Dental tool kit: Caregivers and autistic loved ones
At home
In this section for Caregivers and autistic loved ones: At home | At the dentist | Autistic perspective
Getting started at home in the early years
Good dental hygiene habits for a child start at infancy, according to the American Academy of Pediatrics. Parents and caregivers should wipe their gums with a soft cloth after each feeding. When the child’s first tooth pops through, it is time to use a small, soft toothbrush designed for infants. Establishing a dental routine like this at a set time every day, and eventually twice a day, is one of the most important things you can do for your child.
“We use a toothbrush that is connected to an app - so it's a game - making sure each area is adequately brushed for long enough. We have also used toothbrushes that have lights or vibrating prompts when it is time to switch areas.”
- Lindsay Austin, Autism Speaks Legal, Risk and Compliance Director
Brushing
Starting at age 2, children can start learning to brush their own teeth and about the importance of doing it twice a day. But brushing can be difficult for those with autism. Among the issues they can experience: sensory issues with a toothbrush or with the texture or taste of toothpaste, difficulty with fine motor skills, behaviors that require extra care and attention during brushing, anxiety or general fear of what might happen or just a general aversion to doing it.
But with patience, practice and maybe even rewards, your autistic loved one can get used to brushing and even learn to independently brush regularly. The following are tips from dental professionals, medical providers, autistic adults and parents of autistic children to help you and your loved get to that point.
- Let your loved one pick out their toothbrush if they are willing and able. You just want to make sure the brush is the right size for their mouth and that it has soft bristles. Your dentist can recommend some and can typically give you samples before you go and buy one. Major brands now offer several options in a variety of colors, with popular characters. It is best to start with a manual toothbrush. But powered toothbrushes are safe if the child can handle using them, tolerate the noise and is comfortable with the vibration. Many now come with music, lights and built-in timers to help control the brushing experience and keep it engaging.
- If you or your loved one has an aversion to a standard toothbrush, there are alternatives on the market, advertised as no-fuss, sensory-friendly and even autism-friendly. Just make sure they have the American Dental Association (ADA) Seal —your assurance that the product has been objectively evaluated for safety and efficacy by the ADA Council on Scientific Affairs.
- Let your loved one pick out a toothbrush holder and pick out a safe, clean spot for it.
- Let your loved one pick out a toothpaste that contains the age-appropriate amount of fluoride. Like with toothbrushes, many brands have character-themed tubes, and come in a variety of flavors.
- Showing a loved one how you brush your own teeth can be helpful. Letting them brush their teeth next to you, or practice with a dry toothbrush, is too.
- Create a visual chart outlining the steps to brushing teeth and hang it near the bathroom sink. Or use erasable markers and write the steps on the bathroom mirror.
Ten steps to brushing
- Put toothpaste on the toothbrush. (For those just starting to use a toothbrush and toothpaste, the ADA recommends a rice-sized smear for children ages 0 to 3 years. For those ages three and up to adult, a pea-size amount should be used.)
- Brush the bottom back teeth first. Start on the right side. Gently move the toothbrush back and forth on the outside, inside and top (chewing surface) of the bottom back teeth five times. Repeat on the left side. Pause and spit out any toothpaste into the sink, if needed.
- Move up and brush the top back teeth. Start on the right side. Gently move the toothbrush back and forth on the inside, outside and bottom (chewing surfaces) five times. Repeat on the left side. Pause and spit out any toothpaste into the sink, if needed.
- Brush the bottom front teeth outside and inside five times. Pause and spit out any toothpaste into the sink, if needed.
- Move to the top front teeth and brush the outside and inside five times. Pause and spit out any toothpaste into the sink, if needed.
- Brush the top front teeth inside, outside, and chewing surfaces five times. Pause and spit out any toothpaste into the sink, if needed.
- Brush the tongue gently.
- Rinse the mouth with water and spit the toothpaste into the sink.
- Rinse the toothbrush and put it back in the toothbrush holder.
- Put the cap on the toothpaste.
Flossing
Another important part of oral health is flossing.
Just like brushing, this should be introduced early, as soon as a child has two teeth touching. Also like brushing, flossing can prevent some issues with autistic people. To help, instead of using your typical 18-inch-long piece of floss wrapped around your fingers, consider alternatives like handheld flossers. Like toothbrushes and toothpaste, they come in different colors and with character themes and typically are ergonomically friendly making them easy to hold. Or even use a water flosser if your loved one can handle the gentle stream of pulsating water on their gums. You should also do a show-and-tell with them using whichever method they can handle and be prepared to help them as needed. Do not worry about flossing before or after brushing. Both are acceptable so let your loved one pick which they prefer. The most important thing is to make sure they floss between each tooth. Unlike brushing, you only need to floss once a day. So either let your loved one pick whether they prefer to do it morning or night, or pick which time works best with their mood, and then make it part of their routine.
Other tips
Get a timer and set it for two minutes. For many autistic children it is helpful to see their progress and be able to countdown to being done.
Put a clock in the bathroom with an alarm that is set to ring for the time in the morning and the evening when the child should brush their teeth.
Overcome struggles & track progress
If your child struggles to hold a standard manual toothbrush, try placing a tennis ball or foam grip on the handle to make it easy to hold.
Keep a daily progress chart each week and reward your child when they successfully fill it out. Maybe you give them a favorite candy, drink or other treat that is on the list of sugary treats the dentist says to only have on special occasions. Or take a cue from the dentist office: have a grab bag of trinkets and let them pick from it.
