Many parents find toothbrushing challenging. The sensation could be uncomfortable, the child may not like the taste. Desensitisation may be helpful. If it does not get easier over a period, seeking advice from an occupational therapist may be worthwhile as maintaining good oral hygiene is a very important part of ensuring good oral health and general health.
There are many types of toothbrushes available. In general, one with a small head and soft bristles is preferable. There are other manual toothbrushes with larger handle for better grip. Some children with ASD like using an electric toothbrush and may find the vibration soothing. Every child is different so you would need to try a few different types of toothbrushes before you find one that is most suitable and easy for you or your child to use. Most children require assistance by an adult with toothbrushing. A rule-of-thumb is if a child can tie up their own shoelaces, they may have adequate co-oridnation skills to brush their own teeth properly.
Take one step at a time. You may need to teach your child to 'open wide' first, or show them how you brush your teeth. If they are orally defensive, try brushing their lips first or just the cheek of the mouth. You or your child may find using a visual aid helpful. We have included an example of visual aid here you can modify. This series of photos demonstrate where one needs to focus on when brushing the teeth and although the visual aid may not be suitable for all children with ASD, it may still be valuable for the parents/carers to look through.
Some toothpaste has stronger flavour than others. If the child does not like the strong minty taste of toothpaste, there are other mild-mint or fruity flavour ones available. Toothpaste with fluoride is recommended for prevention of dental decay. You can also try brushing the teeth with a smear of toothpaste on a dry toothbrush. This reduces the amount of foaming up and may be more acceptable to some children. Some toothpaste do not contain foaming agent - sodium lauryl sulphate - and do not foam up as much.
Toothbrushing tips (may not be suitable for all children with ASD, read the tips and modify them to suit you and your child to help establish a good brushing routine)
If you are brushing your child's teeth
Stand behind your child and use one head to support their head or chin and the hand hand for toothbrushing
If your child tend to bite or chew onto the toothbrush, give them an old toothbrush to bite on and use another one for brushing
If your child is not comfortable with the standing position, try lying them on the sofa/lounge, bean bag, on the floor between your legs to keep them comfortable that way
Distraction like brushing in front of the tv, having music on may make things easier for some children
Flexiliby (with time of brushing, place, position) is important
Some children with ASD may prefer setting time limits for each task. Using a timer could be suitable so the child will know when the brushing will finish
Set the number of strokes for each side of the teeth (for example, brush five times on the outside top left side of the teeth)
Use a visual aid (example provided here) - can be in form of a series of photos, flash cards, poster, App, digital photo frame
What you can do to prevent dental decay/caries
Attend the dentist regularly
Toothbrushing with fluoride toothpaste at least twice a day
Healthy diet and drink only water wherever possible. Avoid food that is high in sugar or hidden sugar
Check your child's teeth routinely, for example, by lifting their lips to check for white/brown spots or cavities
Dental decay is a balance between preventive (for example, brushing with fluoride toothpaste) and risk (e.g. snacking on sugary snacks throughout the day, drinking soft drinks) factors. As long as the balance is tip towards 'preventive', then dental caries will not occur. That means if you cannot control some of the preventive or risk factors (e.g not able to change the type of drink your child prefers), then you would need to work harder on the preventive side of things to ensure the balance won't be tipped towards the risk factors side and dental decay will occur.
Lift the Lip
For young children, you can routinely lift their lip and look for early signs of dental caries at home
In South Australia, the SA Dental Service promotes Lift the Lip program. Click here for more information.
Before the appointment
Many parents or carers of children with ASD do not tell the children about their dental visit until the last minute or on the day of the appointment. This could be due to past negative experiences, uncertainly of new experiences, or to avoid causing a behaviour change. However, in most situations, it is better to try and inform children with ASD about the dental appointment as early as possible. This can be difficult if the child's concept of time is poor or non-communicatiive. The use of visual aids could be useful for some children. This could involve a calander, images, social stories. Ask whether the dental clinic have photos you can look at, or pictures on a website, so you can review with your child before the appointment. Further ideas and examples on an example visual aids we developed regarding visiting the dentist could be find here.
