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Autistic tween won't clean teeth

sasuke_mum

Hello! I can guess what you're thinking… does any tween clean their teeth willingly?!
My son is 12 and has recently stopped cleaning his teeth. I wondered if anyone has any tips? He understands why he should; the dentist has shown him that he's not doing it properly and we remind him morning and night. I've suggested that if he won't clean his teeth we'll have to cut out sugary food - I know this isn't the right way to tackle it, but I'm out of ideas. There's definitely a sensory issue here, I've tried different tooth pastes in case it's the taste and we've tried different toothbrushes. I think he put up with us brushing his teeth when he was small, but just can't bring himself to do it himself. He's also very sensitive to bad breath, but even suggesting that his will be stinky hasn't swayed him. I'm worried he'll end up with cavities, which will mean a potentially traumatic next trip to the dentist.

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[Deleted User]

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sasuke_mum

Whilst it's perfectly possible that could happen, I'd not instigate that myself. I'm looking for something that is upbeat and positive. Shaming isn't our style.

Rachel_Scope

It seems like a tricky situation @sasuke_mum. Have you spoken to the dentist about alternatives you could try? I know it's not ideal but could he brush with his finger?

Nightcity

As an autistic myself I am also extremely stubborn.

I also had this phase for about 3 years, I responded well to something for me, something for you, so it might be worth a try for every week you clean your teeth you'll get A,B or C that you like back in my time it it was a VHS or audio cassette I got, work with whatever would excite him to receive for a reward.

I never got any teeth issues, I'm 43 now and it's literally this minute I'm having trouble for first time because of my anxiety I've ground two teeth down to virtually nothing in my sleep.

But cavities rarely happen quickly so plenty of time to turn it around.

sasuke_mum

Thanks @Nightcity that's a really good shout. He's saving for a Switch2 so something for the piggy bank might work - HOWEVER - how long did that go on for? Was there a point when you stopped being rewarded for brushing but continued anyway?

Nightcity

Yes I reached the point where it became part of my routine and I just did it anyway, Everyone's different but there's a good chance as he gets older he'll just transition into it.

It was approximately three years but the rewards were scaled off so at first weekly, then fortnightly, monthly etc.

sasuke_mum

Thank you @Nightcity That sounds like it will work for us. If we can reestablish the routine we'll be fine. Thank you so much.

Nightcity

https://forum.scope.org.uk/discussion/comment/1083074#Comment_1083074

absolute pleasure, glad to have helped.

Hopeless

As an interim measure (better than nothing) could they use mouthwash?

[Deleted User]

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sj2025

how about using a visual aid like a digital timer/stopwatch

Or egg timer with the sand in,to show when the activity will be over 2 minutes timed ….

Nightcity

blackmail by saying do it or a,b,c will be removed will result in either worsening of the behaviour or an outright autistic meltdown that's definitely not the answer here like it would be for the average child.

Mrs

hi my youngest is 25 and I also went through this with him ..I let him use his finger first and using mouthwash helped then I gradually got him to a toothbrush I started with a child’s soft brush he mastered that as it wasn’t too big in his mouth and was gentle I also used the child’s toothpaste a flavour he liked he’s now on an adult toothbrush but he still only uses the soft .hope these tips help 😊

sasuke_mum

Thank you @Nightcity that response mirrors what I'd have said. The smallest, and to us sometimes strangest things can send an autistic person into fight or flight mode; accepting that their reaction is real and not 'being a drama queen' is important. Punishing, by removing something is not helpful at all.

@sj2025 we have the egg timer shaped like a friendly tooth 😁

@Mrs he tells me he's OK with the flavour of the toothpaste (we've tried a few) but I think trying a smaller, softer toothbrush will definitely be worth a try. Thank you!

OverlyAnxious

Don't want to add negativity to this but it's been an interesting read as I also had this issue around the same age, and still do decades later unfortunately. I knew it wasn't 'right' but never realised that other people were experiencing sensory inputs so differently until very recently. In my case I also had another worsening issue at that age, with increasing digestive issues and a gag reflex getting more and more sensitive.

I was still forced to the dentist once a year for a traumatic experience every time. Although I never needed any proper work done, even a bit of descaling felt utterly horrific to me. When I got home I would count the months on the calendar hoping I would d*e before the next dental visit! There was no sympathy from either relatives or the dentist. The dentist would just patronise me by saying 'why are you scared, your teeth are ok?' and 'you need to brush better' and of course the best one 'stop shaking or it'll be worse'! Obviously that was just words, didn't change the sensory inputs or my body's reactions so my behaviour didn't change. And there was certainly no amount of blackmail or bribery that would have made any difference. I stopped going to the dentist completely when I was old enough to refuse.

Around 14 I managed to start using a flannel just to attempt to clean the front ones, but couldn't get anything near the back ones. At some point I did start to use a toothbrush again, but only for a very short time, only the fronts, and only once a day, as my nausea is too severe by the evening. Eventually that did become a reliable daily task, but that's pretty much the best I can manage even now, still unable to do the backs and still not able to manage many seconds each day, and definitely not in the evening. I do need some dental work done now, and it's been restricting my food intake for many years, but I can't see any realistic chance of getting it done. I made several attempts to visit a dentist pre-covid but there was no understanding, no adjustments, no practical support, which is the same experience I've had with other health services as well.

One thing I do to try and limit further teeth issues is to always have a glass of water after each meal, hoping that will wash away much of the debris from the meal. That might be something to consider while your son is struggling to clean his teeth regularly. I also only have sugar once a day. That is immediately after lunch (and before a glass of water) hoping to have minimum impact from it. Unfortunately I do need to have a sugary item each day because I just can't enough calories in without. I would gladly give up sugar otherwise.

Biblioklept

Find a way to make it fun or rewarding, I always struggled with toothbrushing, it was sensory hell and my executive functioning made it hard to remember or want to do boring tasks like this. It felt like to many steps and while it's such a simple thing it doesn't feel like it.

When I was in my late teens I managed to gamify it in a way that worked for me and it's now something I look forward to doing ❤️The idea is, once he does it so often due to the 'bribe'/reward and associated dopamine, it'll become part of his routine and come more naturally

Speak to his dentist but xylitol gum is meant to be really really good for oral hygiene as well

sasuke_mum

Oh no @OverlyAnxious it's horrible that you suffer like this. For what it's worth, the things you've put in place really demonstrate to everyone reading that even if the willingness is there, the actuality of doing the thing can be excruciating. Goodness knows it's hard enough to find a dentist let alone one that understands, sympathises and adjusts to your needs. You will see that @Biblioklept has mentioned xylitol gum, maybe you've tried that already?

sasuke_mum

https://www.england.nhs.uk/wp-content/uploads/2023/10/PAR1514-oral-health-user-guide-for-mouth-products.pdf

Some weird and wonderful shaped brushes here and a non-foaming toothpaste. Just thought I'd share in case they help - from NHS England.

[Deleted User]

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Nightcity

I'm not going to get into an argument because you are both right when discussing the average child, HOWEVER that's not how it works with autism he hasn't "chosen" to not clean his teeth there's a reason and punishments that would work and be the way for the average non autistic child will only create more issues.

And I didn't end up running the home or even trying to nor do any of the others who have refused various activities as a child I know and have read about.

All taking that path will do is create an almighty meltdown which is not good for the physical or mental health of the child or parent, and will create even more stubbornness and trust issues.