A DAILY CRISIS: Tooth brushing is a daily crisis for many families who have a child with autism. A mother of a 4 year old told me she dreaded brushing her child's teeth more than any other daily activity. Her son cried, screamed and fought the toothbrush. He clamped his mouth shut, turned his head sideways
and refused to cooperate. Another told me that her daughter "had a conniption" as soon as he saw her putting the toothpaste on the brush. But tooth brushing can become an accepted daily routine like any other activity if approached the right way.
CREATE A ROUTINE: According to the American Dental Association, tooth brushing should be a regular daily routine by the time a child is 2 years old and by 6 or 7, children should be able to brush their own teeth twice a day with supervision. Children with ASDs are creatures of habit, and are more likely to cooperate if tooth brushing is always done at the same time and the same routine is followed. Brushing after breakfast and before bedtime are usually good times because they are invariable parts of every day's routines.
CHILD'S PERSPECTIVE: If we consider tooth brushing from the childs vantage point it makes no sense. Why would they put something in their mouth, move it around and then spit it out. The only things they put in their mouths are food or beverages, which they swallow, or their thumb or pacifier that they suck. Toothpaste doesn't taste like food and a toothbrush isn't very much like a pacifier. To the child it is a weird activity that doesn’t feel right, and we all know how children with ASDs react to things that don't feel right.
INITIAL GOAL: The initial goal is to help the child accept placing the a toothbrush with a small amount of appealingly flavored toothpaste his or her mouth, swish it around, and then spit it out in the bathroom sink.
SOFT TOOTH BRUSHES: Children who resist tooth brushing either dislike the feeling of the brush on their teeth and gums, or they dislike the taste of the toothpaste. Several companies manufacture soft or ultrasoft toothbrushes. Amazing Products Store http://www.pacwestserv.com/index.htm sells ultrasoft tooth brushes for children and flavored toothpastes and gels. Soft toothbrushes have nylon bristles of 0.007" diameter or less. These bristles are soft enough to remove sticky plaque but not so hard that they cause damage to the soft tissues of the gum. The Biotene Toothbrush Super Soft with 0.003 diameter bristles is even softer. All bristles should be end-rounded, which means that the toothbrush maker has run the bristle tips through a polishing machine to round the rough cut ends of the filaments. Some companies advertise their toothbrushes as being soft, but they arent, so consumers must check with the company to make certain the bristles are under .007 inches (preferably smaller).
FLAVORED TOOTHPASTE; For a 2-3 year old child a pea-sized amount of toothpaste is sufficient. Flavored toothpastes usually overcome the dislike for the stringent mint taste of most tooth pastes. While several tooth pastes sold by the Amazing Products Store (above) are mint flavored, they also offer strawberry, strawberry-banana, cherry, herbal bubble-gum, and mango flavored toothpastes or gels. Breath Palette.Com sells a variety of flavored toothpastes, such as Fresh Yogurt, Monkey Banana, Kiwi Fruit, Strawberry, Blueberry, at least one of which is likely to be appealing to your child. The toothpaste is sold in the US by Bravo Port, Inc., P.O.Box 1712, Sausalito, California.
REWARD PROGRESS: Before beginning tooth brushing training, figure out how you are going to reward your child for cooperating. If they have a favorite short video, allow them to watch it immediately after breakfast tooth brushing. In the evening, if they enjoy playing a specific game, plan to play the game with them as soon as their bed-time brushing routine is complete. If you are inconsistent, the procedure won't work.
DESENSITIZE TO BRUSHING: Begin by placing a very small amount of flavored toothpaste on the childs finger and encourage them to taste it by placing it in their mouth. Because the child has control over what they put in their own mouth this tends to work better than it being placed there by a parent. Once the child discovers they like the taste, the next step is to place a small amount on a child size soft bristle tooth brush, and allow them to place the brush in their own mouth with manual guidance. Say "Brush your teeth". They will usually suck or chew on the bristles. Thats OK for now. This should be repeated for at least 3-4 days.
The next step is to manually guide their hand so the bristles brush lightly across their tongue once or twice. Encourage your child to spit out the toothpaste rather than swallowing it, but that is often difficult to manage with younger children with ASDs. For the first few days, the child may spit out other things, like broccoli at the dinner table, but with practice that will stop. Next, guide the childs hand so they feel the bristles brushing lightly once over the outside of upper teeth and lower teeth. If they resist, say "OK, were almost done", and stop as soon as possible. Remember, always reward them immediately after they have spit out the toothpaste and wiped their face. Within a week or two most children will tolerate brushing upper and lower teeth on the inside and outside surfaces. Over the next two weeks gradually increase the length of time you brush, from 15 seconds to 30 seconds, to one minute, and so on.
FADING TO NORMAL TOOTHPASTE; Parents may decide to continue using the exotically flavored toothpaste or eventually fade in the more conventional toothpastes, selecting one with the least flavoring. Specialty stores often sell very mildly mint flavored toothpastes that can be gradually mixed with one of the fruit flavored toothpastes or gels, and then fading from one of the exotic flavors to standard flavor most children will accept over several weeks.
SELF SUFFICIENCY: At some point most children indicate they want to brush their own teeth, and all you have to do as a parent is observe and assist with rinsing the toothbrush and making certain they have wiped the excess toothpaste off their face. Children should be able to brush alone by age seven.
HYGIENE: Do not allow your child to share her/his toothbrush with a sibling. Sharing a toothbrush can result in risk for transferring colds or other infections. Thoroughly rinse toothbrushes with a strong stream of tap water after brushing to remove any remaining toothpaste and debris. Store the brush in an upright position and allow the toothbrush to air-dry until used again. Do not cover toothbrushes or store them in closed containers. A moist environment such as a closed container is more likely to lead to growth of microorganisms than the open air. Replace toothbrushes every three to four months. Some of the softer toothbrushes need to be replaced more frequently, especially if a child chews on the bristles during the first few weeks of learning to brush.
Patience, patience, patience!!!