Autistic Children and Teeth Brushing: Expert Tips

Written by Dr Lucy Russell DClinPsyc CPsychol AFBPsS
Dr Lucy Russell Clinical Psychologist Founder of They Are The Future
Author: Dr Lucy Russell, Clinical Psychologist

As a child psychologist, I’ve specialized in working with autistic children over the last twenty years, and one common issue parents face is teeth brushing. 

This seemingly simple task can become a significant hurdle when sensory issues come into play.

Obviously this can affect not only your child’s dental care but also the family’s overall well-being because of the stress caused. 

In this article, I’ll delve into some of the teeth brushing challenges specific to autistic children, with practical parental guidance. 

If you’re a parent of an autistic child who won’t brush their teeth, I’ll aim to give you he support and knowledge you needed to tackle this tricky area of your child’s routine with confidence and understanding.

Understanding Sensory Sensitivities in Teeth Brushing

Navigating the world of sensory sensitivities with your autistic child can often feel like solving a complex puzzle, especially when it comes to oral care.

Many autistic children experience sensory sensitivity or hypersensitivity, which can deeply affect their response to teeth brushing.

It might be the pressure of the brush on their gums, the taste or texture of the toothpaste, or even its scent that can lead to sensory overload and aversion.

As a child psychologist, I can tell you that an aversion to teeth brushing can develop quickly and as you probably know if you’re reading this, it can be extremely stressful for parents.

This aversion is a sensory reaction that can cause your child to become anxious and avoidant around brushing their teeth. 

It’s important to approach this with empathy and patience, acting as a detective to uncover what specifically about the brushing experience is causing discomfort. 

Whether it’s the gag reflex triggered by certain toothpaste flavors or the overwhelming feeling of bristles against their gums, understanding your child’s triggers is the first step.

Our aim is to gently shift teeth brushing from a negative to a more positive experience, gradually easing the sensory issues associated with it.

Selecting the Right Tools

Finding the right tools for your child’s oral hygiene can be a game-changer in their daily routine.

It’s essential to remember that every child is unique, especially when it comes to sensory preferences.

This means that what works for one child may not work for another, and a bit of trial and error is often necessary.

For some children, the gentle hum and vibration of electric toothbrushes can be soothing and appealing, while others can’t tolerate this vibration and prefer the simplicity and control of a manual toothbrush.

When choosing a toothbrush, look for options with soft or silicone bristles. These are gentler on the gums and can be less overwhelming for your child’s sensory system.

Silicone toothbrushes, in particular, can offer a different texture that some children might prefer over regular toothbrushes.

The right size is crucial too. It should fit comfortably in their hand and mouth.

Toothpaste texture and taste are equally important. While gel toothpastes might appeal to some children, others might prefer the smoother texture of traditional pastes.

Child-friendly toothpaste comes in a variety of flavors, and finding one that your child enjoys can make a significant difference.

You can buy flavor-free toothpaste if this is your child’s preference. Whatever sensory-friendly oral hygiene products you try out, the overall aim is to make teeth brushing a more pleasant part of their daily routine.


Making Tooth Brushing Bearable For Autistic Children

Navigating the toothbrushing process with autistic children requires a thoughtful approach, especially when considering desensitization techniques.

Gradual desensitization involves slowly exposing a child to what they fear (i.e. brushing their teeth) to reduce their sensitivity and increase tolerance over time.

For example, if the texture of the toothpaste is an issue, a gradual desensitization plan might involve starting by adding only a minuscule amount of toothpaste. This would then be gradually increased over time.

The mixed evidence surrounding desensitization with sensory processing difficulties means that although it’s something you could consider, you need to tailor tailor your strategies to your child’s unique needs and sensitivities.

In my experience, gradual desensitization is often not an effective strategy for sensory issues.

Creating a comfortable brushing environment is essential.

For some children, taking charge and brushing their own teeth under your supervision can make a significant difference as it gives them a sense of control.

Others might find the experience more bearable with your gentle assistance, especially if navigating the toothbrush around their mouth feels very challenging.

Through experimenting with different approaches you’ll discover what makes toothbrushing manageable for your child and you.

Whether it’s adjusting the time of day, the type of toothbrush, or the level of involvement they have, each adjustment can contribute to a more positive experience.

The goal is to ensure your child’s oral care is consistent and effective, without causing undue stress for either of you.

Verbal praise and encouragement can also play a vital role, acknowledging their efforts and resilience in facing the challenges of the toothbrushing process.

child's hand holding a toothbrush

Adapting the Environment

For neurodivergent kids, adding an element of fun to teeth brushing can be one strategy to reduce overwhelm. For instance, incorporating toothbrushing songs can add an element of fun and predictability to the routine.

Music can be a relaxing auditory cue but can also help in timing, ensuring that children brush long enough to effectively clean their teeth. The rhythm and repetition of songs can be soothing and provide a structured framework for the activity.

Here’s an example from Super Simple Songs!

YouTube video

Another effective strategy is the use of visual aids, which can provide clear, step-by-step guidance through the toothbrushing process.

These visual supports range from simple picture charts to more elaborate digital apps like the Disney Magic Timer. They all offer a visual sequence that children can follow, making the abstract concept of time and sequence more concrete and manageable.

