Dental care and concerns in children with special needs

The first dental visit should occur within six months after the baby’s first tooth appears, but no later than the child’s first birthday. At this time, the dentist can provide or recommend information on baby bottle tooth decay, infant feeding practices, mouth cleaning, teething, pacifier habits, and finger-sucking habits.Most initial office visits are to help acquaint the child with the dentist. The first visit generally includes a thorough examination of the teeth, jaws, bite, gums, and oral tissues to monitor growth and development, and, if needed, a gentle cleaning. The dentist may demonstrate proper home cleaning, including flossing, and assess the need for fluoride.

• Before teeth erupt, clean gums with a clean, damp cloth. Use a finger brush for gum massage; it also reduces pain and irritation caused during teething.
• Brush teeth with a small, soft-bristled toothbrush. Introduce a pea-sized dab of fluoridated toothpaste after 2 years of age, once the child is old enough to spit out the toothpaste after brushing. A non-fluoride toothpaste is recommended below 3 years of age. Above 4 years of age,a pea sized dab of 1000 ppm fluoridated toothpaste is to be used.
• Prevent baby bottle tooth decay: Don’t give children a bottle of milk, juice or sweetened liquid at bedtime or when put down to nap.
• Limit the time your child has a bottle. Your child should empty a bottle in 5 to 6 minutes or less.
• Avoid foods and treats that increase tooth decay: breakfast cereal, commercially available milk flavours/additives, hard or sticky candies, candied fruits, and sweetened drinks and juice. Offer fruit rather than juice; the fibre in fruit tends to scrape the teeth clean, whereas juice just exposes the teeth to sugar. A bunch of grapes or slices of an apple make much more desirable snacks than store-bought munchies.

• Help your child brush his or her own teeth until 6 years of age. Allow the child to watch you brush, and follow the same brushing pattern to minimize missed spots. Make sure you are cleaning your child’s teeth daily. If your child resists the traditional way of tooth brushing, try to brush your child’s teeth with their head in your lap. This can sooth their nerves.

• If your child can’t grip the toothbrush, cut a hole in a tennis ball and slide the toothbrush through. If that doesn’t work, try using a piece of Velcro to wrap around the child’s hand and hold the brush in place.

•  If your child has special healthcare needs, it would be worthwhile investing in a set of three headed toothbrushes that would enable the caregiver clean all erupted tooth surfaces. A portable suction machine with an electronic water flosser would be helpful oral hygiene aids.

If possible, schedule morning appointments, when young children are alert and fresh. Do not ask for an appointment during the child’s nap time as it makes them cranky and irritable.

Prepare a pre-schooler or older child for the visit by giving him or her a general idea of what to expect. Explain why it is important to go to the dentist. Build excitement and understanding.

Print out or prepare your own picture book or Social Story, showing and telling what will happen in the dentist’s office. Find pictures online, or take pictures in your own paediatric dentist’s office, with permission. Read through the story often with your child before you go to the dentist, and bring it along when you go.

A dental visit may be overwhelming, so be prepared to support your child and understand their fears.

Parents need to be aware that not all dentists may be trained to treat children with special needs .Look around for dentists who specialize in special needs patients and ask other parents who have children with special needs for a referral. Paediatric dentists are more likely to be a good choice, but even then, it’s well worth your time to ask around for recommendations, talk to the dentist, and visit the practice.

Make your dentist a part of your child’s health team. Visiting a dentist should be held at the same priority level as visiting the medical doctor.

