Gag Reflex Research Articles

Best Practices to Verify Ongoing Placement of NG or OG Tube After Initial X‐ray Confirmation

Many patients in intensive care units (ICU) require nasogastric (NG) or orogastric (OG) tubes. These patients often require a combination of sedatives that can alter level of consciousness and impair cough or gag reflexes. Such factors can lead to NG/OG tube displacement. Using a misplaced tube can lead to aspiration, lung injury, infection, and even death. To standardize ongoing verification of NG tube placement practices in our 34-bed Medical-Surgical ICU. The Johns Hopkins Nursing Model was utilized to guide this project. A literature review and critical appraisal were performed to establish NG/OG tube best practices. Best practices were implemented and assessed (via a survey and charting audits). Fifteen publications were identified and appraised as Level 4 and 5 sources. Best evidence supported that at the time of radiographic confirmation of the tube site, it should be marked with inedible ink or adhesive tape where it exits the nares; tube location should be checked at 4-hour intervals; and placement/patency should be checked in patients who complain of pain, vomiting, or coughing. Following the practice change, N=40 nurses indicated improvement in verification of NG/OG tube knowledge, "OK to use" order was verified for 89% of patients, and 63% of tubes were marked with tape at the exit site. Adherence to current, evidence-based strategies for NG/OG tube verification promotes patient safety. Monitoring practice changes is critical to determine whether a best practice is sustained. Electronic health records must be current to guide and support evidence-based nursing practice.

Management of Gagging and Anxiety in Children by Play Way Method

Introduction: The gag reflex (GR) is an innate healthy defense mechanism that helps prevent foreign bodies from entering the trachea. Psychological, anatomic, iatrogenic, local, and systemic factors influence the GR. The pharyngeal reflex that prevents choking involves five triggering zones in the oral cavity: the palatoglossal and palatopharyngeal folds, the post-pharyngeal wall, the uvula, the palate, and the base of the tongue. So, this study is undertaken to determine gag reflux using the Intellectual Colored game distraction technique during the dental impression. Aim: The aim of this study is to determine the effect of distraction using the intellectual colored game (ICG) on the severity of GR and anxiety in children during the dental impression. Methodology: 50 children aged between 5 to 11 years, needing upper alginate impressions will be selected for the study and will be divided into 2 groups of 25 each. Children’s baseline anxiety will be evaluated according to the Buchanan’s Facial Image Scale (FIS) before any impression attempt. In Group 1 the upper alginate impression will be taken without playing ICG and group 2 upper alginate impressions will be taken while playing ICG. Result: Statistical analysis showed that 28% and 76% of children from the control and treatment groups respectively had a higher level of anxiety before the use of the distraction technique. However, 12% and 4% of children had higher anxiety after the use of distraction technique and a statistically significant change in anxiety in the treatment group with existing anxiety level (Z = -3.412, p = 0.001) was observed. Conclusion: Intellectual distraction is a safe, successful & cost-effective method for gag reflux management in pediatric dentistry. The Intellectual coloured game diverted the child’s attention during the stressful alginate impression, henceforth it should be considered to further advance behaviour management techniques.

