Toothpaste troubleshooting

Sensory preparation before toothbrushing can be beneficial. You can read about sensory preparation here. Brushing after a period of active play may also be helpful. Whilst brushing the teeth, you might incorporate controlled movement whilst still supporting your child, such as rocking or swaying. This may be easier when sitting down as having increased body contact with the floor will increase stability. Music with a tempo that matches the rocking or swaying may be helpful. [Link back to safe ways to brush] You will need to think about why your child is struggling to sit still. It may be because they find it hard to balance and hold themselves upright. If this is the case a more stable, seated position may help. Moving around whilst brushing may help your child feel more regulated. They could wriggle in a beanbag whilst having their teeth brushed or be hugged and rocked gently in your lap. Some children like to move on the spot to music and you could mark the places to stand on the floor with tape. Kneeling on the ground can give more deep pressure input, or your child might like to use a foot roller whilst they sit down and brush. (It is possible to make your own which would be just as effective as a more expensive version). A raised texture play mat can be fun to explore with the feet. Other ways to gain sensory input include placing the child’s feet on a slightly inflated wobble cushion whilst standing or sitting. It is important to keep their back well supported whilst doing this. The same effect can be achieved by using a wobble wedge on the chair You could also try a wobble wedge on the chair. This can improve posture whilst offering the option of some movement. It is important to make sure the child’s feet can rest on the floor.

Rather than forcing the toothbrush in the mouth, use the methods above to encourage. Some parents find it useful to give their child an extra toothbrush. This means they can place it in their mouth while you go in with another brush. Using something to gently prop the mouth open, such as another toothbrush, a chew toy, a foam mouth prop or a clean flannel can make it easier to get a second toothbrush inside the mouth. You can use finger protectors if your child usually bites your fingers during toothbrushing. Make it a positive experience and avoid turning toothbrushing into a negative experience. If the child becomes distressed, take a break, and try again later.

There are several reasons why your child might be biting together on the toothbrush. Think about the following: Are they seeking calming deep pressure? Consider whether this can be given in a different way. It may also be necessary to evaluate the environment to see whether any of the other stimuli can be reduced such as light, sounds or smells. This would then reduce the demand on the child and allow them to conserve energy for brushing their teeth. Are they using their jaw to try and find postural stability? This can be helped by making sure the child’s body is well supported and they have enough feedback regarding where their body is in space. Allowing your child to lean on you for support may help with this. Is clamping down on the toothbrush an escape behaviour? It is important to identify what in the toothbrushing experience is not working for them and seek to modify it. If needed, professional guidance from a dentist or an occupational therapist with experience of sensory processing challenges could be beneficial.

We know that parents have reported using mouthwash. This is because mouthwash can help freshen breath in between brushing. Mouthwash is not recommended for use in children under the age of 7 so we recommend avoiding this.

Some children require higher levels of sensory input when brushing their teeth. Light-up toothbrushes, which turn off after two minutes of brushing, can visually represent the length of time needed for brushing. Brushing until the light turns off reduces the uncertainty of when toothbrushing will finish. This can help children who struggle with transitions between tasks. See some advice on supporting transitions here.

Transitioning to toothbrushing can be challenging for autistic children. Sensory preparation can help with this, please see here for more information. The use of a visual schedule will help with anticipating change. Bringing a transitional toy from the previous activity may also be beneficial. Ensuring that the new environment is prepared in advance means that the child will not have to wait when reaching the new activity which will help with the child’s frustration. You can make the trip to the bathroom a sensory adventure for your child to help with toothbrushing. Try adding a few fun activities along the way. These could be simple movements or three to four short activities you plan ahead, like jumping, squeezing a stress ball, or doing a quick dance. This can help your child feel more comfortable and ready for brushing their teeth. More examples are provided below: Climb or crawl up the stairs and bump down on bottom, climb back up Carry a weighted lap pad or sensory toy Try different animal walks – frog jumps, bunny hops, crawl like a bear, slither like a snake or crawl like a very slow turtle High kneel march and swing arms. Add a rhythm with counting, or a song Walk in slow motion like an astronaut Bend over and place both hands on a sturdy wheeled toy and push the toy to the bathroom. Add tape for ‘tracks’ Push against a wall or a person as hard as they can with extended arms. You could mark a spot at the correct height with their own handprints if using a wall or door. Turn round, bend knees and press bottom or back against wall as hard as they can. Marking the spot can be helpful. Do a simple yoga pose on the spot. Look at ‘Cosmic Kids’ for ideas Do ten jumps on the spot. You could also try this holding hands Slowly ‘walk ‘ hands up a wall to a marked spot where they have to stretch up tall and go up onto their toes. Hold for a count of 5 if they can.

