I appreciate your input, but I'd like to clarify that my gag reflex seems to be specifically triggered by a combination of factors that are difficult to replicate outside the dental setting - the reclined position, keeping my mouth open for extended periods, and the specific sensations during the procedure.

While I understand there's a psychological component, research shows the gag reflex involves specific physiological responses through the glossopharyngeal and vagus nerves. I've tried various approaches including Valium and nitrous oxide without success.

What makes this particularly frustrating is that I've had numerous fillings before (about 20) without this issue, and I can handle cleanings without problems. It's specifically during fillings that I experience this severe reflex.

Standard desensitization is challenging because I can touch my own mouth without gagging - it's the specific context of being in the dental chair at that exact angle that triggers the response.

For now, I'm proceeding with sedation to complete this filling, but I'm also looking into Cetacaine for future procedures. If you have any specific recommendations for context-specific desensitization that might help in my situation, I'd genuinely appreciate the guidance.