Acute Ischaemic Stroke With Hyperprolactinemia:A Case Report

Background: Macroincidentalomas were reported in 0.2% of patient underwent imaging (CT scans) for central nervous symptoms (1). In acute ischaemic stroke with hyperprolactinemia, the diagnosis of a double pathology of ischemic stroke and sellar tumour especially prolactinoma need to be considered. Hyperprolactinemia itself may be considered as a risk factor for ischemic stroke due to its thrombogenic effect (3). Clinical Case: A 47-year old man underlying hypertension and diabetes mellitus for 5 years presented with sudden onset of right sided body weakness associated with facial asymmetry and aphasia. No history of fever or trauma. Asymptomatic of hyperprolactinemia previously. On general examinations Glasgow Coma Scale 11/15 Eye 4 Verbal 1 Motor 6, blood pressure was unstable with readings of systolic 244mmHg and diastolic 142mmHg. Neurological examinations showed expressive aphasia, right hemianopia, right facial nerve palsy and absence of gag reflex. Cerebellar signs were negative. Motor function examinations of right upper and lower limbs showed hypertonia, reduce power of 2/5, normal reflexes and up going plantar response. Sensory functions of right upper and lower limbs were reduced. Clinically diagnosed as stroke with hypertensive emergency. CT brain showed multiple hypodensities due to recent infarct and incidental finding of an aggressive sellar mass. MRI brain showed left Middle Cerebral Artery territory infarct and an aggressive sphenoid sinus mass with suprasellar and bilateral cavernous sinus extension possibility of a macroadenoma. Serum prolactin level showed markedly hyperprolactinemia (21146 ng/ml, n 4.04 – 15.2 ng/ml) which level of 500ng/ml or greater is diagnostic of a macroprolactinoma (2). FSH level (0.929 IU/L, n 1.5-12.4 IU/L) and LH level (1.11 IU/L, n 1.7-8.6 IU/L) were low in this patient due to suppression of GnRH secretion from hypothalamus by prolactin. Testosterone level (0.15 nmol/L, n 8.64-29.0 nmol/L) was low secondary to low LH. Serum cortisol, growth hormone and TSH were normal. Platelet count and coagulation profiles were normal. The patient was treated conservatively in ward for acute ischaemic stroke and later was started on dopamine agonist cabergoline for hyperprolactinemia. Conclusion: This is a case report of acute ischaemic stroke with markedly hyperprolactinemia secondary to incidentaloma macroprolactinoma. Reference: (1)Freda PU, Beckers AM, Katznelson L, et al. Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96 (4): 894-904.(2)Abha Majumdar and Nisha Sharma Mangal. Hyperprolactinemia. J Hum Reprod Sci. 2013 Jul-Sep; 6(3): 168–175.(3)Sankalp Kumar Tripathi, Pallavi Kamble, M.G. Muddeshwar. Serum Prolactin Level in Patients of Ischemic stroke. International Journal of Contemporary Medical Research 2016; 3(12): 3459-3460.

Comparative evaluation of isoflurane and sevoflurane in avian patients

Background and Aim:Literature comparing the use of isoflurane and sevoflurane inhalation anesthetic agents in birds is scarce. This study aimed to evaluate the comparison of isoflurane and sevoflurane during induction, maintenance, and recovery of anesthesia in avian patients.Materials and Methods:In this study, 24 injured avian patients (n=24) were selected randomly and divided into four groups during kite flying festival. In the present study, isoflurane and sevoflurane were used as induction and maintenance anesthetic agents, with and without butorphanol tartrate premedication agent in all the birds. Different physiological parameters were evaluated, namely, cloacal temperature (°F), heart rate (beats/min), respiratory rate (breaths/min), and SpO2 (%) were recorded at 0, 10, 20 min, and at recovery time. The quality of anesthesia was assessed on the basis of induction time, quality of induction, production of analgesia, muscle relaxation, body reflexes, recovery time, quality of recovery, sitting, standing, and complete recovery time (CRT).Results:The mean±standard error value of induction time was 230.00±32.55, 280.00±25.29, 180.00±21.90, and 260.00±36.87 s, respectively, in Groups I, II, III, and IV. The feather plucking, pharyngeal, and toe pinching reflexes were noticed, when the birds were passing through the light plane of anesthesia during induction. Comparison of cloacal temperature at the time of recovery between Group-I versus Group-III revealed a significant difference (p<0.05). Comparison of mean respiratory rates at the time of recovery between Group-II versus Group-IV revealed a significant difference (p<0.05). Excellent quality of recovery was observed in all the groups of anesthetic protocols. Sitting, standing, and CRT were observed shortest in avian patients maintained with sevoflurane as compared to isoflurane.Conclusion:The quality of induction of anesthesia was rapid in avian patients when induced with sevoflurane as compared to isoflurane. Rapid onset of induction and recovery of anesthesia were found with sevoflurane followed by isoflurane. Induction and maintenance of anesthesia in avian patients with sevoflurane resulted in the lowest time required for sitting, standing, and CRT.

