Many fixed areas can trigger the gag reflex, commonly including the faucial pillars, the base of the tongue, and the soft palate, uvula, and posterior pharyngeal wall. Frequent gagging is even related to correlative fear and hinders the receipt of adequate dental care. Nausea is a physiological defence reflex, and the prevalence of self-reported gagging during dental treatment is 8.2%. However, providing oral care deeply or improperly may cause nausea, which is associated with the gag reflex. It has been reported that approximately one in ten cases of death caused by pneumonia in residents of nursing homes for the elderly could be prevented by improving oral hygiene. As routine care, oral care is an effective measure to reduce the risk for infection, decrease the incidence of pneumonia, prevent the occurrence of mucositis and significantly improve the quality of life of the patient. One of the effective approaches to maintain oral health is oral care, which has been evidenced to maintain oral health by reducing bacteria in the oral cavity. Oral health profoundly affects general health. Moreover, coronal cleaning causes lower levels of nausea, and traditional oral care appliances should be improved. It is appropriate to increase the cleaning depth of the palate and tongue for adult males and overweight/obese individuals. Other discomforts included itching, saltiness and coldness. 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). Participants of male sex and with high BMI (overweight/obese) were associated with greater tolerable cleaning depth. The tolerable depths (without causing nausea) for cleaning the palate and tongue were 6.75 ± 1.07 cm and 6.92 ± 1.11 cm, respectively. Additionally, the qualitative data were types of discomfort other than nausea reported by the participants. In group A, palates and tongues were cleaned coronally and then sagittally, with the converse order used for group B. After that, participants were randomly divided into two groups. 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. Our study recruited students (n = 276) from a medical university. 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. Furthermore, traditional cotton balls, forceps and normal saline are still used in clinical in China. To date, no robust data are available regarding how to implement this procedure properly. However, improper cleaning may cause nausea. It is advisable to clean the palate and tongue thoroughly during oral care to protect against nosocomial infections.
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