James Main BDS MFGDP is the Principal and owner of TRUSTDental in Street, Somerset, and a restorative, cosmetic and implant dentist with over 40 years' clinical experience. Beginning his career in the Maxillofacial Department at Westminster Hospital before serving as a Royal Navy Dental Surgeon, James went on to build and lead private practices across the UK and overseas. He has had decades of experience in treating very anxious dental patients and ameliorating their dental anxiety. James has been on the register of the British Society of Medical and Dental Hypnosis. 

James is best known for his work on hypersensitive gag reflex (HGR). Drawing on sixteen years of clinical practice treating hundreds of affected patients, he developed the MAGIC technique, published in the British Dental Journal in April 2024. In November 2025 he launched his book on the subject, Gagging for It, at the Royal Society of Medicine — an independent survey of 100 HGR sufferers found that over 58% reported their gag reflex significantly diminished or resolved after following its exercises. 

At London Dentistry Show, James will explain why the gag reflex happens and share practical, evidence-based strategies — including the MAGIC technique — for helping patients overcome it. 

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James Main on why gagging is more than a reflex problem 

For many dental professionals, gagging can feel like an unavoidable challenge that occasionally makes treatment more difficult. For James Main, however, that view significantly underestimates both the scale of the problem and the impact it can have on patients. After more than four decades in dentistry, James has experienced almost every side of the profession. Since qualifying from Edinburgh in 1984, he has worked in hospital dentistry, served as a dentist in the Royal Navy, worked in mixed NHS practice, and practised overseas in the Cayman Islands. He has also built his own dental group and, more recently, opened a squat practice. But it was a problem he repeatedly encountered in everyday practice that eventually became a particular area of interest. 

Around 15 years ago, James became increasingly frustrated by seeing patients who were unable to tolerate even relatively straightforward procedures, including having an X-ray taken. 

“I started thinking about the problem more seriously,” he explains. “If these patients gagged so severely, how were they able to eat normally?” 

That question eventually led James to look beyond the gag reflex itself. 

“It dawned on me that it was an airway problem,” he says. “Once I began approaching it from that perspective, I stopped experiencing the same difficulties when treating these patients.” 

A hidden barrier to dental care 

James believes hypersensitive gagging is far more significant than many clinicians realise. For some patients, the expectation that they will gag can create such intense anxiety that they delay appointments or avoid dentistry altogether. 

“People who gag severely often do not visit the dentist because they already know what is likely to happen,” James explains. “It is not simply the gagging itself; it is also the anxiety and distress surrounding it.” 

This can make the problem appear less common than it really is, as those with the most severe reactions may never make it into the surgery. James points to estimates suggesting that as much as 20% of the population may experience some degree of gagging difficulty. 

“If we were able to help even half of those people, that could potentially bring millions of patients back into dental practices across the UK,” he says. 

Looking beyond the mouth 

Central to James’ approach is the idea that gagging should not be viewed purely as a dental issue, but as a response linked to a perceived threat to the airway. 

“People who gag often feel that their airway is under threat,” he explains. “Their body responds as though something is going to obstruct their breathing, even when there is no genuine danger.” 

Over the years, James began noticing similarities between patients with pronounced gagging responses. Many disliked tight clothing around their neck, while others felt uncomfortable in crowded lifts, busy trains or enclosed environments. 

“There is clearly a psychological element, but the important question is how that response first developed,” he says. “In my view, the gagging response is connected to a perceived threat to the airway.” 

Understanding that connection, he believes, can begin to change both the patient’s perception of the problem and how the dental team manages it. 

Removing embarrassment from the conversation 

One of the biggest barriers is often embarrassment. 

Patients who have struggled with gagging for many years may already feel anxious about visiting the dentist and, if their oral health has deteriorated, may also fear being judged. For James, the starting point is therefore communication. 

“We must create a caring, non-judgemental environment in which patients feel that they will be supported rather than criticised,” he says. 

Dental professionals can also open the conversation through simple questions, such as whether a patient struggles brushing their back teeth, dislikes tight clothing around their neck, or finds crowded spaces uncomfortable. 

“The key is to show the patient that the dental team recognises their anxiety and has a clear plan for supporting them,” James explains. 

The whole team has a role to play. Nurses and treatment coordinators can spend time reassuring patients, explaining what will happen, and reinforcing consistent messages throughout their journey. 

Moving beyond distraction 

Traditional approaches to gagging can range from distraction techniques and salt on the tongue through to acupuncture points or sedation. James’ approach begins with a simple method patients can use themselves, which he refers to as the “magic technique”. The approach was described in the British Dental Journal in April 2024 and is designed to provide immediate relief in situations such as taking dental X-rays. 

But the wider aim is not simply to distract someone long enough to complete a procedure. The technique is combined with communication and cognitive approaches intended to help change the way a patient responds over time. 

“Patients do not want to gag, but they may have lived with the response for decades,” James explains. 

A simple toothbrush demonstration can often help patients see that change may be possible. 

“That moment can be incredibly powerful because it shows them that their response is not necessarily permanent,” he says. 

James has subsequently treated patients who previously struggled to tolerate almost anything in their mouths but were later able to undergo significantly more involved dental procedures without the same response. 

Changing how the profession thinks about gagging 

For attendees joining James at Dentistry Show London, his message begins with a change in perspective. 

“The first takeaway is that gagging is not simply a gagging problem; it is an airway problem,” he says. 

He wants dental professionals to recognise how widespread the issue may be and how easily patients affected by severe gagging can disappear from the dental system altogether. 

“People who gag often believe it is simply part of who they are, like the colour of their eyes,” James explains. “Our role as dental professionals is to show them that the response may be changed and that they can receive treatment without the same fear and distress.” 

Ultimately, James believes greater awareness could help uncover a patient population that has remained largely invisible to dentistry. 

“Hypersensitive gagging is a hidden epidemic,” he says. “It is an embarrassing subject, but there is no reason why we should not talk about it.” 

By changing the conversation and reconsidering what sits behind the gag reflex, he believes the profession has an opportunity to help patients who may have spent much of their lives believing dental treatment simply was not possible for them. 

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James will be speaking this October, where she will deliver a presentation on The gag reflex unlocked: why it happens and how to overcome it.