Special Needs Kids and Toothbrushing, Part 2: Selecting Your Tools for Success

Once you have recognized the issues that contribute to your child’s difficulties, it is time to think about what brushes and toothpastes you are using.  The choices you make could improve or aggravate your situation.

Toothbrushes come in a wide range of styles and designs.  

Motorized toothbrushes frighten some kids but enchant others.  Sensory seekers are especially fond of the vibration of a motorized toothbrush.  Children with low muscle tone and low proprioceptive registration are next in line to sign up for a motorized brush.  They tend to like the increased sensory stimulation delivered with moving vibration.  Children who are poor sensory modulators may be overwhelmed by sensory input.  They start out enjoying the vibration but not be able to tolerate it enough to finish brushing all dental surfaces.  Sensitive children or children who do not understand that the toothbrush can be turned off or controlled tend to be frightened when you suggest they allow a moving object into their mouth.

Manual toothbrushes come in standard styles at the drug store, but there are specialty brushes that can work well for special needs children.  Often your child can eventually “graduate” to a standard brush after developing confidence and skill with a brush that has some adaptations.

  • Handles: Brushes with longer handles are available for parents to reach easily into another person’s mouth for toothbrushing without setting off sensory aversion.  Imagine a child who dislikes your hand pressing intermittently on his face and lips as you brush his teeth.  Longer handles limit the excessive light and unpredictable tactile contact that is known to be the most alarming to sensory sensitive children.  Some toothbrush handles have texture (not a smooth plastic shaft)  that helps weaker or unsure hands grip firmly.  Triangular or loop handles can prevent a child from placing the bristles too far back into the mouth and triggering a gag reflex.  This style is safer for the child that insists on holding his own brush.  If your child has a bite reflex or is likely to bite you while you brush, you need a thicker, firm-surfaced brush to place on the opposite side of the jaw to maintain your child’s mouth open while you brush your side.
  • Brushing surface:  You can find a 3-point bristle pattern on Surround or DenTrust brushes that make brushing faster.  All tooth surfaces get brushed in one swipe.  Bristles that are soft or extra-soft are usually tolerated more than any other bristle stiffness.

Toothpastes and mouth rinses for children tend to have less floride than adult toothpastes.  There is a reason for that:  children swallow more paste as they practice swishing and spitting.  Floride in larger quantities is known to stain teeth.  There are floride-free pastes and rinses that minimize this risk.  Xylitol is a sugar that is known to decrease bacteria build-up.  Some toothpastes/rinses will use xylitol, and you can buy mouth wipes for infants and older children that contain xylitol.  A child who is so agitated with toothbrushing may only tolerate having their teeth and tongue wiped.  I don’t believe is as effective as brushing, but it might be the first step in achieving the ultimate goal of toothbrushing.  The only concern I could find regarding xylitol is that it is known to contribute to gas and bloating.

Next:  Positioning and creating a positive environment

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