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Some people who are fed via a medically inserted feeding tube may still be able to take some food or liquid by mouth. Others may be ‘nil-by-mouth’ due to severe problems with swallowing and so cannot have any food or liquid by mouth at all.
People who are tube-fed may be taking very little or no food by mouth, but they still need their mouths’ to be cleaned.
This information will try to answer the questions frequently asked by those who are tube-fed or their carers and aims to provide some practical advice about how to achieve effective mouth care.
The advice is suitable for those who are able to take some food or liquid by mouth and those who are ‘nil by mouth’ and rely fully on tube feeding.
Brushing is important because:
If plaque is not removed it can harden and become calculus. Studies have found that those who are tube-fed are more likely to have calculus build up than other people who are not tube-fed. This is largely because those who are tube-fed do not use their chewing muscles as effectively and so do not clear their mouth in the usual manner.
Abnormal muscle tone and altered tongue and lip movements can often result in the teeth becoming crowded. This can then make them more difficult to clean and so can make them more likely to have calculus build-up.
The presence of calculus around the base of the tooth makes it harder to clean around the gum margin and as a result can lead to inflammation of the gums (gingivitis) and result in bleeding on brushing.
Your dentist will discuss with you the best way to manage calculus build-up.
People who are tube-fed often have Gastro-Oesophageal Reflux (GOR) which can result in acid from the stomach reaching the mouth and teeth. This acid may cause tooth wear called erosion that will result in thinning or shortening of the teeth.
Sometimes medication can help to reduce GOR and so we can work with your doctor to see if there is any way to help reduce this.
Acidic foods and/or drinks (for example citrus fruits, fruit juice, diluting juice, and fizzy drinks) can make tooth erosion worse. If some food is still being taken by mouth, then these types of food/drink should be kept to a minimum.
Your dentist will be able to give you more personal advice about this at your appointment
Those who are tube-fed often have the feeling of a dry mouth, which may be caused by a lack of saliva stimulation. Some medications and certain medical treatment (such as radiotherapy) can also affect saliva flow to make the mouth feel dry.
A dry mouth can cause discomfort and problems with ease of swallowing, oral clearance and removal of secretions. Ensuring that a water based gel is applied to the lips, tongue, cheeks and palate regularly can help the mouth to feel more comfortable and may optimise any swallowing function that is present. See ‘Mouth Hydration’ below for examples of suitable gels.
Ensuring that the person with the feeding-tube is adequately hydrated is also important.
Yes, it is important to look after the gums and keep the mouth clean and free of debris even if there are no teeth present. This applies for very young children and adults.
All parents and guardians are advised to ensure that young children in their care are taken to see a dentist as soon as their first teeth come through, and before their first birthday.
Those who are tube-fed may also have neuromuscular impairment that can cause swallowing problems, called dysphagia.
This can increase the risk of aspiration pneumonia (inflammation of the lungs due to breathing in food/liquid/saliva/calculus). This risk can be reduced by good mouth care. Sometimes this can be more difficult if a person who is tube-fed has a sensitive mouth and is orally defensive.
Your dentist will be able to suggest some ways to manage effective tooth brushing
Toothpastes (examples below in ‘Plaque Removal’) are widely available to buy in supermarkets, pharmacies and from online shops.
Water based mouth gels (examples below in ‘Mouth Hydration’) are available to buy from pharmacies. Occasionally your doctor may be able to prescribe these for you in specific cases.
The specialised toothbrushes (‘Collis Curve’, ‘Dr Barman’s Superbrush’), ‘Mouth-Eze’ (MC3) oral cleanser and ‘OpenWide’ foam mouth rest can be bought from online shops
Barnsley (New Street)
Telephone: 01226 645150
Doncaster (The Flying Scotsman Centre)
Telephone: 01302 563163
Rotherham (Rotherham Community Health Centre)
Telephone: 01709 423110
Please don’t hesitate to ask your dentist if you have any further questions.
Produced by the Community Dental Service
Date Produced: May 2021. Revision Due: May 2023. Version: 1.0
©The Rotherham NHS Foundation Trust 2021. All rights reserved.