A Survey of Mechanical Ventilation Weaning Practices in ICUs of Bangladesh

Objective : To determine mechanical ventilation discontinuation (weaning) practices in Bangladesh as there is currently no data available on this issue.&#x0D; Method : Analyzing the Survey on Bangladeshi respondents using questionnaire developed by and used by a pan Asian study where Bangladesh critical care physicians participated.&#x0D; Result : 40 physicians from 10 ICUs of Bangladesh participated. Majority of our participating doctors (62.5%) came from private for profit hospital. 19 out of 40 respondents were certified in critical care medicine. In our study spontaneous breathing trial (SBT) was liberally used with pressure support being used by 30% respondents. Most of the extubation trial took place during day. As criteria for extubation, respondents mainly considered consciousness and cooperation and along with gag reflex, cough strength, suction frequency and cuff leak at different times. Noninvasive ventilation (NIV) was commonly used for early extubation in cases of COPD, cardiogenic pulmonary edema, neuromuscular disorders, post-operative cases and obesity. Slightly less than half of respondents did not follow any sedation protocol and 42.5% followed weaning protocol. Protocolized weaning by nurses are not known to be practiced in Bangladesh.&#x0D; Conclusion : Weaning practices are diverse in Bangladeshi ICUs. Protoclized weaning is rarely practiced in Bangladesh.&#x0D; Bangladesh Crit Care J March 2021; 9(1): 4-11

The Effect of Low Level Laser Therapy and Acupressure in Controlling Gag Reflex in Children Undergoing Dental Procedures

Background: Impression making can be challenging in children due to the exaggerated gag reflex. It not only hinders the basic dental examination procedure but also delivery of the treatment procedure becomes more challenging. Aim: Comparative evaluation of Low Level Laser Therapy (LLLT) and in combination with acupressure in controlling gag reflex in children undergoing impression making procedure. Experimental Procedure: A total of 90 children (10.1 + 2.6) years were divided into three groups depending upon the strategies used. Group A received LLLT whereas group B received LLLT with acupressure and group C was placebo group. Each patient underwent two impressions to record GSI and GPI scores for all groups. Results: Mean values of GSI and GPI scores for each group were calculated at three different stages. The mean values revealed least gagging with LLLT as compared to LLLT with acupressure and placebo group at stage 1 (p-0.001) and stage 3 (p-0.000) which was statistically significant. Mean values of GPI score was less than GSI score at all three stages for all the groups except for stage 1 in group C, which was not statistically significant. Conclusion: LLLT and in combination with acupressure was effective in controlling gag reflex in comparison to acupressure in children undergoing impression making procedure. Keywords: Acupuncture, acupressure, acupoints, gag reflex, impression making.

An oropharyngeal device for airway management of conscious and semiconscious patients: A randomized clinical trial.

ObjectiveNo oropharyngeal devices exist for use in conscious and semiconscious trauma patients during emergency evacuation, transport, or resuscitation. We aimed to test the hypotheses that the ManMaxAirway (MMA) is better tolerated than the standard Guedel‐style device in awake volunteers and that it produces a jaw thrust and improves air flow.MethodsThis was a randomized cross‐over study of healthy volunteers with either the MMA or standard device. The primary outcome of tolerability was defined as maintaining the device in place for 60 seconds. Secondary outcomes included respiratory system function and jaw thrust. Resistance to airflow through the device lumen was measured in situ and when placed in subjects in the pulmonary laboratory alone. Jaw thrust was quantified as displacement between the mandibular condyle and condylar fossa apex relative to baseline visualized with magnetic resonance imaging (MRI).ResultsWe enrolled 19 subjects. Of these, a convenience sample of 5 individuals was selected for MRI; the remaining individuals (n = 14) were randomized for the cross‐over study. All 14 subjects were able to maintain the MMA for 60 seconds compared with 2/14 (14%) with the standard device (odds ratio, 145; 95% confidence interval, 6.3‐3314). Subjects reported that the experimental device was more comfortable and its placement did not trigger the gag reflex. Airway resistance produced by the MMA in an oscillatory flow model was nearly an order of magnitude lower than that of the standard device (experimental vs standard, 8 Hz—0.092 vs 0.786 cmH20·s/L; 15 Hz—0.193 vs 1.321 cmH20·s/L). Rapid induction of the gag reflex precluded further measurements with the standard device. Forced oscillation pulmonary testing in conscious volunteers with and without the MMA demonstrated that the device decreased respiratory system resistance to airflow and reduced respiratory elastance (31% ± 8% and 44% ± 13.4%, respectively; P < 0.05). MRIs of the subjects (n = 5) with the MMA in place showed a significant jaw thrust compared with baseline (7 ± 1 mm).ConclusionsThe MMA proved well tolerated in conscious subjects, resulting in an opening of the anatomic airway and a decreased resistance to airflow.

Lidocaine Infusion Improves the Functionality of Intraoperative Nerve Monitoring During Thyroid Surgery: A Prospective, Randomized, Double-Blinded Study.

