Gag reflex is considered a normal, protective, physiological mechanism. But a patient with active gag reflex is a nightmare for the dentist, and may also be a barrier to optimal patient care. The cause of gag reflex has been categorized as either somatic (initiated by direct contact of trigger zone) or psychogenic (modulated by higher centres in the brain, and may be induced by smell, sight or anxiety). There are many management techniques, such as behavior modification technique, pharmacological methods, complimentary therapies and miscellaneous techniques. Dentist should assess the cause of gagging, and recognize whether, single or multiple factors are causing the problem. Then use some techniques to prevent and control the gagging problem. The case is reported as a 3-year-7-month-old boy with gag reflex. The patient turned to cooperate with dental treatment after behavior modification and miscellaneous techniques.