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The Challenges of Toothbrushing!

Tooth brushing is very intrusive. When teaching staff to train tooth brushing, we used to have them brush each other's teeth so they see could feel how intrusive it is. When we brush our own teeth, we know how hard to brush, where we feel sensitivity, how to miss our gums, and how fast to brush. To have someone shove a toothbrush into your mouth and brush your teeth, without you controlling it, can be discomforting. Also, many of these children have strong sensory sensitivities. Kids that tend to be tactile defensive (touch) are often orally sensitive. There are a variety of strategies we can try; however, we always need to start by validating that you recognize that the brushing causes discomfort for him and that it is understandable. Then from there, try one or more of the following strategies.

1. Work slowly and talk him through it, telling him what side is next.

2. It often helps to have a set number of strokes you use for each side (top, bottom, side, front, etc.). Like five back and forth strokes. Count out each stroke. Counting gives the child a definite end. This provides predictability to the brushing, allows him to see that is will not last long, as well as provides a distraction.

3. It is best to give the child as much control over the brushing as possible. Brush five strokes on one surface, then pause and wait for the child to let you know when ready for next.

4. Let the child do as much of it as he can. Even if he does it poorly, you can go over it.

5. Throw away your toothbrush; it may be too hard of bristles. Use a soft baby toothbrush or sponge toothbrush call a toothette. These are good if the child has sensitive gums.

6. Experiment with different kinds of toothpaste to find what the child likes the best. Or, don’t use toothpaste at all. Simply use water. Some children will accept a mouth rinse on their brush.

7. Work slowly and pause whenever the child shows discomfort. Continually show the child you are working with them, pausing when discomfort occurs, and letting them control the pace of brushing.

8. Many children with oral sensitivity like to use a battery operated, vibrating toothbrush. The vibration tends to dull their oral sensitivity.

9. Have fun with it. Brush together, or you brush his teeth and let him brush yours.

10. Reinforce the child with a strong reward once the brushing is complete.

11. Put up a chart and let the child get a star for each time he brushes. After he fills up the chart (five squares, one for each star), then he gets a special reward.

12. the child doesn't like the taste of toothpaste, start with just water, no toothpaste. Then slowly put a little on. There are liquid washes that you can substitute for those who do not like paste.

13. For some kids, we use a soft washcloth over our finger to rub the teeth and gums, instead of a toothbrush.

When in doubt, stay supportive and try not to force. I know it takes time, but having someone force a toothbrush around your mouth can be very intrusive.

This series on “mentoring children on the spectrum” can be found in the green book “Autism Discussion Page on Anxiety, Behavior, School and Parenting Strategies.”

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