BackgroundIntraoperative nerve monitoring (IONM) to assess the recurrent laryngeal nerve function during thyroid surgery is becoming the standard of care across many institutions. The successful deployment and data analysis from the IONM require complete laryngeal relaxation and reflex suppression. We investigated the role of intravenous lidocaine infusion (IVLI) to provide such operating conditions, under a lighter plane of anesthesia and fewer hemodynamic fluctuations.MethodsSixty-five patients were randomly assigned to lidocaine group (LG) or placebo group (PG) based on the computer-generated coding developed by the pharmacy department. The study medication (SM) was delivered by the pharmacist in a pre-filled coded syringe to the investigator 30 min prior to the surgery. All the patients were anesthetized by narcotic and inhalation based general anesthesia. The SM was administered at the rate of 1.5mg/kg/h following a loading dose of 1 mg/kg. Dragonfly® laryngeal surface electrode and Nerveana® nerve locator system were used for IONM during surgery.ResultsThe proportion of patients requiring lower strength stimulating current (StMC) at 0.5 mA was significantly higher in the LG than in the PG (X2 (1, N = 61) = 10.1615, P = 0.001434). Similarly, the proportion of patients with the drop in the aggregate impedance level (DAIL) by < 50% at the end of surgery was significantly higher in the LG than in the PG (X2 (1, N = 61) = 15.982, P = 0.000064). In addition, the proportion of patients with the hypotensive episodes requiring rescue medications more than twice during surgery was significantly lower in the LG than in the PG (X2 (1, N = 61) = 0.0183, P < 0.05).ConclusionsThe enhanced laryngeal relaxation and the reflex suppression afforded by the IVLI could have enabled a lower StMC to elicit a positive signal. The lower StMC promotes less intense laryngeal alterations as evidenced by the lower DAIL in the LG. IVLI can enhance the functionality of the IONM during prolonged operating time and the resultant increased number of IONM stimulations, while providing a stable hemodynamic environment.

Predictive Factors for Postoperative Tracheostomy Requirement in Children Undergoing Surgical Resection of Medulloblastoma

This study is aimed at identifying factors predicting tracheostomy requirement in children diagnosed with a posterior fossa medulloblastoma postoperatively. A retrospective chart review of all patients younger than 18 undergoing medulloblastoma resection from 2012 to 2020 at Namazi Hospital was conducted. Forty-five patients (26%) needed tracheostomy after the operation. The most common correlates were brainstem compression and absence of gag reflex before operation. Patients who had brainstem compression and infiltration by medulloblastoma, bilateral absence of gag reflex before operation, subtotal resection of the tumor, and postoperative brainstem contusion were more likely to require tracheostomy. No statistically significant difference was observed between males and females and different ages. Medulloblastoma is the most common pediatric malignancy. Postoperative ventilator dependency is an important complication in postoperative recovery of patients undergoing medulloblastoma resection. Considering the mutism syndrome with all its question marks by means of predisposing factors, we dealt with a 2-week policy whether there would be any clinical resolution regarding patients' gag reflex. The results show that if we aim for total tumor resection, tracheostomy that is a highly costly and stressful postoperative morbidity can be prevented.

Anaesthesia for Awake Fiberoptic Intubation: Ultrasound-Guided Airway Nerve Block versus Ultrasonic Nebulisation with Lignocaine.

Background: In anticipated difficult airway, awake fiberoptic guided intubation should be the ideal plan of management. It requires sufficient upper airway anesthesia for patient’s comfort and cooperation. We compared the efficacy of ultrasound guided airway nerve blocks and ultrasonic nebulisation with lignocaine for airway anesthesia before performing awake fibreoptic guided intubation. Methods: This prospective, randomised study included sixty consenting adult patients of both genders (American Society of Anesthesiologists' physical status 1–3) with anticipated difficult airway undergoing surgery. Ultrasound guided airway nerve blocks group received ultrasound-guided bilateral superior laryngeal (1 ml of 2% lignocaine) and transtracheal recurrent laryngeal (2 ml of 2% lignocaine) airway nerve blocks and ultrasonic nebulisation with lignocaine group received ultrasonic nebulisation of 4 ml of lignocaine 4%. The primary outcome was to compare the time required to intubate, whereas the secondary outcomes were to compare cough reflex and gag reflex, hemodynamic changes, number of attempts required, and comfort score during awake fibreoptic guided intubation in both the groups. Results: The time taken for intubation was significantly lower in the ultrasound guided airway nerve blocks group 69.27±21.85 s than ultrasonic nebulisation with lignocaine group 92.43 ± 42.90 s (p = 0.015). Hemodynamic variables changed during the procedure but the values were comparable in both groups. There were no statistical differences in cough and gag reflexes, number of attempts, and comfort score in both groups. Conclusions: This study shows that significant lesser time required for performing awake fiberoptic intubation when patient received ultrasound guided airway nerve block in comparison to ultrasonic nebulisation for airway anaesthesia.