If it is the child's first time to the dentist, it may be a good idea to contact the dental staff by giving them as much information about your child and your child's (and yours) specific preferences as possible (e.g. time of the day, to be allowed to wear headphones to listen to music in the clinic, quiet waiting area, allow a longer time slot, avoid waiting too long in the waiting room) so they can be aware and make adaptations or arrangements to suite your child's need where possible. You may be visiting a dental team who have a reputation of looking after children with ASD. If you are unsure about their experience, it is perfectly fine to ask them their past experience with treating with children or individuals with ASD or their awareness of ASD in general. It may be a good opportunity to raise awareness of the special needs of children with ASD with an eager and passionate dental team even if they have limited experiences with treatming children with ASD. However, if you are uncomfortable with their answers or communications before the appointment, it may be worthwhile to ask for recommendations of which dentist to go to from your local organisations or support groups. Click here to find out the different types of dentists or dental service providers.
Seeking other professional imput, for example, from occupational therapists, psychologists, could be worthwhile for some children with ASD.
You may want to practice lying your child back and have they open their mouth wide at home. Practice brushing with an electric toothbrush may help with desensitising your child to the use of some dental instruments. There are disposable dental mirror available you may want to get for practising at home.
Most dental clinics require a new patient and medical form to be completed prior to the first appointment. It may be worthwhile to ask the clinic to email you a copy (or collect from the clinic prior to the appointment) and fill in the form at home before the appointment, and return to the clinic earlier if possible. This will provide the dental team more information about your child in advance, and more importantly, avoid prolonging the length of waiting period in the waiting room.
While you are waiting
It is a good idea to take your child's comfort item, fiddle toy, or distractor (e.g. electronic device, headphones) to help occupy or distract them. These items can also be used during the dental visit if possible. If you think your child copes better waiting in the car and prefers to do so, you can let the dental staff know in advance or call ahead to see if they are running on time. You may also want to bring a family member, a friend, or another carer to help provide support and make the visit easier.
During the appointment
The movement of the dental chair alone may be upsetting for some children. You can ask the dentist to lay the chair back first before sitting your child onto the chair, or ask the dentist to demonstrate how the chair moves first.
Some children with ASD are very sensitive to bright light. Some dentists provide sunglasses to wear for the visit, you can bring along your child's own sunglasses to use.
If your child is particularly sensitive to noise. Wearing headphones and listening to music or audio can be a good distract during the visit. Earplugs is another option if your child is happy to wear them.
Don't hesitate to suggest ways the dental team can do to make the dental visit easier for your child. You know your child best and should feel comfortable and in control. It's also fine to ask questions and more information about the treatment options until you understand and are comfortable with the discussions.
After the appointment
It is a good idea to follow up on your dentist's suggestions or recommendations. For example, using an electric toothbrush, home care, and other preventive care. Feel free to talk to the dental team about what can be improved to make it better for your child's next dental visit.
Lift the Lip
Going to the Dentist
Going to the dentist can be challanging at times.
Some parents are so worried about how their children with ASD will cope at the dentist and avoid going in the first place. This is not ideal as if the teeth are not checked routinely, early problems can be missed and once the problem becomes symptomatic, extensive treatment, sometimes a general anaesthetic procedure may be required. It is always best to see the dentist routinely starting at an early age to get your child familiarised with the dental clinic, dental staff, simple procedures, and to prevent problems to happen in the first place. Visiting the dentist should not be a stressful experience.
There are some strategies one can consider before, during, and after the dental appointments to make it easier for you and your child to visit the dentist. Of course every child is different and you would know your child best and can use some of the ideas from this website to come up with your own set of strategies tailored to your child's need.