Mouth Gags are surgical instruments placed between the upper and lower jaw to prevent the mouth from closing and gaining access to the oral cavity during throat and oral procedures.
Despite a long history of usage, they are still found in every OR setting.
These tools are essential in many dental, ENT, and oral surgeries, ensuring surgeons have a clear and stable view of the operating area. By keeping the patient’s mouth open safely and securely, mouth gags not only enhance surgical precision but also reduce the risk of accidental tissue injury.
They come in different shapes and designs, each tailored to specific procedures, from tonsillectomies to dental restorations and airway management during anesthesia. This versatility and continued evolution highlight how indispensable mouth gags remain in modern surgical practice.
In this blog, we’ll take a closer look at how mouth gags have evolved over the centuries, explore different types of surgical mouth gags, and understand why they continue to play a vital role in surgical procedures today
The earliest known medically used mouth gags date back to the late 1500s. In 1714, Lorenz Heister, a military surgeon, developed a screw-like tool, to open the patient’s mouth in trismus, a condition caused by tetanus in which jaw muscles become so tight that patients can’t open their mouths.
The Heister gag became the prototype for future models, and in 1930, 250 years later, it could still be ordered with minor modifications. Primarily, the development of general anesthesia in 1846 resulted in an increased demand for jaw-opening tools. Anesthesia required unobstructed access to the endotracheal tube, and a mouth gag allowed more access to the mouth whilst staying fixed in place during the procedure.
Over time, based on the needs of surgeons, the characteristics of an ideal mouth gag were identified to guide future alterations to the design.
These characteristics can be summarized as:
• Provides adequate exposure to all parts of the oral cavity to perform surgery
• Be compatible with different shapes and sizes of the oral cavity
• Facilitates safe anesthesia administration via the endotracheal tube without kinking or putting pressure on it
Ensures secure fixation to prevent slippage and subsequent tissue trauma or damage
Based on these requirements, early tools were modified to allow the jaws to be "jacked" open and to hold an anesthetic tube securely in the tongue depressor. They were also designed in several parts for easier sterilization and more freedom of use.
Eventually, they started to look like the mouthgags we are familiar with today.
Since Heister’s design, a vast variety of mouth gags, with or without tongue depressors or plates, single- or double-sided, have been invented and distributed.
Let’s take a look at some of the most common varieties of mouth gags that are still frequently used.
Let's have a look at the different mouth gag types:
In 1910, a modification of the earlier Hartman gag caught the attention of anesthesiologist S. Griffith Davis, who further adapted it for use in tonsillectomies. Henry Boyle eventually popularised the resultant variant, which led to the gag being better known as the Boyle or Boyle-Davis gag. It consists of a frame that joins a handle with a selection of tongue depressors called blades.
The paddle of the depressor holds the patient’s tongue and lower jaw, while rubber-lined extensions at the top of the frame support the patient’s upper teeth. At least 20 further modifications of the Davis Gag were made from the 1920s through the 1990s.
However, the original design is still made by manufacturers and continues to be used every day by surgeons and medical practitioners.
• Used in tonsillectomy and adenoid surgery.
• Provides clear access to the oropharynx.
• Maintains airway during anesthesia.
• Adjustable frame with removable blades.
• Rubber-lined supports protect teeth.
• Supports easy mouth gag sterilization and maintenance.
This instrument was first introduced in 1887 by Dr. Charles Denhard as a modification of O’Dwyer’s gag, which was reported to be easily dislodged during surgery. To prevent this, the arms of the gag curve sharply at the point they exit the mouth.
This design ensures that the handles are located close to the side of the face, so an assistant can easily keep the gag and the patient’s head stable. This improvement cemented the use of the Denhard gag for decades to come, and future modifications, such as the Denhardt–Hoefert Mouth Gag, have only improved on what is already a reliable and time-tested instrument.
• Common in oral and airway surgeries.
• Helps maintain mouth and head stability.
• An ideal mouth gag used for pediatric and adult surgeries.
• Curved arms prevent slipping.
• Compact design for easy control.
• Made of strong stainless steel.
This gag was introduced in 1914 by St. Louis physician John Ellis Jennings. It is a modification of the earlier Whitehead gag. The built-in tongue depressor of the older gag was removed and simplified for more effortless adjustment. The Jennings Mouth Gag is operated via a single ratchet that can be controlled with one hand using the finger and thumb.
Unlike earlier designs, which featured two spring-loaded ratchets, this variation has dramatically increased the instrument’s ease of handling. The Jennings gag’s functional form and ease of use have kept it in production today. It is widely used.
