Brushing Teeth for Children with Autism

Parents and caregivers across the board often seek creative ways to teach their children toothbrushing and proper oral hygiene. While many children may avoid toothbrushing in favor of other activities, children diagnosed with autism may dislike brushing their teeth due to sensitivity issues.  Medical professionals typically categorize these issues either hyposensitivity or hypersensitivity.

Hyposensitivity refers to limited sensation or numbness in the oral region. This lack of sensation can cause a child to feel anxiety about the steps in the toothbrushing process. In contrast, hypersensitivity refers to heightened awareness and sensation with anything that goes on in mouth area. Children with hypersensitivity can perceive toothbrushing as unpleasant overstimulation if not performed with care.

Children in early childhood intervention and self-help programs often work with occupational therapists and speech-language pathologists to improve their oral-motor skills. Following an evaluation, these experts can often customize an individualized treatment program relative to your child’s diagnosis and need. With the right knowledge and practice, you can also help your child gain more independence in self-care at home. The following tips and tricks can help your child develop good oral hygiene practices to last a lifetime.

Choose the Right Toothbrush

Regular toothbrushes can feel foreign and unfamiliar, particularly to children with oral sensitivities. Instead of a regular toothbrush, find a toothbrush with soft or silicone bristles. These gentler toothbrushes can help desensitize your child’s mouth and gums. Many specialty or baby toothbrushes feature small silicone bristles that allow your child to gradually grow accustomed to the sensation of brushing.

Choose the Right Toothpaste

Although adults have had years to get used to mint toothpaste, this common toothpaste variety can cause a bitter or burning sensation in sensitive children. Fortunately, you can now find toothpaste in a range of child-friendly flavors like bubblegum, berry, or even vanilla ice cream. If your child is visual and enjoys experimenting with colors, you may wish to try a multicolored children’s toothpaste like GUM Crayola Squeeze-a-Color or other brands of rainbow toothpaste. Your pediatric dentist may also offer flavors that you cannot find in stores.

Try Unflavored or Fluoride-Free Toothpaste Brands

For some children, toothpaste flavor and foaming might be the cause of sensory overload. Instead of a highly flavored toothpaste, choose and unflavored and non-foaming toothpaste like Auromere or similar brands. Since the common ingredient of sodium laureth sulfate causes the foam in regular or gel toothpastes, your pediatrician may also suggest herbal or powder toothpaste instead. Similarly, children who have a hard time swallowing may need to start with non-fluoridated toothpaste instead before gradually transitioning to fluoride toothpaste to help protect their teeth.

Try Floss and Other Toothbrush Varieties

Flossing is also part of developing good oral hygiene. Let your child choose a favorite flavor. You should also consider correct sizes. Thick floss works well for teeth that are far apart while thinner flosses work better for teeth that are closer together. If you child struggles with manual floss, you can also try an electric or water flosser. Same with a toothbrush – if you child struggles to hold a regular manual toothbrush, you can try placing a tennis ball or foam grip on the handle to make it easy to hold. You may also wish to invest in an electric toothbrush or power brush to provide stimulation for children with hyposensitivity.

Teach the Appropriate Length of Time for Toothbrushing

Children can often struggle to put the right timeframe to brushing their teeth “for two minutes.” Fortunately, there are toothbrushes (such as the Crayola Timer Light toothbrush) that can light up to signify that brushing is complete. Similarly, the Clean & Play “singing” toothbrush uses a waterproof battery to play a song for two minutes until brushing is complete. If singing and lights are not your child’s style, you can simply keep a bathroom timer on the counter to help your child develop a daily routine.

Help Your Child Learn the Steps of Toothbrushing

It is often helpful to position children in front of the mirror to give them a greater sense of independence over the situation. Stand behind the child and place a pea-sized amount of toothpaste on the brush. Help the child guide the brush (as if you are brushing your own teeth).

• Brush the top front teeth (inside, outside, and chewing surfaces) five times.
• Brush the bottom front teeth (inside and outside) five times.
• Brush the bottom back teeth (outside, inside, and top surface) five times.
• Brush the top back teeth (inside, outside, and chewing surface) five times.
• Brush the middle teeth (upper and lower incisors) five times.
• Finally, brush all around the outside surfaces of teeth and rinse.

Toothbrushing instruction songs (such as “Brushing My Teeth” by Barney) can also help children memorize the steps to brushing.

If brushing teeth in front of the mirror is too overwhelming at first, you can also try brushing your child’s teeth in the bathtub. Children can often grow accustomed to the brushing sensation while technically distracted with cups or bathtub toys. In addition, this process can also help the child associate toothbrushing with washup and cleanliness.

Develop a Reward System and Routine

Children diagnosed with autism often benefit from visual supports and schedules (such as laminated wall posters, calendars, or whiteboards) to associate toothbrushing with a daily routine. You can set up a specific time for toothbrushing as well as a designated area for your child’s special supplies. Sometimes it helps to offer choice (such as letting your child choose a favorite toothpaste or toothbrush for a day). Parents can also turn toothbrushing into a game called “Your Turn, My Turn” to help guide the child through each step. Finally, consider using verbal praise or a rewards system (such as a rewards jar) to reinforce positive behavior once toothbrushing is complete.

For more information about early childhood intervention and self-help (including guidance from speech-language pathologists and occupational therapy), contact The Warren Center.

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The Warren Center

We are a nonprofit agency providing professional evaluations, therapy services, and support to thousands of children with developmental delays and disabilities each week. Our Early Childhood Intervention Program serves the entire northern half of Dallas County in 48 ZIP codes.

Services include speech, occupational and physical therapy; developmental services; and nutrition as well as family education and support.