Helping People with Sensitivities to Brush their Teeth

Kids on the autism spectrum have a lot of difficulty brushing their teeth. That's because there are so many sensitive areas in the mouth, because toothpaste has a very strong smell and because as a general rule, we don't teach dental hygiene well enough to kids on the spectrum.

Image by Steve Buissinne from Pixabay

The most common problems that kids and adults have with brushing their teeth are as follows;

• knowing when to do it
• knowing when to stop
• brush texture and pressure
• the taste of toothpaste
• other forms of dental hygiene
• cleaning and cleaning everything away

The reason that I've broken this up into so many steps is that children with autism don't always pick these things up naturally just by watching others. Often, you really do have to break up "simple tasks" into steps.

Knowing when to do it

Apart from the obvious routine of every morning and/or every night (nights are generally better), there's a few other things that need to be handled.  First of all, as a parent, you need to stress that brushing your teeth is not a part of personal hygiene that can be skipped.  If your kid is allowed to skip brushing once, you'll be surprised at how quickly they'll decide that skipping is okay.

The other part of knowing when to brush your teeth comes from understanding that you may have issues and motivating yourself to do something about them.  For many of us, it's natural that after eating garlic or onions, a good brushing is in order.  Our children (and adults) with on the spectrum won't always realise that (a). they have bad breath and (b). that it can offend people.

Bad breath is one of those topics which when broached can send the recipient of the news into a fit of anger.  Perhaps you have seen the episode of Doc Martin where he is about to have first kiss with a very suitable partner only to comment on her dental hygiene right before the event? The results are catastrophic.

People with aspergers syndrome often get into a lot of trouble for commenting on someone else's breath but with neurotypicals, it's the opposite. Their comments are often careful, considered and indirect.  For example they may say "have you been eating garlic?".  

A person on the spectrum may answer this question with a yes or a no but the real statement being made is; "Your breath stinks, will you go and deal with it?". We need to teach our children to interpret these types of questions.

Knowing when to stop

How do you know when to stop brushing your teeth?  When you're done right? For a start, your child needs to be reminded to brush all of their teeth, those which are visible and those which are not. They may also need to be specifically reminded to brush invisible surfaces, such as behind the front teeth.

A good rule of thumb can be that if the teeth feel rough on the tongue, brush until they're smooth - not all kids will get this though.  

In her book "The parents guide to teaching kids with aspergers syndrome and similar ASD's real life skills for independence" (reviewed very soon),  author Patricia Romanowski Bashe suggests that kids sing happy birthday through twice in their heads while brushing.  It's as good a timer as any.

Brush texture and pressure

Many children with asd's have "sensory issues" and certain types of toothbrushes will send shivers down their spine. If your child has problems with one brush, don't keep forcing them to use it.  Try other brushes.  The latest gimmicky brushes with tongue scrapers on the back may seem like a great idea but remember that the tongue scrapers have an additional texture of their own and sometimes it all becomes too much. Often a simpler brush is better - ideally one emblazoned with a character associated with your child's special interest.

Some children find that electric toothbrushes are easier or more exciting but not all do.  A gimmicky toothbrush isn't necessarily going to increase the chances of teeth being brushed.and some kids find the vibration and noise a bit too sensory or frightening.

There's also the matter of knowing how much pressure to apply. Some children don't apply much pressure at all while other press until their gums bleed.  While a little bleeding is ok, putting too much pressure on teeth can damage their enamel.  You may have to do a little hand-over-hand work with your child to get the pressure right.

The taste of Toothpaste

Some children find toothpaste so unappealing that they can't use it.  If that's the case, start brushing with just water (it's better than nothing) until your child has a bit of a technique, then gradually introduce very small amounts of toothpaste.  If your child doesn't like one toothpaste, try others, sometimes the gels or the bicarbonate toothpaste is less abrasive than the normal stuff.  Don't forget that there are children's toothpastes on the market too - and you should be using them for younger kids.

The other thing to remind the kids about is that toothpaste is for teeth brushing.  It's not glue (even though you'll probably find it squeezed into cracks everywhere).  It's also not for general eating.  Believe it or not, there are some kids out there who like the taste of toothpaste so much that they'll try to put it on sandwiches. It's generally not something you swallow.

When I was younger, I used to have terrible issues with spitting.  I guess I must have had a lot of lectures from my parents or something but I ended up not being able to see myself spit and as a result, I often didn't rinse and swallowed the toothpaste.  It took me a long while to realize that I could just close my eyes for this bit.

Other forms of Dental Hygiene

There are other forms of dental hygiene that your kids need to be aware of.  These include flossing and tongue scrapers, both of which can lead to massive sensory issues. There's also mouthwash to be considered (the ultimate in taste reaction) and things such as toothpicks.

Your child should know what these other items are for and why we might use them but it's really not worth trying to enforce them at early ages as the sensory issues cause way too much trouble.

The other thing to remember is that your child will need to visit a dentist every so often.  Make sure that the dentist is aware of their needs and sensitivities.  Believe it or not, there are actually dentists and clinics which specialise in kids with special needs. Make sure that you go to one of those and be prepared to take several trips to get something done that most children would do in one.  Sometimes it takes our kids a while to just get used to the chair, the lights and the feeling of things in their mouths.

Cleaning  and clearing everything away

The last point about dental hygiene at home is that a dirty toothbrush isn't going to do anyone any good. Make sure that you inspect your child's toothbrush regularly to ensure that it is both clean and serviceable.  Many people simply aren't aware that a toothbrush has reached a point where it is no longer effective.  If nothing else, then at least encourage your adults and teens on the spectrum to replace their toothbrush annually.

Being clean also means, clearing off bathroom benchtops and putting the lid on the toothpaste.  Make sure that you child knows that you can't just hold the toothbrush under water for a few seconds to clean it. They need to run their fingers through the bristles underwater too.