• Discuss your questions and concerns with the dentist before the examination.If your child has special needs and sensory processing issues.  Request for an introductory clinic visit, so that the child will be acquainted with the set-up.
• Remember that your interpretations and expectations toward dental visits can be quite different from your child’s. If you have dental anxieties, be careful not to relate those fears or dislikes to the child. Parents need to provide moral support by staying calm while in the dental exam room. Children can pick up parents’ anxieties and become anxious themselves. Be prepared for a sensory meltdown.
• If your child is wheelchair bound, ask if there are facilities to wheel the child in and the treatment area and utilities are wheelchair accessible.
• If your child has a problem with bright lights or loud noises, bring along sunglasses and earplugs.
• Be sure there are no surprises, and come prepared with the toys, foods, videos or other comfort objects your child will need. However, refrain from offering food as a bribe for co-operation.
• Support your dentist. While it’s great to have a parent in the room with a child during dental work, it’s not especially helpful to have the parent flinching, second-guessing the dentist, or leaping up every two seconds. Unless something truly unacceptable is going on it’s best to be reassuring but passive.

At the first visit, provide the dentist with your child’s complete medical history. Request for an appointment at a time when the practice would be relatively free of external noise. Make sure to tell your dentist about any behaviours that may inhibit his work or about eating habits that may contribute to tooth decay. Often, information provided by a parent or caregiver prior to the patient’s visit can assist greatly in preparation for the appointment.

For a treatment visit, such as polishing/getting a cavity filled, tell the dentist if your child exhibits stubborn, defiant, hysterical, or fearful traits in other life experiences.

Analyse your child’s reactions. Many parents are able to anticipate their child’s possible response to certain situations and should inform the dentist. Certain behaviour traits may be linked to the age of your child:

• 10 to 24 months. Some securely attached children may experience developmental separation and become upset when taken from their parents for an exam.
• 2 to 3 years. A securely attached child may be able to cope with a brief separation from parents. In a 2-year-old, “no” may be a common response.
• 3 years. Three-year-olds should not be expected to accept separation from their parents for restoration treatment procedures, such as getting a cavity filled. This is because most 3-year-olds are not socially mature enough to separate from parents.
• 4 years. Most children should be able to sit separately from parents for exams and treatment procedures.

Follow up with your dentist’s suggestions, with your child’s special needs in mind.

Individuals with special needs may be at an increased risk for oral diseases throughout their lifetime. Parents of children with special needs tent to focus on immediate health issues and may not prioritise oral care. Further, dental health is challenging for children with mental, developmental or physical disabilities and/or those who do not have the ability to understand preventive dental care routines, resulting in conditions relating to the teeth, gums, and mouth. Some conditions affect the way teeth and oral structures grow. Others can result in an inability to produce saliva which is necessary to clear food and protect teeth; brush teeth without help; and chew solid food that stimulates teeth, gums, and muscles of the mouth. Some kids who do not know how to chew or cannot chew, hold food in the mouth for long periods. This condition, known as food pouching, increases the likelihood of tooth decay.

In most cases the medication – often liquid syrups and medicines with sugar to help manage the child’s condition for seizure control, sedation, etc, is the main cause of dental cavities. Medications can also disturb tooth formation causing tooth defects.

Education of parents/caregivers is critical for ensuring appropriate and regular supervision of daily oral hygiene.  Sealants reduce the risk of caries in susceptible pits and fissures of primary and permanent teeth and are highly recommended.  Topical fluorides may be indicated when caries risk is increased. For those with seizure disorders, motor skills/co-ordination deficits, the risk of tooth injury is high.

Dental care is important for everybody, but people with Down syndrome can have a number of differences that can require special attention.

What is Different about the Teeth of people with Down syndrome?

DELAYED ERUPTION

The teeth of people with Down syndrome, both baby teeth and permanent teeth, may come in late compared to children without Down syndrome.  On average, babies with Down syndrome get their first teeth at 12 to 14 months, but it may be as late as 24 months of age.  Babies without Down syndrome typically get their first teeth between 6-12 months.  It is typical that a child with Down syndrome may not get all 20 baby teeth until he or she is 4 to 5 years of age, rather than 2-3 years of age, which is typical for children without Down syndrome.  The front permanent teeth and permanent 6 year old molars may not erupt until 8-9 years of age.  It is also common for the teeth of children with Down syndrome to erupt in a different order than in children without Down syndrome.

