Many carers are surprised to learn that a person who takes all their nutrition through a tube can build up tartar on their teeth faster than someone who eats three meals a day. The mouth keeps its bacteria whether or not food passes through it, and without chewing and swallowing, some of its natural cleaning slows down. So the teeth, gums and tongue still need daily attention, and in some ways more of it.
This guide is for family members and carers looking after someone with a nasogastric (NG) or gastrostomy (PEG) tube at home or in care. It covers why the mouth matters, a daily routine that keeps the person safe, and when to involve a dentist or oral health therapist (OHT).
Tube feeding changes the mouth, it does not switch it off
When someone eats normally, chewing stimulates saliva, and the tongue and cheeks move food around the teeth. That constant movement disturbs plaque and rinses the mouth. When nutrition goes straight into the stomach, much of that activity stops.
Two findings from research help explain what carers often see. An early study in the Journal of the American Dental Association (Klein and Dicks, 1984) compared tube-fed and non-tube-fed residents with disabilities over 90 days. Calculus (hardened plaque, or tartar) formed significantly faster in the tube-fed group, with most of it appearing in the first month, even though plaque levels were similar in both groups. Hard deposits like this cannot be brushed off at home and need professional cleaning.
The second finding concerns the type of bacteria present. A study of frail older people in nursing facilities (Leibovitz and colleagues, Journals of Gerontology, 2003) found potentially harmful bacteria in the throat of 81% of people fed by nasogastric tube and 51% of those fed by gastrostomy tube, compared with 17.5% of people who ate by mouth. These are the kinds of bacteria linked with chest infections.
Why carers worry about the chest
Aspiration pneumonia happens when material from the mouth or throat, including saliva and the bacteria in it, is breathed into the lungs. People who are tube-fed often have other reasons for this risk, such as a swallowing disorder, reduced mobility, or spending long periods lying down. A heavily colonised mouth adds to the load.
Cleaning the mouth will not remove the risk, but there is reasonable evidence that it helps. In a trial across eleven nursing homes in Japan (Yoneyama and colleagues, Journal of the American Geriatrics Society, 2002), residents who received daily tooth cleaning from staff plus weekly professional care had fewer cases of pneumonia, fewer days of fever and fewer deaths from pneumonia than those without that care. The study was not limited to tube-fed people, so it is best read as support for regular mouth care in frail, dependent adults generally.
A daily routine that puts safety first
Good positioning comes before any brush or swab. Sit the person upright if they can tolerate it, or raise the head of the bed as far as is comfortable, and tilt their head slightly forward or to one side so liquid drains out of the mouth rather than towards the throat. If the person already has suction equipment for other care, keep it within reach during cleaning. Their speech pathologist or nursing team may have specific advice about position, and their guidance comes first.
Then work through the mouth gently, twice a day:
- Brush every tooth surface with a soft, small-headed toothbrush. A child-sized brush often fits more easily.
- Use only a very small smear of fluoride toothpaste, and wipe away the froth with a damp cloth or swab rather than asking the person to rinse. A low-foaming toothpaste can make this easier.
- Clean the gums, the roof of the mouth, the inside of the cheeks and the tongue with the brush or a moistened swab, without pushing far towards the back of the throat.
- If the person has dentures, take them out, clean them separately and leave them out overnight unless told otherwise. Keep cleaned dentures in a clean, dry container overnight.
- Finish with a plain lip moisturiser, since lips crack easily when they are not moistened by eating and drinking.
If the person bites down or resists, stop and try again later or ask the dental team about tools such as a mouth prop. A shorter clean that is done calmly every day is better than a long one that causes distress.
Dry mouth is common and worth treating
Plenty of fluid through the tube does not guarantee a moist mouth. Many tube-fed people breathe through their mouth, take medicines that reduce saliva, or have a condition that affects saliva glands. A dry mouth feels uncomfortable, makes the lining more prone to splitting and to thrush, and lets plaque cling more easily.
A dentist or OHT can suggest saliva substitutes and moisturising gels. If the treating team allows small amounts of water by mouth, frequent sips or a moistened swab can help. Changes in taste are also common, and a fresh-feeling mouth can make a real difference to comfort for someone who remembers eating normally.
Carers juggling other equipment may find our guides on dental treatment with a tracheostomy and going to the dentist while on home oxygen useful. It also helps to bring up-to-date medical details to each visit, which we cover in our article on medical alert information at dental appointments.
Keep up professional check-ups
Because tartar can build up quickly, regular visits to a dentist or OHT remain important after tube feeding begins. The usual interval is around every six months, but the dental team may suggest more frequent cleans for someone whose deposits build fast or whose gums bleed easily. At the visit the clinician can also look for thrush, ulcers, broken teeth and signs of gum disease that are hard to spot during daily care.
Getting to the clinic can be the biggest obstacle. When booking, mention the feeding tube, any oxygen or suction needs, and whether the person uses a wheelchair, so the appointment can be planned around them. Any mouth ulcer or patch that has not healed within three weeks should be checked by a dentist or GP.
Questions carers ask us
Does the feeding tube itself need cleaning in the mouth?
Care of the tube and its site follows the instructions of the medical or nutrition team. The teeth, gums and tongue still need their own routine regardless of the type of tube.
Should I use a strong antiseptic mouthwash instead of brushing?
Brushing is what physically removes plaque, so a rinse is not a replacement. Ask a dentist or OHT before using an antiseptic product, as some are unsuitable for people who cannot spit out.
The person has no teeth. Is mouth care still needed?
Yes. Bacteria still live on the gums, tongue and dentures. In the Yoneyama study, mouth care helped people with and without natural teeth.
If you care for someone who is tube-fed and would like help setting up a safe mouth care routine or booking a check-up, our general dentist team can talk it through with you. You can also see our current offers before you book.
