Sunday, January 13, 2019

Autistic Life Skills: Toothbrushing

Full Disclosure: I don’t get any money for telling you what products I use, like, or don’t like. My opinions are just that, my opinions. There are no product links on this page. I assume you know how to use google.

My goal, in this “Autistic Life Skills” series is simple. To, hopefully, provide a more comprehensive understanding of the complexities of developing skills that incorporate sensory challenges, so that other teachers and parents (and other autistics who struggle with those same skills) might find some guidance to approach the teaching of these skills with less frustration on everyone’s part. Hopefully, a way to end the episodes of “wrestling a crocodile” (as the parent of one of my students describes their nightly toothbrushing routine.)

As a child, I was lucky that toothbrushing was never a battle my mother chose to pick. I thought I was very clever in the ways I hid the fact that I wouldn’t do it from her. I wasn’t; she just chose not to fight me about it. Through the luck of good genetics and floride in the water, I never got a cavity, but that luck certainly had nothing to do with my (lack of) toothbrushing.

I was in my 30s when I stopped getting nauseous and sometimes physically sick at the dentist, because I was able to advocate for myself to not get any flavored pastes (they make me sick) and to skip the floride treatment (the texture and taste - yes I can taste it!) makes me gag.

I was nearly 40 when I finally developed a tolerance for the electric toothbrushes that the dentist recommended. I still hate the Sonicare ones and won’t use them. But I worked my way up with the pulsar ones (the vibrating ones that look like manual toothbrushes) and now can use the Oral-B electric toothbrush (well, the CVS generic version!) They have a smaller brush head that means the vibrational input in my mouth is more localized, and the handle doesn’t vibrate as dramatically, so I get the input (and cleaning power) without my whole face, hand, and arm vibrating, which I never could stand. I’m still waiting for the dentist to tell me that my toothbrushing has gotten good enough that I can stop going every three months. Maybe next time?

Why do I tell that story? Because most of my students do not have the language to explain things as clearly as I just did. And yet, as verbal and generally self-aware as I am, look at how long it took for me to figure it out and find relief. I’m not saying that everyone with sensory challenges experiences dental hygiene the same way I did. I’m saying these are the places to start looking when a student struggles.

Especially when working with an older student, it’s important to recognize that there is likely a trauma component to the resistance to learning this skill. Do your research: what’s been tried in the past? How does the routine go at home? What are dental visits like? For many of our students, it’s a battle of wills with the parent at home, and either restraint or sedation at the dentist office. This is a breeding ground for trauma. You can’t start with sensory desensitization, or do sensory desensitization alone, and expect it to be effective. It might be effective in the classroom if they have a positive relationship with you, but it won’t transfer to the home environment. You have to work with the student and the parent to build trust around the routine and more positive associations.

What does that look like in practice?

We start by getting the student to hold the toothbrush.
Then we work on bringing to their face (any part accepted)
Slowly we work toward bringing to the lips.
Next is getting them to open their mouth.
Once they will hold it in their mouth for a count of 10 we can start putting it in each section of the mouth.
Then work toward top and bottom of each section.
Only after that do I introduce the “brushing” motion.

Some students can and will skip steps.
Some students do better starting with the vibration on.
The vibration scares some students away (like it did me.)
For some students we alternate: do each step without and then with vibration before moving on to the next step.
That’s going to depend on their sensory profile, and also where their sensory regulation is that day. (I know I’m more sensory defensive when I’m anxious or tired.)


Toothbrushing is a challenge, but it shouldn’t be a battle. Take on the challenge, work with your student, but know when to pick your battles and don’t make it a battle you choose to pick. 

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