Oral hygiene games are another great way to capture the interest of young children. Games that incorporate the steps of toothbrushing into play can make the experience more interactive and less daunting for your child.

Here are a few tooth cleaning games ideas!

Brush the Alphabet: Have the child pretend their toothbrush is a paintbrush and ‘paint’ each letter of the alphabet on their teeth, ensuring a thorough clean while practicing letters.

Magic Wand: The toothbrush becomes a magic wand, and each tooth is under a spell that can only be broken by brushing it well, turning the child into a magical hero every brushing session.

Brushing Buddies: Pair up with your child for brushing sessions, each taking turns to mimic the other’s brushing style. get as silly as you like, as long as your child’s teeth get a thorough clean!

Whether it’s a game that rewards them for completing each step of the brushing process or an app that turns toothbrushing into a mission, these playful approaches can make oral care feel like a more positive part of their daily routine.

a mother helping little girl to brush teeth

Establishing a Routine For Teeth Brushing

Establishing a routine is very important to nurturing good oral hygiene habits, especially for autistic children who often thrive on predictability and structure.

Many parents use a reward system successfully as positive reinforcement for teeth brushing. However, this strategy needs careful consideration.

Reward systems like sticker charts can motivate some children. However, my concern is that they may suggest that your child is choosing not to brush their teeth willingly, rather than it being something they find extremely difficult.

It’s vital to recognize and not downplay the real challenges your child may experience.

Instead, rewards should celebrate the effort and courage it takes to overcome those challenges, rather than just the act of brushing itself. It’s possible to positively reinforce daily oral hygiene habits without undermining your child’s experiences of discomfort or overwhelm. 

Case Study: 8 Year Old Hamsa’s Difficulties With Teeth Brushing

Hamsa, a bright and engaging 8-year-old with a love for puzzles and science fiction, faced significant challenges when it came to his dental care routine. The use of a regular toothbrush was one source of distress and discomfort due as he had significant oral sensitivity. 

Also, the texture of toothpaste, combined with the taste of the toothpaste, added up to overwhelming sensory input, making Hamsa reluctant and scared to brush his teeth.

His parents, eager to make brushing fun and less of a battle, knew they needed to find a solution that accommodated his oral sensitivities.

The first steps towards overcoming Hamsa’s aversion involved switching to a toothbrush with soft bristles, which provided a gentler approach to his sensitive gums. This small change was a great way to reduce the discomfort Hamsa felt.

It made the brushing experience more bearable. 

Additionally, experimenting with different toothpaste flavors helped in finding one that Hamsa found more bearable, further minimizing the sensory overload.

These adjustments, coupled with positive reinforcement and using games to make the brushing process a fun activity, gradually helped Hamsa feel more comfortable about brushing his teeth.

It transformed teeth brushing from a dreaded task into an (almost!) enjoyable part of his daily routine.

He even looked forward to his next dental checkup to show off his progress!

a little boy showing anxiety about brushing his teeth

Getting Further Help For Children’s Teeth Brushing Struggles

If your child struggles with teeth brushing despite your best efforts, the next step may be to seek professional help from either a paediatric occupational psychologist or a child clinical psychologist.

Consulting with an occupational therapist can provide tailored strategies and occupational therapy techniques specifically designed for your child’s needs. 

Regular dental appointments are, of course, crucial for maintaining dental health and preventing dental problems and the dentist may be able to give you valuable advice about your child’s difficulties. 

It’s also a good idea to use social stories about dental visits to prepare your child, making the experience less intimidating. By providing a clear, step-by-step explanation of what to expect, social stories can help children feel more prepared and less anxious about visiting the dentist.

The ultimate goal is to ensure your child’s comfort and well-being, both at home and during dental visits, with the right support and resources.

What To Do If Your Autistic Child Struggles to Brush Their Teeth: Summary 

When autistic children struggle with brushing their teeth and dental hygiene, our approach must be grounded in empathy and understanding.

It’s important that we try to see the world from their perspective, considering the sensory issues that might make brushing their teeth challenging or even scary.

Adapt your tools, strategies, and environment to create a more comfortable and positive experience for them.

With parental support, professional guidance if needed, and a tailored approach, you can help your child overcome these hurdles, ensuring they thrive with autism while maintaining the health of their teeth and feeling good about brushing.

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The Crucial Impact of Interoception For Your Autistic Child

Empowering Autistic Children: Top 10 Autism Classroom Ideas For Every Teacher and Parent to Know

Autism and Anxiety: Supporting Children in an Imperfect World

Dr Lucy Russell is a UK clinical psychologist who works with children and families. Her work involves both therapeutic support and autism assessments. She is the Clinical Director of Everlief Child Psychology, and also worked in the National Health Service for many years.

In 2019 Lucy launched They Are The Future, a support website for parents of school-aged children. Through TATF Lucy is passionate about giving practical, manageable strategies to parents who may otherwise struggle to find the support they need.

Lucy is a mum to two teenage children. She lives in Buckinghamshire with her husband, children, rescue dog and three rescue cats. She enjoys caravanning and outdoor living, singing and musical theatre.

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