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orally defensive Each February, we celebrate National Children’s Dental Health Month at Special-Ism with a focus on isms such as tooth brushing for the orally defensive.

Each year, the American Dental Association, along with the ADA Foundation, offers a new campaign slogan.  This year’s slogan is “Sugar Wars“.

“The Smileys, McGrinns and K9 are in a spaceship, the USS SweetSwatter. It is equipped with toothbrush swatters, fighting against the Sweet Tooth Invaders for good oral health.

On the reverse side, preteen/teenagers demonstrate effective ways to defeat the effects of sugar and maintain good oral health by brushing, flossing, rinsing and eating healthy snacks.” (1)

Challenge: Orally Defensive

We all know that brushing and flossing are effective ways to ensure good oral hygiene – but what to do with a child who is orally defensive?  The sensory over-responsive kid may do everything in his or her power to avoid the toothbrush.

What are parents to do when the softest toothbrush is just too much for little James and it sends him over the edge?

How is mom to ensure healthy teeth when Kiley runs and hides when it’s time to brush her teeth?

Or what about Jacob, who tells his parents that he brushed his teeth, but mom repeatedly discovers toothpaste still on the brush after he left for school.

Gwen Wild, OTR/L of Sensational Brain suggests using a sensory-based routine to support tooth brushing for orally over-responsive children.  For children who are orally defensive, Wild suggests starting with a visual schedule.

Visual Schedule

Use a visual schedule to encourage tooth brushing. Check out the sample below compliments of Sensational Brain.

Whole Body Calming

The first activity on the visual schedule should be an activity that offers whole body calming.  Consider some form of deep pressure such as “rolling” the child out with a rolling pin wrapped in a hand towel as shown in the image above.

A tight snuggle while reading a book or “squishing” the child under a bean bag can do the trick too.

Suggested reading for that tight snuggle:

Have You Ever Seen a Moose Brushing His Teeth?

Maggie, Marshall and the Magic Magnifying Glass: Discover what’s living inside YOUR mouth!

The Teeth That Looked for a New Mouth: A Story of a Boy Who Didn’t Like to Brush His Teeth

Mouth Calming

The second activity on the visual schedule should be a mouth-calming activity.  The image above suggests oral vibration.

Consider a game of oral tug-of-war.  Have the child bite down on a knobby textured chew toy or Nuk brush while you tug on the other end.  Encourage the child to bite down five times on each side of the mouth.

“Bubble Juice”, which is seltzer added to fruit juice can be used to wake up the mouth throughout the day.

Brush Teeth with Calming Strategy

After whole body calming and mouth calming activities, next up is the act of tooth brushing.  However, pair tooth brushing with a calming strategy.

Consider a vibrating neck wrap or a battery operated bubble blower that can watched while teeth are being brushed or the child is brushing her own teeth.

Set a visual timer for the tooth-brushing. We love the Fun Timer app.

If he is VERY over-responsive, start with just 15 seconds. Once he starts tolerating the process, you can increase the time by 10 second intervals.  Work up to the ADA’s suggested 2 minutes, 2 times a day.

Close with Calm

Wrap up the tooth brushing experience with a highly preferred calming activity.  Make it a reward for the child and use it as an incentive.

Ideally, all of the activities suggested, (other than tooth brushing) should be choice-based.  The parent offers up the varied choices based on the child’s needs.

Selecting a Toothbrush

Now that you have a plan in place with a visual schedule, don’t forget toothbrush selection.

Provide the Power of Choice

Wild recommends getting a variety of toothbrush types with different heads, vibration, soft and firm, different colors and decorations.  Allow the child to experiment with the different types.  Encourage the child to make his own choice, giving him the locus of control.  One the of the biggest solutions for over-responders is offering them choices.

Some children may find soft bristles more tolerable while others find them to be tickly.

Some kids love the vibrating toothbrushes while other kids can’t stand them.

Fine Motor Adaptations

Some kids with sensory isms also struggle with fine motor skills.  Consider adapting the favored toothbrush by bulking up the handle with play dough or a tennis ball depending upon the child’s need.

Look for large handled toothbrushes if needed.

Finding the Right Brush

The Alabama Council on Developmental Disabilities offers a video resource on toothbrush selection.  In the video below, you will be walked through the following steps:

  1. Find the right size
  2. Find the right angle
  3. Watch the colors
  4. Clean the tongue and cheeks
  5. Handle sensitive teeth
  6. Get a grip
  7. Go for power

 

Behavioral Interventions

Wild offers a few additional suggestions from a behavioral standpoint.

Role Play

Role play and allow the child to brush a stuffed animal’s teeth with a giant toothbrush.  Parents, allow your child to brush your teeth for you.

Experiment

Allow the child to brush his “clean” fingers and hands with each new toothbrush selected from the variety mentioned above.  This will increase her comfort level and decrease anxiety and she knows what to expect from the soft, firm or vibrating toothbrushes she will be putting her in mouth.

Timing

Ensure a definitive start time and stop time for the tooth brushing activity.  Consider singing a song or playing a favorite song as most songs are about two minutes in length.

Establish counting such as one – one thousand, two – one thousand all the way up to 20.

Say the alphabet three times.

As suggested above, use a visual timer such as the Fun Timer app.

Taste

Keep in mind, for some kids, the toothpaste is more obnoxious than the brush itself.  Explore and experiment with a variety of toothpaste flavors designed for kids.  Sometimes, kids prefer the adult mint version over the kids flavors.  Wild shares, “I’ve been told by two dentists that the act of brushing is more important than the toothpaste, so you can try just brushing with water while the child adjusts to the visual schedule above.”

Visiting the Dentist

Ideally, a trip to the dentist should be on the schedule every six months.  Orally defensive kids consider a trip to the dentist an absolute nightmare.  However, as Wild states, “once tooth brushing becomes more tolerable, going to the dentist shouldn’t be quite so traumatic. Still, I always recommend calling around and seeing if the pediatric dentist has experience working with kids with sensory isms. Some are much more willing to accommodate than others.”

Explore 7 Tips for a Trip to the Dentist and A New Dental Program to Mirror

References

(1)   National Children’s Dental Health Month.National Children’s Dental Health Month. American Dental Association, n.d. Web. 09 Feb. 2016.

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An "Ism" is our coined term synonymous with a “challenge”. Many children, with or without a diagnostic label, experience various challenges throughout their developmental years which are impacting them in the classroom and at home. At Special-Ism, the Ism is our focus. We do not look at the diagnostic label, instead, we look at the Isms and offer solutions no matter the diagnosis.