SMALL AND MISSING TEETH

Frequently, people with Down syndrome have smaller than average teeth and missing teeth.  It is also common for the teeth of people with Down syndrome to have roots that are shorter than average.

LARGE TONGUES

People with Down syndrome may have large tongues or they may have an average size tongue and a small upper jaw that makes their tongue too large for their mouth.  It is also common for people with Down syndrome to have grooves and fissures on their tongues.People with Down syndrome are more prone to experience acid reflux than people without Down syndrome.

PROBLEMS WITH BITE

People with Down syndrome may have small teeth, which can cause spacing between the teeth.  They also tend to have a small upper jaw.  This may cause crowding of the teeth and may result in the permanent teeth being “impacted” because there is no room in the mouth for them to come in.  The small upper jaw may create a situation where the top teeth do not go over the bottom teeth the way they are meant to; instead, the bottom teeth may be out further than the top teeth in the back of the jaw, the front of the jaw, or both.  It is also common that the front teeth of people with Down syndrome do not touch.

Braces may be able to improve some of these issues.  Orthodontics require a lot of cooperation and make the teeth even more difficult to keep clean, so it may not be possible in all people. It may be a good idea to wait until a child is older and able to tolerate it a bit better.  Having orthodontic appliances in the mouth can also pose challenges to speech.

GUM DISEASE

People with Down syndrome are at an increased risk for gum disease (periodontal disease).  Even when individuals with Down syndrome do not have a lot of plaque and tartar (calculus), they get periodontal disease more frequently than others.  This is because people with Down syndrome have an impaired immune system and do not have some of the natural protections against the disease that people without Down syndrome have.

CAVITIES

People with Down syndrome do get cavities, so brushing with fluoride toothpaste, flossing between any teeth that touch, and limiting the amount and frequency of sugar and refined carbohydrates eaten will help to prevent the development of cavities.

Bacterial endocarditis is an infection caused by bacteria that enter the bloodstream and settle in the heart lining or heart valves. Bacteria can enter the bloodstream in many ways. One common way is through infection of the gums or teeth (cavities). Poor dental hygiene in conjunction with inflamed, bleeding gums can greatly increase the risk for bacteraemia (bacteria in the blood). Any professional dental treatment that causes bleeding – such as cleaning below the gumline, repairing or removing teeth – can also allow bacteria to enter the bloodstream.

Usually bacteria entering the bloodstream circulate through the body and are destroyed by normal body defences. Sometimes, however, bacteria find a place to settle, and an infection starts. When the infection is in the heart, it is called endocarditis.

Basic prevention can start at home with careful dental care. Anyone at risk for endocarditis should be especially careful about daily brushing and flossing to maintain healthy teeth and gums.

Antibiotics given immediately before teeth cleaning (or other procedures which may cause bacteraemia) protect against infection. This is called SBE prophylaxis: protection against sub-acute bacterial endocarditis. Individuals at risk should receive this protection each time they have a procedure that increases their risk of bacteraemia. The goal of antibiotic treatment is to provide short-term protection. Usually, one dose of antibiotic is given one hour before the procedure. This provides protection at the time it is needed, but limits the child’s exposure to antibiotics.

Cleaning of teeth below the gumline, tooth extraction, treatment of the vital nerve of the teeth and placement of orthodontic and appliance bands require premedication.

Ask your physician or cardiologist if antibiotics are needed and be sure to inform your dentist of all health conditions, including heart issues.

Processed and modified food with additives is stripped of essentials and has a lot of preservatives. Potato chips, white bread, pizza, pasta and burgers can easily get lodged between teeth and in the crevices between two teeth. They are neither sweet nor sugary but the starch in these foods soon begins converting into sugar almost immediately because of the predigestive process that begins in our mouths. The sugar is harmful and our enamel starts becoming decalcified.

