguishes between somatic (physiological) and psychogenic (psychological) origins of the gag reflex, with most clinically problematic cases involving a combination of both. Management strategies range from simple prosthetic modifications and behavioral desensitization techniques to pharmacological interventions, acupressure, acupuncture, and, in refractory cases, hypnotherapy or conscious sedation. The choice of strategy depends on a thorough clinical assessment of the trigger zone, severity grading, and the patient's psychological profile. This review synthesizes current evidence to provide clinicians with a structured, stepwise approach to managing the gagging patient in the context of new maxillary denture delivery. Practical recommendations are provided to guide clinical decision-making, from initial patient assessment through to definitive management, with the goal of improving patient comfort, compliance, and long-term prosthetic success.