An expert answers the most important questions about feeding tubes and dental hygiene

zahnhygiene1What are most common dental issues experienced by tube-fed children?

Dr Maja Marotti: Among the most common problems is thick saliva, which in turn can lead to discolouration of the teeth and inflamed gums. Sometimes, decalcifications of the enamel surface can occur, as well as cavities, mostly at spots prone to caries, such as at tears in the enamel and in pits.

How do severe reflux and frequent vomiting affect the teeth?

Gastroesophageal reflux disease (GERD) is a condition caused by acid from the stomach leaking out and up into the oesophagus. If stomach content reaches the oral cavity on a frequent basis, it will ultimately also affect the teeth. Following the path of the vomit – over the back of the tongue, along the upper teeth and to the sides over the tongue onto the chewing surfaces of the lower teeth and into the cheeks – we can observe erosion caused by acid. This means the enamel decreases, the teeth become more sensitive to temperature, cavities are more likely. It is therefore crucial to at least thoroughly rinse the mouth after vomiting.

All about that first tooth – what needs to be done and what should we consider?

Starting with the first tooth, the parents should start brushing the teeth with a soft children’s toothbrush, or a finger toothbrush, and some water. From the first birthday onwards one should also add a pea-sized amount of children’s fluoride toothpaste in the evening. From the second year onwards, one can use children’s toothpaste twice per day. The first baby tooth appears on average at around six months. At about the age of one, both middle baby-incisors have erupted. If the child accepts solid foods, one should no longer give him or her a bottle with milk or formula at bedtime or during the night. If the child is thirsty during the night, he or she should be given unsweetened tea or water. This is also one of the most common causes of incisors being destroyed by cavities, which then have to be removed, in children as young as two. The flow of saliva is subject to the circadian rhythm. Throughout the entire night, we only produce as much saliva as in one hour during daytime. Deposits from sugary foods, such as juices and other drinks (including breast milk) are therefore not rinsed off the teeth during the night. The bacteria in the teeth’s plaque thus have an unlimited supply of carbohydrates throughout the night and can form lactic acid, which attacks and demineralises the teeth’s enamel surface.

What is the best way to get started with oral hygiene?

You should help your children adopt the habit of teeth brushing in a playful and patient manner. Starting with the first tooth, you should prepare them for oral hygiene, ideally every day. This should be a daily ritual in the bathroom like the bedtime bath.

How to brush the teeth of a child who easily retches or vomits?

The best way to do this is with a small children’s toothbrush on sight, i.e. sitting in front of the child, while moving the brush over the teeth. Which is what one should do anyway.

How important is toothpaste? Could we do without?

A toothpaste containing fluoride should be used twice a day from the age of two. The depositing of the fluoride counteracts the demineralisation of the enamel surface caused by the daily ingestion of food. If this does not take place, the tooth’s surface, i.e. the enamel, gradually decalcifies. The bacteria from the saliva can now get into the tooth and with their waste products, for example lactic acid, soften the dentin. This leads to cavities.

Should I force my child to brush?

As a basic principle, one should not do anything in life by force. However, there has to be daily oral care and hygiene in order to prevent cavities.

feeding tube and dental hygiene

Is it true that tube-fed children are also prone to develop more plaque? Is it a problem?

Plaque or film forms on every smooth surface, naturally this also occurs on our teeth. Plaque forms there as a result of the establishment of a bacterial flora in a layer of saliva proteins and epithelial desquamation. If it is allowed to remain on the teeth for too long, it hardens and leads to an increased rate of growth of bacteria, which cause cavities. Children who are tube-fed have thicker saliva, which is more prone to sticking to the teeth, which is why brushing is so important.

What do you think about chewing gum?

The chewing of gum increases saliva production and neutralises acids, which are present in the oral cavity after eating, and bacteria, which produce lactic acid after the ingestion of carbohydrates (especially sugar). But I would only recommend chewing gum for children from the age of 5 or 6. Chewing gum should of course be sugar free. In addition to stimulating the production of saliva, chewing gum containing xylitol reduces cariogenic bacteria, such as streptococcus mutans. Xylitol is absorbed by the bacteria, but cannot be metabolised and thus they die.


Dr Maja Marotti is a certified endodontist and child dentist. Since 2006, she has been an assistant professor at the Medical University Graz, Austria. In addition, since 2013, she has also been running her own practice in Graz.

Christof Huemer