DISCLOSURE: Noelle Copeland RDH is an Oral Care Specialist and Dental Consultant who provides content for Brilliant Oral Care and Baby Buddy.
Autism spectrum disorder (ASD) varies widely and is complex in its challenges and coexisting conditions. As a healthcare provider, I am very aware of meeting the needs of my patients, no matter who they are or what their struggles may be. Those needs are not always physical either; I have found, in many instances, I must meet someone’s emotional and sensory needs first before they will allow me to meet any other requirements. Autism is particularly specific when it comes to this circumstance.
I would never try to compartmentalize oral care for a child with autism down to any rigid set of tips. I don’t think it’s possible, and personalized oral care is always best. However, there are three foundational considerations to implement for autistic children regarding dental care at home and how that carries over into professional intervention.
#1 Start Oral Care Early
Starting oral care early is the #1 preventative tool for anyone and everyone, which is why I advocate it so rigidly. For families of children with autism, this can be a game-changer early on. Autism is often not fully diagnosed until sometime after age two and can go well beyond that even into the teen years. Autism typically has some sort of “highly sensitive sensory measure” that can make oral care a potential challenge.
When a routine is started early in infancy, a child comes to expect it and may often find comfort in its repetitiveness. My children knew that bedtime meant rocking in the red chair with mommy, reading a book, and twirling my hair. My youngest child refused any other piece of furniture; it always HAD to be the red rocking chair. Children with autism might respond in this same way, but they typically have a much harder time letting go of an established routine, so keep an oral care routine as a regular, comforting part of the schedule.
- Start wiping your infant’s mouth after feedings.
- Use silicone toothbrushes to brush and rub their gums starting at three months old.
- Whenever the “First Tooth” erupts, introduce a soft bristle toothbrush.
- Use pastes and gels with fluoride and Xylitol to help protect the teeth.
- Be cautious of strong mint or cinnamon flavors.
- Floss their teeth for them.
- Train them to help with oral care, but plan to be the one doing all the toothbrushing to remove plaque and bacteria.
- Find a pediatric dentist early, before age 1. Plan to see a professional that specializes in special needs oral care if needed.
#2 Make Oral Care a Familiar Process
ASD seems to thrive vividly on familiarity with routine, faces, and surroundings. Understanding this might mean eating at the same time every day or eating the same foods every day; it may also mean wearing the same type of fabric or clothing style or using the same design or style in hygiene products, like a toothbrush. I once had a precious patient who would only use a particular blue race car toothbrush for oral care. His mother had successfully gotten an oral care routine established, but she was concerned about providing this same toothbrush for the rest of his life. She bought it in bulk as often as possible but asked me to help her integrate something similar but simpler and less specific. We eventually settled on a blue toothbrush that was the same color, but we had to name it, which helped him acclimate to the new brush. The name was simple but meant something to him, so he accepted it with a little bit of encouragement and excitement. If I could suggest anything for ASD parents and their children, it would be the following:
- Use appropriately sized products, not too big, not too small, and something you, as the parent, are comfortable holding since you will be doing all of the oral care.
- Keep it “simple” as much as possible. Of course, if you are struggling and need whatever tool has all the bells and whistles that make a task or routine easier, then, by all means, do whatever you need to. But start simple and go from there.
- One step at a time. If you can’t get toothbrushing done in one session, split it up into several mini sessions.
- Tell-Show-Do. Sometimes this involves you, as the parent, too. I’ve had great success in instructing parents to allow their ASD child to brush their adult teeth; at the same time, they are brushing their child’s teeth.
- Use language they understand and accept. Now, this is the exception to keeping it simple. If your ASD child LOVES something specific, then utilize that in language or drama for cooperation. This could be a song or tune that you sing or play on your phone, a particular character you learn to mimic like Mickey Mouse, Lightning McQueen, or Fancy Nancy.
#3 Provide Oral Care Protection
Oral trauma doesn’t have to be inevitable for children, but most kids experience some sort of injury or trauma to the mouth during their childhood. For families with ASD, trauma can happen from an injury to the mouth due to a fall, self-harm, clenching and grinding the teeth, biting and chewing on non-food items or objects, oral disease, and even cavities are considered trauma. Protecting their mouth and teeth as much as you can is worth the time and investment. Try some of the suggestions below, and of course, talk to your dental professional about any special treatment.
- Use Fluoride and Xylitol to protect the teeth. Introduce flavors slowly and ask for plain versions whenever they are available.
- Mouthguards may be possible for some ASD children. This can be tricky to determine and maneuver, so it must be prescribed by a dental professional and custom-made from a dental office/lab. Mouthguards, night guards, or sports guards can be very helpful for children who are prone to self-injury, have seizures or epilepsy, or other co-conditions that put teeth at risk of being fractured or broken.
- Diet and Nutrition. I know how difficult food acceptance can be for ASD children and the best advice I can give is to leave sugar and highly refined carbs out of their diet as long as possible. Nothing feeds the pathogenic bacteria in the mouth faster and easier than processed sugar and carbs. If crunchy is the desired food texture, try apples and carrots before giving them crackers or cookies. If soft is the desired food texture, try applesauce and cheese before sugar-filled options like gummy bears or pudding.
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