Injection laryngoplasty under ultrasonographic control.

Cervical ultrasound allows real-time visualization of the laryngeal structures. We describe its application for injection laryngoplasty in the voice clinic. Hyaluronic acid infiltration of the vocal fold under ultrasonographic control. With this technique, the position of the needle in the depth of the vocal fold and its spatial relations with nearby structures can be assessed. This allows for an accurate infiltration of the material in contrast to other techniques and avoids discomfort related to the gag reflex with nasofibrolaryngoscopy. No specific complications have been observed so far, however, this technique may be difficult in cases with calcified cartilages or uncooperative patients.

Knowledge Attitude and Awareness Of Dental Students About The Role Of Acupuncture In Controlling Gag Reflex

Introduction: Gagging is a normal reaction to safeguard the airway from foreign body entry. In some patients this is exaggerated and hence may hinder the dental treatment. There are many methods to control gagging and one of it is acupuncture which a traditional Chinese method. Aim: This survey is done to assess the knowledge attitude and awareness of dental students about the role of acupuncture in controlling gag reflex. Materials and methods : A questionnaire with 11 questions based in the acupuncture and its effect in gagging were prepared and distributed through an online link to a total of 80 students and the results were obtained. Results: 45% of the students are aware of acupuncture used for preventing gagging and no one have ever done acupuncture in their clinical practice. Conclusion: Awareness should be created about the acupuncture and its benefits in controlling the gag reflex since it is an effortless and effective treatment.

Pediatric Brain Death.

1. Brooke T. McLaughlin, MD, MPH* 2. James J. Filiano, MD* 1. *Dartmouth Hitchcock Medical Center, Lebanon, NH A 3-year-old boy was airlifted from a nearby hospital after a motor vehicle collision. At the scene he had a prolonged extraction and was not breathing. He was intubated and experienced cardiac arrest during transport. Cardiopulmonary resuscitation was performed, with return of circulation. On arrival at the emergency department the patient exhibited complete loss of consciousness, vocalization, and volitional and reflex activity. Computed tomographic scans consistent with global cerebral infarction and laboratory results of multiorgan failure indicated little hope for meaningful recovery. The team waited 24 hours from the time of injury and prepared to initiate the brain death examination. The family was despondent and refused to believe that the damage could be irreversible. The team called the chaplain, social worker, and primary care physician to support the family in the subsequent hours. The initial brain death examination found the child unresponsive to painful stimuli, with fixed pupils and absent light, corneal, cough, gag, and oculovestibular reflexes. An apnea test demonstrated no spontaneous respiratory effort to PaCO2 greater than 60 mm Hg. A post–24-hour examination and apnea test confirmed that the child fulfilled the criteria for brain death. The family struggled to accept the news because their child appeared alive to them: his heart was beating and his chest was rising on the mechanical ventilator. Brain death is a legal definition of death recognized in every state in the United States. It is the irreversible cessation of all function of the entire brain, including the brain stem. There is medical, legal, and social consensus that loss of this function equates to death just as definitively as irreversible cessation of circulatory and respiratory function. However, it remains a challenging issue because brain-dead patients often maintain the appearance of life while on a ventilator (or while receiving other assisted support). This …

One- or two-operator techniques for oesophago-gastro-duodenoscopy in unsedated patients: A comparative prospective randomized study

