Oral and Dental Care

Oral hygiene is important when feeding by G-tube because the gums still need to be exercised in order to maintain their health.

Here's some Q&A's I found on the internet:

• Q. What are some of the problems likely to occur in the tube fed person?
  

  A. Malalignment of teeth - developmental abnormalities such as problems with muscle tone, persistence of certain oral reflexes and patterns of movement may lead to orthodontic problems. For instance, a tendency to tongue thrust may cause an "open bite", where the front teeth poke out. The actual problem may depend on the disability and which reflex is strong.

  It can be hard to treat these alignment problems. It is not difficult to make teeth move into better positions (a.g. by braces or plates), but after the treatment is finished, they may not stay there if the reason for the problem is still present.

  Plaque is a film on the teeth that builds up if they are not cleaned. Plaque can cause two problems. One is that bacteria may produce acid by fermenting sugars from the food we eat. This acid can demineralise or destroy the enamel of the tooth leading to tooth decay.

  The other problem is that bacteria may produce toxins and enzymes that cause gingivitis, and the breakdown of gum tissue. Gums look swollen; they bleed easily. Periodontitis, a condition where the membrane holding the tooth to the gum is broken down, may develop; eventually the tooth may be lost.

  Calculus is mineralized plaque. If the muscles around the mouth do not work well, if the tongue does not wipe the teeth, the person does not chew, then calculus can build up readily. The presence of calculus around the base of the tooth makes it harder to clean around the gum margin. Calculus build up is likely opposite the salivary ducts on the outer side of the upper back teeth and the tongue surface of the lower front teeth.

• Q. How should teeth be cleaned?

  A. In the very young child, the teeth and gums can be rubbed with a piece of gauze or a face washer. Later on, a small brush can be used. Dental floss could then be added.

  While twice a day is best, if you are going to pick one time, then the most important time is before bedtime. Try not to make it at the "chaos" time, but rather when it is convenient and realistic.

  The best position for brushing someone else's teeth is from behind. Flossing is best done from the front. Use a soft bristled brush with a small head.

• Q. Can an electric toothbrush help?

  A. Electric toothbrushes are not better cleaners than ordinary toothbrush; however they may be easier to use for some clients.

• Q. What can be done if there is a strong bite reflex?

  A. Be aware if there is sensitivity to certain stimuli. There are soft mouth props that can be used to gently keep the mouth from closing.

  Dental floss holders make it easier to get the floss between the teeth. Even if you can't open the person's mouth, a lot of effective cleaning can be done just on the surfaces of the teeth in contact with the insides of the cheeks.

• Q. What is the role of fluoride?

  A. It can be coated on the teeth from flouride gel. Flouroide painting is rarely done now that the water supply is flouridated .

  However, I found a flouroide liquid gel toothpaste I used on Kelly. Towards the end of her life, since it is impossible to get dental care at home, we used our finger with some cheese type cloth to keep her teeth, roof of mouth and tongue cleaned. If your loved one is not able to get continous professional dental care, remember to check for toothaches or gum senstivity when someone because unexpectedly ill. There may be an abses or a severe toothache causing the problem.

• Q. Should water be given orally, even if plenty is being delivered through the G-tube?

  A. If possible, small amounts of water should be given at least once a day in order to maintain the swallowing action and to moisten the mouth. One way of delivering water very slowly is to prime a bolus feeding tube, clamp it well up towards the attached syringe and then gently squeeze so that drops come out. This method is very good for those who gag easily.

• Q. How can gagging be minimized when brushing teeth?

  A. There is a toothbrush which attaches to a suction machine. It is called Vacu-Brush. Also, if the foaming of tooth paste causes gagging, either reduce or eliminate the paste. For children the amount of toothpaste should be the size of half a pea.