Our mouths are full of bacteria. When your child eats or drinks anything with lots of sugar, and doesn’t clean their teeth thoroughly afterwards, that bacteria will use the sugar to stick to the surface of the teeth and feed itself. As it feeds, it will quickly multiply, forming plaque and producing acid. This acid destroys the tooth enamel, which is the protective outer layer of the tooth.Soda, fruit juice, and sports drinks, for example, are acidic in addition to being full of sugar or sweeteners. This can cause damage to the tooth enamel almost immediately.

Cavities are essentially a bacterial infection created by these acids forming a hole in the teeth. Left untreated, cavities are able to progress beyond the enamel and deeper into the tooth, causing pain and possible tooth loss.

Water is the best thing your child can drink! Not only will it keep them hydrated, it’s good for their body, and also great for their dental health.

Sealants protect the surfaces of teeth with grooves and pits, especially the chewing surfaces of back teeth where most cavities are found. Made of shaded, tooth colored resin; sealants are applied to the teeth to help keep them cavity-free.

Even if your child brushes and flosses carefully, it is difficult – sometimes impossible – to clean the tiny grooves and pits on certain teeth. Toothbrush bristles are just too thick to reach into the pits and fissures. Food and bacteria build up in these depressions, placing your child in danger of tooth decay. Sealants “seal out” food and plaque, thus reducing the risk for decay.

Sealants can last for a period of 3-5 years. So, your child will be protected throughout the most cavity prone years.

The teeth most at risk of decay – and therefore most in need of sealants – are the six-year and twelve-year molars. But any tooth with grooves or pits may benefit from the protection of sealants.

Eating high-fibre foods keeps saliva flowing, which helps create mineral defences against tooth decay. Good sources of fibre are dried fruits such as dates, raisins and figs, and fresh fruits, like bananas, apples and oranges. Not only does saliva wash away food particles and clean your mouth, about 20 minutes after you eat something, saliva begins to neutralize the acids attacking your teeth. Opt for crisp fruits and vegetables like apples, carrots, cucumber etc.

Calcium is a prime ingredient for preventing tooth decay, especially for growing children. Dairy is a great source, with choices such as milk, yogurt and cheese.

Sticky foods such as lollipops, caramels and hard candies — make it difficult for saliva to wash the sugar away. Snacks like biscuits, cakes or other desserts contain a high amount of sugar, which can cause tooth decay. These are best avoided. Fruit is an important part of a healthy diet. Whole fruits have fibre and are a less concentrated source of sugar (and sometimes acids) than juice.

Chewing sugar-free gum after meals and snacks can help rinse harmful acid off your teeth to help you preserve tooth enamel. Chewing gum containing sugar may actually increase your chances of developing a cavity. Sugarless gum containing xylitol, which has been shown to have decay-preventive qualities, may even have an added benefit. Xylitol  inhibits the growth of Streptococcus mutans, the oral bacteria that cause cavities.

For those on restricted diets, discuss individual dietary needs with the child’s physician.

It is normal for breath to smell of recently consumed food for a few hours. If the food is sticky, like caramel, jaggery, sugar syrup, etc., it may stick to the teeth surfaces and will not be washed away by saliva. Moreover, when food lacks the fibre needed for chewing and cleansing the mouth, food accumulation increases. Food containing simple sugars, like glucose (glucose-rich biscuits, simple carbohydrates, baked and pastry items with icing, etc.) can be easily used by bacteria to produce smelly sulphur compounds. Making sure children rinse their mouth after sugary treats is the most essential among bad breath remedies.

In the vast majority of cases, bad breath in kids is caused by the breakdown of food particles that remain in the crevices of the mouth. This debris is turned into sulphur gases like hydrogen sulphide or methyl mercaptan by protein-eating bacteria. These gases produce a foul odour.While food collection accounts for 90 per cent of the cases of bad breath, coated tongue (fungal disease), sinusitis, throat infections, gastric problems, urinary problems and uncontrolled diabetes are responsible for 9 per cent of them. In 1 per cent of the cases, the cause of halitosis is diet or drugs.

