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.