BackgroundThe standard oesophago-gastro-duodenoscopy procedure is performed with a single endoscopist (SE). Nurse-assisted (NA) oesophago-gastro-duodenoscopies have not yet been studied. We aimed to evaluate the efficacy of an NA endoscopy compared to an SE endoscopy. MethodsA prospective, single-center, randomized trial, in which 500 adult patients were divided into two groups. In the first group, patients underwent an endoscopy with an SE. In the second group, the endoscopy was performed with an NA. The ease of the procedure (scores 1–4; 1 difficult, 2 satisfactory, 3 easy, 4 veryeasy), evaluation of patient satisfaction (scores 1–4; 1 uncomfortable, 2 satisfactory, 3 comfortable, 4 verycomfortable), total time of the procedure and vocal cord observation were determined as quality indicators. ResultsMean patient satisfaction scores in groups 1 and 2 were 2.98±0.79 and 3.11±0.78, respectively (p=0.043), with uncomfortable ratings in 5.2% vs 4%, satisfactory in 16.8% vs 13.2%, comfortable in 53.2% vs 50.4%, and very comfortable in 24.8% vs 32.4% of patients in groups 1 and 2, respectively. Retching rates during the procedure were 54.4% and 45.2% (p=0.040) in groups 1 and 2, respectively. No differences were seen in vocal cord observation (54.4% vs 56.0%), total procedure time (2.35±1.56 vs 2.41±1.48min) and easy score (3.26±0.603 vs 3.25±0.64) in groups 1 and 2 for the procedures. Very easy, easy, satisfactory, and difficult ratings were given by 33.6% vs 34.8%, 60.4% vs 56.4%, 4.8% vs 7.6% and 1.2% vs 1.2% of groups 1 and 2, respectively. ConclusionsCompared with the conventional method, the assisted endoscopic technique provides more comfort and less gag reflex without increasing the processing time or difficulty of performing the procedure.

Novel Method of Administering Pharyngeal Anesthesia before Transesophageal Echocardiography

The most unpleasant reaction upon insertion of a transesophageal echocardiography (TEE) probe is a gag reflex, which is a normal defense mechanism that prevents foreign bodies from entering the trachea, pharynx, and larynx. The gag reflex causes excessive salivation, which may increase the risk of aspiration. When extreme, a hyperreflexive gag may result in lacrimation, sweating, fainting, or overt panic attacks, which further impair the ease of TEE probe insertion, may force a deeper level of conscious sedation with increased associated risk, and could impact future decisions by patients needing repeat TEE.

Questionnaire survey on pharyngolaryngeal sensation evaluation regarding dysphagia in Japan

ObjectiveThe objective is to conduct a questionnaire survey regarding pharyngolaryngeal sensation evaluation in dysphagia to understand the current situation in Japan. MethodThe questionnaire was sent to the councilor of the Society of Swallowing and Dysphagia of Japan and the Japanese Society of Dysphagia Rehabilitation-Certified Clinician. The prospective questionnaire survey included the questions listed below: Q1: What do you think of the importance of pharyngolaryngeal sensory evaluation? Q2: Select one of the essential swallowing sensations. Q3: Select one of the following regarding the frequency of sensory examination of the larynx. Q4: Select the proportion of cases the sensory test results affect. Q5: As a pharyngolaryngeal sensory evaluation method in swallowing function evaluation, please fill in the table below for the frequency, difficulty, and effectiveness of the following tests, such as gag reflex, touching the larynx by endoscopy, touching the larynx by the probe with endoscopy, cough reflex test, swallowing provocation test. ResultsThe essential swallowing sensations of mechanical stimulation, chemical stimulation, thermal stimulation were 84.9%, 5.4%, and 9.7%, respectively. The frequency of touching the larynx by endoscopy in the otolaryngology group and cough reflex test in dentistry was significantly higher than the other groups (p < 0.05). The correlation between the frequency and difficulty or effectiveness of the sensory tests indicated that the frequency and difficulty are significantly correlated between each item. ConclusionOur results aid in increasing understanding and selection of pharyngolaryngeal sensation evaluation for dysphagia patients.

Cleaning the palate and tongue without nausea: a mixed methods study exploring the appropriate depth and direction of oral care

BackgroundIt is advisable to clean the palate and tongue thoroughly during oral care to protect against nosocomial infections. However, improper cleaning may cause nausea. To date, no robust data are available regarding how to implement this procedure properly. Furthermore, traditional cotton balls, forceps and normal saline are still used in clinical in China. This mixed methods study aimed to explore the appropriate depth and direction of cleaning methods for palates and tongues without causing nausea and the factors influencing cleaning depth and discomfort in traditional oral care.MethodsOur study recruited students (n = 276) from a medical university. The first phase was a quantitative study, in which forceps were slowly inserted into their throats until the gag reflex was triggered, and then, the insertion depth was measured. After that, participants were randomly divided into two groups. In group A, palates and tongues were cleaned coronally and then sagittally, with the converse order used for group B. The extent of nausea was measured. Additionally, the qualitative data were types of discomfort other than nausea reported by the participants.ResultsThe tolerable depths (without causing nausea) for cleaning the palate and tongue were 6.75 ± 1.07 cm and 6.92 ± 1.11 cm, respectively. Participants of male sex and with high BMI (overweight/obese) were associated with greater tolerable cleaning depth. The extent of nausea caused by cleaning both the palate and the tongue sagittally was higher than that elicited by coronal cleaning (p = 0.025 and p = 0.003, respectively). Other discomforts included itching, saltiness and coldness.ConclusionIt is appropriate to increase the cleaning depth of the palate and tongue for adult males and overweight/obese individuals. Moreover, coronal cleaning causes lower levels of nausea, and traditional oral care appliances should be improved.