• Used in dental and oral procedures.
• Suitable for tonsil and throat exams.
• Allows one-hand operation.
• Easy single-ratchet control.
• Lightweight and ergonomic.
• Provides a firm, comfortable hold.
The Doyen-Jensen is a variation on the Doyen Gag, an early design that simply held the mouth wide open but required stitching the tongue to maintain an airway and clear view for the surgeon.
The Doyen-Jansen variety offers improved handling with its Grip-Lock mechanism, which holds the blades in place at the desired width during the procedure and provides a firm hold on the instruments.
Its ratchet mechanism allows the mouth to remain open during the surgery, reducing tissue damage, and its curved front design allows for traumatic handling inside the mouth.
These advantages, along with Doyen-Jansen’s enduring and functional design, mean it is still a regular part of many surgeons' toolkits.
• Used in oral and maxillofacial surgeries.
• Maintains airway and mouth opening.
• Common in palate and throat procedures.
• Secure grip-lock system.
• Curved front for better access.
• Smooth blades minimize trauma.
The McIvor Gag is another early design designed by Robert J. McIvor in 1945. It was designed to protect patients' teeth from cracking or chipping, which used to occur during sudden unconscious muscular contractions or convulsions under general anesthesia. It also improved on previous designs by reducing traumatization of the mouth tissue caused by the sharp edges and corners of prior tools.
Compared to earlier variations, it was also designed to cause minimal obstruction to the view into the oral cavity or for the use of instruments. The all-around capabilities of the McIvor gag mean it is still in service in operating rooms to this very day.
• Used in tonsillectomy and laryngoscopy.
• Protects teeth and oral tissues.
• Keeps the airway clear during surgery.
• Smooth, rounded design.
• Prevents dental damage.
• Provides a clear surgical view.
| Instrument Type | Key Design Feature | Primary Use | Advantages |
| Davis Gag | Adjustable frame with interchangeable blades | Tonsil and adenoid surgeries | Provides stable access and airway control |
| Denhardt Gag | Curved arms with close-face handles | Oral and airway surgeries | Prevents slipping and enhances stability |
| Jennings Gag | Single-hand ratchet control | Oral, dental, and throat exams | Easy handling and quick adjustment |
| Doyen-Jansen Gag | Grip-lock and ratchet system | Maxillofacial and palate surgeries | Firm hold and reduced tissue trauma |
| McIvor Gag | Rounded, tooth-protective design | Tonsillectomy and laryngoscopy | Prevents dental injury and ensures a clear view |
As you can see, mouth gags have evolved a lot over the years. They have evolved from simple retractors to keep the mouth open to multifunctional instruments that assist medical practitioners during surgery and simultaneously facilitate anesthesia administration.
The fact that numerous modifications have been made and new variants continue to appear today proves that no single gag is perfect for all situations.
At GerMedUSA, we are committed to bringing you the latest, high-quality mouth gag instruments that combine historical reliability with modern innovation. Our selection of surgical mouth gag is carefully curated to meet the needs of professionals seeking precision, safety, and efficiency in every procedure.
High-Quality Instruments: All our mouth gags are made from premium materials, ensuring durability, precision, and long-lasting performance.
Trusted by Professionals: Our instruments are used and recommended by experienced surgeons and medical practitioners worldwide.
Wide Selection: GerMedUSA offers a comprehensive range of mouth gags to suit different surgical needs, making it easier to find the perfect tool for your practice.
A mouth gag is a surgical instrument used to keep the mouth open during oral, throat, and dental procedures. It allows surgeons clear access while protecting soft tissues and teeth.
Common types include Davis Gag, Denhardt Gag, Jennings Gag, Doyen-Jansen Gag, and McIvor Gag. Each is designed for specific procedures and offers unique features like ratchets, grip-locks, or tooth protection.
Selection depends on the procedure type, patient anatomy, and whether additional features like tongue depressors or grip-lock mechanisms are needed. Our comparison table in the blog can help guide your choice.
Yes. All our mouth gags are made from high-quality materials, tested for durability, and designed to withstand repeated sterilization while ensuring patient safety.
Some designs are suitable for children, but it’s important to choose a size and type that matches the patient’s oral anatomy. GerMedUSA offers instruments suitable for various age groups.
Most mouth gags are made of stainless steel and can be sterilized using standard autoclave procedures. Regular inspection and proper cleaning ensure longevity and safety.
We provide a wide range of premium instruments trusted by professionals worldwide, combining historical reliability with modern innovation to meet your surgical needs efficiently.
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