It’s great that you are thinking about introducing toothbrushing into your routine. Before you begin, we recommend you watch the video 'Nikki’s Story: Small steps that make a difference'. We found a good starting point is to introduce a toothbrush as part of playtime. It is hoped that by doing it in a fun way, your child may be more willing to try toothbrushing, and see that it is not threatening.

If you want to work towards trying an electric toothbrush, introduce vibration through play first, allowing them to explore the sensation with their body and hands. Then demonstrate that the vibration might be pleasant on their face. Try vibrating pull toys, battery-operated mini massagers or vibrating cushions. IIf you have a therapy ball, you can use a mini massager on one side of the ball to create vibrations. Your child can then rest their cheek on the ball to feel the soothing vibrations. If your child is learning to brush themselves and is over-scrubbing the brush on their gums, try a massage before brushing. Massage the outside of their face along the jawline: Use medium firm pressure during the massage. Use the pads of your index and middle fingers to press along the face level with their gumline, starting from their chin and pressing and releasing outwards to level with back of gums. Repeat from centre of top lip and move outwards towards back gums. Gum massage: If your child is not prone to biting or clamping their teeth, you could try a gum massage. Use a clean finger to massage their gums. Start by placing your fingertip in the middle of the upper gums. Gently rub along the gumline towards the back of the mouth and then back towards the centre. Repeat this process on the lower gums on the same side. Then, switch to the opposite side and repeat for both upper and lower gums. Ensure your nails are very short to prevent discomfort. Apply pressure: Use a medium firm pressure during the massage. This helps provide the sensory input they seek without the intensity of an electric toothbrush. If there is a risk of your child biting, you can apply pressure externally instead of inserting your fingers into their mouth. Use the pads of your index and middle fingers to press along the gumline from the outside of the cheek. Apply medium pressure here as well.

Once a day is better than none, so this is a good place to start. When trying to introduce brushing twice a day, one time could be led by the child and the second time by the adult. Alternatively, the child could brush first on both occasions and the adult could finish the brushing afterwards. You might find the information below useful (a little is better than nothing). If needed, professional guidance from a dentist or an occupational therapist could be beneficial. They can provide personalised strategies and tools to help make tooth brushing a more positive experience. You can also look at this link here about how you can speak with your school or nursery about eating and drinking to support their overall tooth care.

Please read the guide above as there could be some toothbrushes that your child prefers (a firmer toothbrush electric toothbrush for example). Medium toothbrushes are ideal. We recommend you should avoid the use of a firm if your child brushes too hard as this may result in injury to the gums. If your child’s gums are bleeding often you may need to see the dentist. Sometimes, you might notice bleeding from the gums when brushing. If you notice any bleeding when brushing it is important to consult a dental professional. The dentist can then reassure you and the child as to the cause of any bleeding gums, and how to resolve it.

If dental plaque isn’t properly removed from your child’s teeth and gums over time, their gums can become red and inflamed. You might notice bleeding when brushing, which can make brushing uncomfortable or cause anxiety for your child. If you see any bleeding, it’s important to visit a dentist. The dentist can explain why the gums are bleeding and how to fix the problem, helping to reassure both you and your child.

This may be because of sounds, smells, what things feel like to touch, the lighting or what they can see. It may also be because the bathroom is associated with other hygiene tasks that might be uncomfortable such as having a bowel movement or bathing. See tips on creating a calm bathroom environment here.

We have had some parents talk to us about how their child won’t let them brush if they have teeth coming out or if they have wobbly teeth. This can be challenging to overcome. Often, children can be anxious about the changes happening in their mouths, so using Social Stories to explain these changes can be beneficial. If teeth are becoming wobbly and this is preventing brushing, you could try using a softer brush in these areas, or a smaller, single-tufted brush to allow brushing very carefully around the wobbly tooth. It is important to still attempt to brush around wobbly teeth because there will be an adult tooth underneath starting to grow. Once the new tooth has grown or the wobbly tooth has fallen out, it is likely that the ability to brush teeth will return, although it may take some time because there may still be the residual anxiety about potentially having pain when brushing. TOP TIP: Some families find that allowing your child to chew on a chilled flannel or sensory chew toy before and after brushing can help with this. Having two of the chosen objects would allow you to have one that is cold before and after brushing.

Proprioception helps us make sense of our touch and movement experiences and naturally helps regulate the body. Activities that include lots of deep pressure can help reduce uncomfortable responses to information received from all the other senses. Finish with at least one calming deep pressure activity – this could be a big 10 second bear hug, your child pushing against you, firmly hugging a favourite soft toy, a swaddle in a towel, massage or squash with a cushion or therapy ball, for example Find a quiet, low-stim area for your child to relax and recover with a preferred activity Look at the sensory preparation page for sensory calming ideas which can also be used after brushing

See the One Step at a Time box above.