While food accumulation in the mouth can be easily detected and corrected by simple gum cleaning treatments or restoration of the teeth, the other causes of persistent bad breath problems need to be investigated thoroughly.

When food accumulation is left unattended for a few weeks, it builds up as plaque and later forms a hard coating over the teeth called calculus. Calculus in children can be yellow or sometimes even green in colour. It harbours all the odour-causing bacteria. It slowly infects the gums and causes bleeding gums. If it is untreated, it can infect the bones that surround the teeth, causing the teeth to lose their support structures and start wobbling.

Saliva performs many essential roles in the oral cavity. One of them is to suppress the growth and proliferation of bacteria which cause bad breath. The intensity of sulphur compounds is increased by the reduction in the flow of saliva, caused by certain drugs and medical conditions.

Dry mouth, which leads to bad breath, could also be caused by some food and drugs. Over-use of medicated mouthwash could result in a build-up of fungus, again resulting in bad breath.

Inhalers that contain low doses of steroids, used to treat children with wheezing or asthma, can cause bad breath too, if not used properly. Since steroids can also increase the chances of tooth decay, children using the devices should be trained to use them with a spacer and to rinse the mouth after every use.

Children rarely complain of dental pain but will adapt to it by not chewing on the side that aches. This results in the build-up of calculus in the region that is not used, resulting in bad breath, gum disease and more decay or the spread of decay. This situation needs to be identified quickly and remedied so that the normal chewing pattern is restored.

Sinus issues cause fluid to collect in the nasal passages and throat, making your child’s throat the perfect place for bacteria to gather.If you suspect a sinus infection (potential sore throat, burning nasal passages and post nasal drip), call your doctor for a visit and see if medication will be prescribed.Bacteria can collect in the pits of swollen tonsils and, paired with the sour smell of infection, can cause bad breath. When kids use antibiotics for an extended period, bad breath can also temporarily rear its head.

Injuries to the teeth in children can occur from falls or during play or sports activities. The injury may be to a primary (baby) tooth or a permanent tooth. A tooth can be cracked, chipped, or totally detached from its socket. Your child may experience bleeding from the area, pain, or increased sensitivity when a tooth is injured.

• Remain calm and reassure your child that you can help.
• If the area is bleeding, place a small piece of folded gauze at the site and have your child bite down or hold it in place.
• Offer your child cool water or an ice pop to suck on to help reduce swelling and pain.
• Do not try to put a baby tooth back into the socket.
• If it’s a permanent tooth, hold it tooth by the crown (top of the tooth), not by the root (bottom of the tooth). Plug up the sink to prevent losing the tooth down the drain and gently rinse the tooth with milk (do not scrub the tooth or use tap water as it contains chlorine and may injure the tooth).
• Place the tooth back in your child’s mouth in its socket if he or she will cooperate. Push down until the knocked-out tooth is level with the tooth on either side. Have your child bite down on a gauze pad placed over the tooth to keep it in place. This needs to be done quickly after the tooth has been knocked out as the chances of survival of the tooth are higher if done within 20 min.
• You can also have your child spit saliva into a cup and transport in your child’s saliva if you are worried about him or her swallowing the tooth.
• Contact your child’s dentist immediately for further follow-up and care.
• If other injury to the mouth or teeth is suspected, X-rays of the area may be needed.

Call your child’s dentist for:

• Any tooth injury that results in a loose or knocked-out tooth, a tooth that has sharp or ragged edges, or if a tooth is in pieces.
• Any signs of infection following a tooth injury such as fever, or increased pain, swelling, or drainage from the site.
• Any concerns you have about the injury or if you have any questions.

• Teach your child not to walk or run while holding an object in his or her mouth.
• Teach your child not to suck or chew on hard, sharp, or pointed objects.
• Have your child wear a mouthguard for sports activities that could cause injury.
• Discuss with your dentist regarding use of mouthguards if your child is prone to seizures or lacks motor co-ordination.