Comparison of &amp;ldquo;Earplug and Temporal Tap Technique&amp;rdquo; with Standard Distraction Method on Gag Reflex Related to Maxillary Impression Making in 6&amp;ndash;12-year-old Children: A Crossover Study

Comparison of &amp;ldquo;Earplug and Temporal Tap Technique&amp;rdquo; with Standard Distraction Method on Gag Reflex Related to Maxillary Impression Making in 6&amp;ndash;12-year-old Children: A Crossover Study

Satisfaction and Complaints of Patients with Removable Partial Dentures: In Sample at Baghdad City, Iraq

Objective: This study examined patients’ complain regarding pain on eating, esthetic and speech problemsand gag reflex with various types of removable partial dentures (RPDs).Method: The study sample included 60 RPD wearers (36 females and 24 males) aged between (25-60)years old. Sex, age, occupation, any experience with previous RPDs, and the complaint with RPDs wererecorded. Data were analyzed using Chi-square test was applied for comparison among different variablesof oral complaints related to removable prosthesis; an independent a sample t-test was utilized. A P-value &lt;0.01 was the criterion for rejection of the invalid hypothesis.Results: the results show 60 patients, 16 (47.05%) were satisfied on acrylic and14 (77.77%) were satisfiedon flexible. And 6 (75%) were satisfied on metallic. The mean level of satisfaction among the three typesof RPDs was significantly different (P &lt; 0.01). In cases satisfaction between flexible and acrylic RPDswas significantly different. But, between either metal or acrylic, or metal and flexible RPDs no significantdifferences (P &lt; 0.01) were recognized.Conclusions: Within the limitations of this study, approximately half of cases that tooka removable partialdentures treatment were satisfied with it, showing that the quality of RPDs(in Iraq/Baghdad city) wassuitable for patients. Pain in eatingis the most common complaint that shows that dental treatments withRPDs should be provided with care when patients have pain in eating.

A Difficult Pill to Swallow: An Investigation of the Factors Associated with Medication Swallowing Difficulties

BackgroundMany medications are available as solid oral dosage forms such as tablets and capsules; however, some people find these medications difficult to swallow.AimTo identify whether certain psychological, oral sensory, and oral motor characteristics contribute to medication swallowing difficulties.MethodsA sample of healthy adults from two academic institutions in Brisbane were assessed for their experiences with swallowing solid oral dosage forms, food preferences, and food neophobia. The gag reflex, oral cavity size, fungiform papillae count, and chewing efficacy were also evaluated followed by a capsule-swallowing task. Primary outcome was the incidence of medication swallowing difficulties. Secondary outcomes were the association of medication swallowing difficulties with psychological, oral sensory, and oral motor factors.ResultsOf 152 subjects, 32% reported difficulty swallowing tablets or capsules whole. This group was significantly more likely to have had a memory of choking on medications compared to those without medication swallowing difficulties (OR = 7.25, p < 0.05). Current medication swallowing difficulties were significantly associated with a smaller mouth cavity size (OR = 2.98, p < 0.05), a higher density of taste receptors on the tongue (OR = 3.27, p < 0.05), and were higher among those who chewed a jelly candy to non-homogenous particle size (OR = 4.1, p < 0.05). Current medication swallowing difficulties were associated with lower confidence in swallowing large capsules (000 size: OR = 0.47, 00 size: OR = 0.39, p < 0.05). No associations were found between medication swallowing difficulties and the gag reflex or food neophobia.ConclusionA combination of heightened oral perception characterized by a small oral cavity and high taste sensitivity compounded by a past choking episode on medications may be precipitating factors for medication swallowing difficulties. These factors may be helpful in identifying individuals who are more likely to experience difficulty swallowing medications.