Having a tracheostomy does not rule out dental care. Check-ups, cleans and most fillings can usually go ahead in a general practice, provided the team knows about the tube beforehand and plans the visit around it. The two things that need extra thought are keeping water and debris away from the airway during treatment, and keeping the mouth clean between visits when normal saliva and swallowing may be reduced.
Why the mouth needs more attention after a tracheostomy
With a tracheostomy, most breathing happens through the tube in the neck rather than through the nose and mouth. That is a common point of confusion: the mouth is not working harder, it is often used less. Less airflow, less talking, less eating by mouth and, for some people, less swallowing all reduce the natural rinsing that keeps teeth and gums clean. Medicines, oxygen therapy and the underlying illness can also leave the mouth dry.
When saliva drops and the mouth is not being used much, plaque builds up faster and the gums can become inflamed. The mouth can also hold bacteria that may be breathed or aspirated into the lungs. Researchers have studied whether better mouth care lowers pneumonia risk in frail people. A 2022 Cochrane review (Cao and colleagues) looking at nursing home residents found the evidence on pneumonia prevention was uncertain, so careful mouth care is best seen as sensible protection rather than a proven way to prevent chest infections. Our article on the causes and treatment of dry mouth covers ways to manage dryness that apply here too.
Tell the practice before the day of the appointment
Ringing ahead gives the dentist time to plan rather than adapting on arrival. Useful things to share include:
- why the tracheostomy was placed, and whether it is temporary or long term
- the type of tube, whether it has a cuff, and whether a speaking valve is used
- who manages it, such as a respiratory, ENT or community nursing team
- whether suctioning is needed during the day and who usually does it
- any recent chest infections or hospital stays
- all current medicines
Bring a carer or support person who is confident with tube care if one is usually involved, along with the spare tube and suction equipment the person normally carries. For anything beyond routine care, the dentist may want to speak with the treating medical team first. The same pattern of disclosure and coordination applies to other medical devices, as described in our articles on dental treatment with a pacemaker or ICD and dental treatment with an LVAD.
Keeping water away from the airway in the chair
Dental instruments use water spray, and in an ordinary mouth most of that is caught by suction or swallowed. With a tracheostomy, the dental team takes extra care that fluid and debris do not reach the stoma or run down towards the airway. In practice that can mean sitting more upright than usual rather than lying flat, using high-volume suction continuously, protecting the area around the neck, and sometimes isolating the tooth with a rubber sheet (a rubber dam) so water stays in a small area.
The team will also keep instruments, bibs and hands clear of the tube and its ties so nothing pulls on it. Appointments are often shorter, with pauses so the person can rest or have their airway suctioned. Because speech may be limited, agree on a simple signal, such as a raised hand, that means stop.
Routine care in a practice, complex care in hospital
Most people with a stable, long-term tracheostomy can have examinations, cleans and straightforward fillings in a general dental practice. Longer or more invasive procedures, or treatment for someone who is medically unstable or relies on a ventilator, may be safer in a hospital dental service where airway support and monitoring are close at hand. The dentist can help work out which setting suits, ideally together with the medical team.
Mouth care at home between visits
Daily cleaning matters more than any single appointment. A soft brush, used gently twice a day with fluoride toothpaste, is the base. Some points to raise with the dentist or OHT and the tracheostomy team:
- Use only a small smear of toothpaste and very little water if swallowing is difficult, and have suction available if a carer is brushing.
- Keep the person upright or slightly forward while their teeth are cleaned.
- Clean the tongue and cheeks gently, and keep the lips moist with a plain balm.
- If the mouth is dry, ask about saliva substitutes or gels before buying products, as some contain ingredients that are not suitable for everyone.
- Ask whether a higher-fluoride toothpaste or a fluoride varnish at visits would help if decay risk is raised.
A heat and moisture exchanger on the tube helps humidify the air entering the lungs. It does not moisten the mouth, so mouth care still needs its own routine.
Questions we are often asked
Can I still have a scale and clean?
Usually, yes. Hand instruments produce no spray, and ultrasonic cleaning can be done with strong suction and the person sitting up. The approach depends on how well the airway can be protected.
Does it matter if the tube has a cuff?
It is useful information for planning, which is why the dentist will ask. Whether a cuff should be inflated or deflated during treatment is a decision for the person's medical team, not something to change for a dental visit without their advice.
Will a dental visit cause a chest infection?
Careful technique aims to keep debris out of the airway. Leaving plaque and gum disease untreated is generally the bigger concern for the mouth, so regular care is worth continuing with the right precautions.
Do I need a hospital dentist?
Not necessarily. Many people are treated in general practice. Referral to a hospital-based service is considered when the procedure or medical situation calls for more support.
If you or someone you care for has a tracheostomy, call Lumi Dental in Melrose Park before booking so we can plan the visit together. You can also read about general dental care at Lumi or see our current offers.