Some children need more support than a gentle, caring manner to feel comfortable during dental treatment. Restraint or mild sedation may benefit your special child. This may be done at the same facility or at a well-equipped localhospital.

General anaesthesia provides a way of effectively completing dental care while a child is unconscious.Children with severe anxiety and/or the inabilities to co-operate are candidates for general anaesthesia. Usually these children are young or have compromised health issues and helping them control their anxiety is not possible using other methods.

Paediatricanaesthesiologists are responsible for delivering the general anaesthesia, monitoring and medical care of the child. Many precautions are taken to provide safety for the child during general anaesthesia care. Patients are monitored closely during the general anaesthesia procedure by anaesthesia personnel who are trained to manage complications.

Most of the time, your child’s surgery will be done on a “day care” basis. This means they will have their surgery in the morning and be allowed to go home by evening.

• A physical examination – is required prior to a general anaesthesia appointment to complete dental care. This physical examination provides information to ensure the safety of the general anaesthesia procedure. The doctors may ask for some routine medical tests essential for planning the procedure.
• Prior to surgery – Minimal discussion to your child about the appointment may reduce anxiety. Explain they are “going to go to sleep when their teeth are being fixed”.
• Eating and drinking – It is important NOT to have a meal the night before general anaesthesia. You will be informed about food and fluid intake guidelines prior to the appointment.
• Changes in your child’s health – If your child is sick or running a fever, it may be necessary to arrange another appointment.

Usually, children are tired following general anaesthesia. You may wish to return home with minimal activity planned for your child until the next day. After that, you can usually return to a routine schedule.

Fluoride is a natural mineral that builds strong teeth and prevents cavities. It’s been an essential oral health treatment for decades. Fluoride supports healthy tooth enamel and fights the bacteria that harm teeth and gums. Tooth enamel is the outer protective layer of each tooth.

Fluoride is especially helpful if you’re at high risk of developing dental caries, or cavities.Fluoride cannot remove decay but, while creating a stronger outer surface to your teeth, it can help stop the decay from penetrating into the deeper parts of teeth. Dentists provide professional fluoride treatments in the form of a highly concentrated rinse, foam, gel, or varnish. The treatment may be applied with a swab, brush, tray, or mouthwash.

These treatments have much more fluoride than what is in your water or toothpaste. They only take a few minutes to apply. You may be asked to avoid eating or drinking for 30 minutes after the treatment so the fluoride can be fully absorbed.Fluoride poisoning is very rare today, though chronic overexposure may harm developing bones and teeth in small children. Many children’s toothpastes don’t include fluoride.

Too much fluoride can cause:

• white specks on mature teeth
• staining and pitting on teeth
• problems with bone homeostasis
• very dense bones that aren’t very strong

Acute toxicity, such as an overdose on fluoride supplement pills, can cause:

• nausea
• diarrhea
• tiredness
• excessive sweating

It can even lead to death. Always keep fluoride supplements out of reach of children.

Finger sucking may be a kind of self-stimulatory behaviour. Both positive and negative emotions may trigger a burst of stimming. Frustration or anger may intensify the stim.Some stims serve the purpose of soothing or comforting. Many infants learn to suck their thumbs /fingers to relax themselves.

Manage the sensory and emotional environment to maximize personal comfort.Vigorous exercise reduces the need to stim, probably because exercise is associated with beta-endorphins just like stimming.Get a medical exam to eliminate the possibility of physical causes for stims, such as ear infections, tooth infections, chronic pain, migraine etc. Try to engage the child in another activity without trying to stop the finger sucking.

Some of these children may avoid accepting new foods, textures or engage in nail biting, mouthing non-food items, chewing objects etc.

An occupational therapist may help with oral motor activities and exercise suggestions to minimize such behaviour.Many times, a sensory diet that is set up by an Occupational Therapist can be very helpful for children who chew.A sensory diet has nothing to do with food. It’s a carefully designed series of physical activities and accommodations tailored to give each child the sensory input she needs. Completing a sensory diet routine can help kids get into a “just right” state, which can help them pay attention in school, learn new skills and socialize with other kids.

