Providing oral care to children can be challenging, especially for a child who has autism spectrum disorder. You may have to be creative and add a little twist to your everyday routine in order to adapt to your child’s situation and ensure the child is comfortable in maintaining his or her good oral health. Patients with autism may have social, behavioral, and intellectual impairments which are challenging for the caregivers. Also, making progress in oral care with these children may be slow at first, but with both patience and determination, it is not hard to see positive results!
Some strategies that parents may find helpful at home:
Position for Brushing: Some autistic children will need their teeth brushed for them. If this is the case it is important to consider where you stand when providing care. For younger children, laying the child down is a good position which allows better visibility and control during brushing. For older children or those who may not tolerate the lying down position, try standing behind the child and even lean against a wall for additional support. You are then able to use your arm to hold the child’s head gently against your body.
When brushing use a pea-sized amount of toothpaste with fluoride. However, if the child has swallowing problems, fluoride may bother them and you can just use water to brush first and smear the fluoride toothpaste on at the end of your brushing so your child still gets the benefit for the fluoride protection on their teeth. You will want to provide water for the child to rinse, if they have trouble rinsing allow them to have a small drink of water or you can absorb the liquid left inside their mouth with a finger wrapped in gauze.
If your child can brush on their own but has difficulties holding the toothbrush, there are creative ways to solve this. There are Velcro straps or elastics that can be used to make it easier to hold, toothbrushes with larger handles and you could even insert the toothbrush into a tennis ball through a small slit in the ball, which would allow the child to hold the ball while brushing.
Autistic children may also have magnified responses to stimuli and unpredictable body movements. As a parent you are probably aware of your child’s habits and anticipated movements since you observe them more than anyone else. This can work to your advantage when helping them with their oral care since you will know how to work around their movements or even blend your movements with that of the child so oral care becomes a more natural interaction for them.
An electric toothbrush may be helpful as it often has a timer to ensure the brushing time (2 minutes) is adequate. Also, it may provide more effective brushing in corners that are hard to reach in the mouth.
Preventing Dental Caries and Periodontal Disease: The use of fluoride and sealant on the child’s teeth can be effective ways to prevent caries. Some children benefit from occasional use of an antimicrobial mouthwash, like chlorhexidine but long term use of the such agent is not recommended. Take caution using medications that contain sugar or those that reduce saliva eg. Concerta,Ritalin,Risperdal, Zoloft, Tenex, Catapres and always ensure the child brushes or rinses with water after taking medications. Rewards for good behavior are often given to children and many times the rewards that entice them are food or beverages. Try to minimize sugary, sticky and starchy foods and beverages to prevent caries and periodontal disease.
Positive Reinforcement and Attention: Children love receiving verbal praise, hugs, kisses, pats and smiles, just like we all do! If they don’t receive enough positive attention for their good behaviors, they may resort to behaviors that result in negative forms of attention. If you use positive attention for your child during procedures and situations that they would not normally behave in a positive way, it can motivate them and over time they will learn what an appropriate or acceptable behavior is – this is especially important with autistic children. This can be modeled at home when helping your child care for their oral health and will be continued when they come in for their dental appointments.
Some tips on how to show effective positive attention:
Be specific/immediate when praising a good behavior
Make eye contact and use an enthusiastic tone
Keep it simple
Try to get in the habit of catching your child’s good behavior as often as every 5 minutes
Give rewards that your child wants and will be receptive to (being mindful of those sweet food and drinks)
At the Children’s Oral Care Centre, we love to work with your child and provide them with successful dental visits. This can be done by tailoring the communication style specific to your child (eg. using a social story or boardmaker pictures – see picture below). Another way we can do this is to plan appointments to help your child familiarize with the dental environment in a step-by-step process. This could take several visits without any actual dental work being completed but practice does makes perfect!! We love to hear from you and find out ways that you think it is going to make the experience easy for them. If you think your child would be receptive to this process do not hesitate to book an appointment with us.
The Canadian Dental Association supports the appropriate use of fluorides in dentistry as one of the greatest preventative health measures in oral care. Fluoride has been shown over the years to be very effective in preventing decay by making the enamel of the teeth stronger. The Canadian Dental Association supports the use of fluoridated toothpastes and mouth rinses. Since fluoride is present in many naturally occurring sources, such as foods and water, you should discuss with your health professional about your child’s caries risks before you decide whether to use fluoridated toothpaste or mouthwash and the appropriate amount for your children. If your child is between the ages of 3-6 only a pea size amount of fluoridated toothpaste should be used. Keeping in mind that all children should be supervised until they develop hand dexterity. Fluoride mouth rinses are not recommended for children under 6 (because of the risk that they will accidentally drink the mouthwash) and should only be used at the needs of the specific child.
(Canadian Dental Association, 2013)
There has been some confusion surrounding the community of Chilliwack regarding the quality of the water. Although an exhaustive number of measures have been taken to ensure the safety of the City of Chilliwack’s drinking water there continues to be bacterial contaminants, especially E. Coli, in the water system. In order to ensure the safety of the drinking water, Fraser Health has decided to add chlorine (NOT fluorine) to the water as an additional way to prevent E. Coli outbreaks. This idea works because the chlorine kills disease-causing bacteria and viruses in the water and then dissipates. Small amounts of chlorine stay in the water until it leaves the tap therefore the bacteria and viruses can’t grow back and once it leaves the tap the chlorine evaporates. This is important because E. Coli can make people in the community very sick. The concerns that some individuals in the community had were that it was fluoride that was being added to the water instead of chlorine, which is not the case. So those of you who live in Chilliwack and had that concern can rest assured and still use fluoridated toothpaste for your children!
Well, the time has come again. It’s September and kids are back to school. Is your child ready? Stationary – check! Clothes – check! New backpack – check! What else is missing, you wonder?
In the Canadian Health Measures Survey (2007-2009), Health Canada found that tooth decay is one of the leading causes of absences from school. The US National Health Interview Survey has once estimated that 51 million school hours are lost every year because of dental diseases. Research published in the American Journal of Public Health recently echos similar observations. Kids with toothaches are more likely than those without toothaches to miss school over a 6-month period. The study showed that students with regular dental care were less likely than those who were inaccessible to dental care within the last year to miss school. In terms of GPAs, students who had toothaches in the past 6-months were almost 4 times more likely to have a lower GPA than those who didn’t. Not only that, compared to those parents of students without toothache, parents of students having toothache were 4 times more likely to miss work because of their children’s dental concerns. Other studies have also found that children with caries often felt embarrassed, withdrawn and anxious. Early childhood caries does not only impact your child’s dental health but also his general health. Cavities often causes pain and infection of the face which may lead to disruptions in quality of life, growth and intellectual development. Kids with cavities on baby teeth are at greater risk of having cavities on their adult teeth.
As you go through the checklist for what your child needs to go back to school , don’t overlook the importance of your child’s oral care:
Schedule a regular dental exam before the school year begins so you are able to work it into your schedule
Be sure to change toothbrush every 3 months or after an illness
Floss your child’s teeth everyday
Educate your child on good oral health habits – let them watch you brush, kids are great imitators!
Prepare nutritious food for their lunches. Bring fruits, vegetables, cheeses for snacks. Avoid soft, sticky sweets that will stay in their teeth a long time, eg. raisins, real fruit rollup or gummies..
There is nothing better than seeing a child laugh and smile. We, at the Children’s Oral Care Centre love to help your child get an A+ in dental health as well as an A+ from school! Please call us at 604 864 0876 to schedule an appointment today!
References: Selrawan et al., 2012; Finucane, D. 2012.