For the last couple months, we’ve been chatting with pediatric dentist Dr. M, (aka @themamadentist) about kids dental hygiene and oral care. She says that one of the main questions she receives from parents is what to do when their child won’t let them brush their teeth or they cry/scream during the process. Here’s our OT-take for when toothbrushing is an uphill battle.

Oral defensiveness is an aversive response to sensations in and around the mouth. In other words, there is no way they are opening their mouth for a foreign object, like toothbrushes, eating utensils, the dentist, etc. There are two types of sensory situations regarding this:

• Hyposensitivity means that a child has limited awareness of what is going on inside their mouth without visual input due to poor processing of touch and proprioception. This can result in fear and anxiety with toothbrushing as this “oral numbness” inhibits their ability to know how to brush and maneuver the bristles.
• Hypersensitivity means that a child is overly stimulated by any type of external touch. The slightest tactile sensation can be too much for them.

So, what can you do to make toothbrushing a little more bearable?

HELLOOO MOUTH!

Whether your child is hypo- or hypersensitive, one way to help them get used to toothbrushing is by using proprioceptive input (deep pressure or vibration) to bring awareness and desensitization to their mouth.

• Deep pressure massage to the face and mouth
  • Start by giving your child a head rub with gentle pressure using the palms of your hands. Think the forehead, sides/back/top of skull, and jawline. Once your kid is comfortable with that input, you can move to other parts of the face, like below the ear and the lower cheekbone. Eventually, they’ll trust you to massage around their lips and corners of their mouth.
  • If they’re routinely comfortable with their face being touched by your hands, try applying that same pressure with a warm washcloth. So it’s like you get a two-fer, a washed face before brushing teeth.
• A passive way to stimulate their mouth is with chew tools, like silicone teethers (as appropriate) or a sports mouthguard so they can explore and understand their teeth and tongue.
• Try using a motorized toothbrush. You can use the vibration on their cheeks, chin, lips, and jaw to wake up the mouth before brushing. Just turn it on and tap each face area for 1-3 seconds. If your child likes it, hold for longer (5-10 seconds).
  • If you are super fancy and you have a Clairsonic or another motorized face scrubber, you can try that as well.
• The Toothbrush Tap: If the actual toothbrush is the big turnoff, get them used to the object by tapping areas on their face with the brush bristles (“I’m going to tap your cheek with the brush”), gradually making your way into their mouth, demonstrating that it will not do them harm. Praise them for each tap they tolerate and stop when they no longer can. The more they get accustomed to the feeling of the toothbrush on their skin, the less likely they will fear it in their mouth.

Now we’re ready to get to the actual tooth brushing…

• If the toothbrushing sensation is too much, you can desensitize this feeling by allowing them to brush their teeth in the tub or shower. Being immersed in water provides body awareness and dulls other tactile inputs, allowing your kid to brush with limited distractions.
• Experiment with manual and vibrating toothbrushes. Some may prefer the vibration as it provides a calming effect and more awareness to the mouth, while others like a manual brush as they will have more sensory control. A triple-angled toothbrush is also a good option if your child can only tolerate toothbrushing for a short amount of time or if they have difficulties maneuvering to the back and sides of their mouth. Your kid might also prefer a smaller or larger brush head, or they might feel braver if their brush has a certain character on it.

Other Sensory Considerations

• Be mindful of toothpaste flavors. Some like mint while others gag on it. Introduce them to different flavors and brands that have different textures (gel vs. paste vs. stripes)
• Something that can get overlooked is the temperature of the water. Rule of thumb: Warmer temps is more tolerable than cold.
• If your kid has a tactile issue and limited awareness of what’s going on in their mouth, let them brush their teeth in front of a mirror. This may allow them to feel more in control, be more aware of their oral cavity, and be more thorough when brushing.

If they don’t get this right away, don’t worry about it. They literally will be brushing their teeth every day for the rest of their life. They have plenty of time to practice and develop their own, comfortable way of brushing their teeth.

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Sources:
Tips for brushing teeth with sensory processing issues (mysillymonkey.com)
Tips for Toothbrushing with Oral Defensiveness – ARK Therapeutic