Also giving lots of breaks where they are able to chew gum, suck on straws for a drink or smoothie, blow bubbles and other activities like that can be helpful!

Self-injurious behaviour is where a person physically harms themselves. It’s sometimes called self-harm. This might be head banging on floors, walls or other surfaces, hand or arm biting, hair pulling, eye gouging, face or head slapping, skin picking, scratching or pinching, forceful head shaking, tongue biting etc.

The person might have no other way of telling you their needs, wants and feelings. Head slapping, or banging the head on a hard surface, may be a way of telling you they are frustrated, a way of getting an object or activity they like, or a way of getting you to stop asking them to do something. Hand biting might help them cope with anxiety or excitement. They might pick their skin or gouge their eyes because they are bored. Ear slapping or head banging might be their way of coping with discomfort or saying that something hurts.

Some forms of self-injury might be part of a repetitive behaviour, obsession, or routine.

The person might still do some things that most people stop doing as young children, such as hand mouthing – putting their fingers or hand into their mouth – causing injury.

Dentists may help to rule out oral causes that may be causing discomfort, such as a sharp tooth. Dental injuries may be common during such episodes. Removing the stressor and distracting the child may help. Potential interventions must be discussed with a developmental paediatrician.

For children on the autism spectrum with sensory issues, toothbrushing can really be even more of a struggle. There can be many different factors and reasons for a child’s aversion to toothbrushing. There may be some HYPO or HYPER sensitivity and oral defensiveness going on. With hypo sensitivity, kids can have little awareness of what’s going on in their mouths which can contribute to anxiety related to the mouth area (think of it as a type of oral “numbness”). On the flip side, kids who are hyper sensitive are overly conscious and sensitive to oral stimulation. The slightest touch can be overwhelming and be perceived as painful.

It is easier to develop good behaviours from the outset, rather than trying to change behaviours that are bad for dental health once they have become established.

• Start gentle gum massage using a finger brush as the child starts teething.
• As soon as your child gets their first teeth, and certainly before their first birthday, introduce teeth brushing and arrange their first dental check-up. A clean washcloth or a piece of gauze wrapped around the finger may be a good substitute.
• Try reading your child stories or showing them books that feature tooth brushing or pictures of the sequence of brushing.
• Stand behind the child to support their body/ ask the child to lean on the sink to promote a sense of balance.
• Make an attempt to desensitize the child’s face, lips and inside of the mouth with firm pressure. Use counting as a means of distraction.
• Some children may find the sensation of the bristles very uncomfortable. Try using a brush with extremely soft bristles or silicone bristles. A baby toothbrush could be a useful transition tool to help your child eventually transition to a regular brush. A three-headed toothbrush cleans faster and gets all 3 sides with just one brushing stroke. The bristles are super soft to gently clean the gum tissue.
• Make sure the toothbrush is the right size for little hands and has soft bristles which don’t hurt gums. An electric brush can make tooth brushing more bearable because some children love the feel of the vibrations. A toothbrush with a thicker handle may be easier to hold.
• Brush your teeth when the child brushes, to show them how it is done. Try using warm water if the child finds it easier to tolerate.
• Some toothpastes may be strongly flavoured and may irritate the child. Try toothpastes that don’t foam and have no flavour.
• Some children may need help from occupational therapists trained in Oro-motor sensory therapy.
• If your child continuously puts things or objects inside the mouth, in may be because of toothache or simply stimming. A regular dental examination may help rule out causes for toothache, if any.

If you have questions about Autism, Down Syndrome, ADHD, or other intellectual disabilities, or have concerns about developmental delays in a child, the Nayi Disha team is here to help. For any questions or queries, please contact our FREE Helpline at 844-844-8996. You can call or what’s app us. Our counselors speak different languages including English, Hindi, Malayalam, Gujarati, Marathi, Telugu, and Bengali.