structures (enamel, dentin & cementum) by exposure to acids not caused by bacteria. in the case of individuals fed by gastric tube, acid may enter the oral cavity through reflux of gastric contents. gastroesophageal reflux (ger) affects up to 67% of children and young adults with central nervous system dysfunction, a condition which in itself is normally an indicator for tube feeding. the effects of gastric acid on the teeth may sometimes be masked or minimized by the abundance of calculus. tube feeding may either resolve, exacerbate or introduce the issue of ger in individuals. aspiration pneumonia individuals fed by tube are susceptible to aspiration through a multitude of factors. firstly, undisturbed plaque is known to shift towards the type of bacteria (gram-negative anaerobic) implicated in aspiration pneumonia. additionally, tube-fed patients are commonly affected by gastroesophageal reflux and a breakdown in the airway protection reflex (breathing while swallowing). this results in the inadvertent inhalation of bacteria-containing gastric juices as they are re-swallowed, leading to the development of aspiration pneumonia. oral hypersensitivity while a child undergoes a period of tube-feeding, there is a lack of oral stimulation that can lead to the development of oral hypersensitivity. this can complicate the delivery of dental care and serve as a barrier for the child’s return to oral feeding. this can also lead to dysphagia (difficulty swallowing), muscle weakness and improper airway protection, resulting in longer periods of tube-feeding and increased risk of dental complications. a dentist may prescribe a “desensitization program”, which involves routine stimulation of intra-oral and extra-oral structures, and encourage oral hygiene procedures to be performed at home. history while enemas were previously used for supplemental enteral nutrition, the practice of surgically inserting feeding tubes emerged in the mid to late 1800s. initially, these procedures were largely unsuccessful, but they quickly improved with advancements in technique. originally, the nasogastric tube (ngt) was described by john hunter in the 18th century as a combination of eelskin and whalebone. it was initially utilized to provide liquid nutrition to the ill.