Effective Strategies for Making Toothbrushing Easier for Sensory Avoiders

Hello, our GiGi’s Playhouse community!  

We were thrilled to welcome our friends from BayCare back to GiGi’s Playhouse to teach us more about the importance of toothbrushing. While it may seem like a simple daily task, toothbrushing can be incredibly challenging for individuals with Down syndrome, sensory sensitivities, and their caregivers. From low muscle tone to oral defensiveness, many factors can make brushing a stressful experience. But with the right strategies, routines, and tools, it can become a successful and even enjoyable part of the day. 

Fortunately, there are ways to increase the likelihood of a positive experience, paving the way for success. General tips can include:  

• Choosing consistent times of day to brush 

• Establishing and sticking to a routine 

• Using a visual schedule or routine chart  

• Offering choices to increase engagement and independence 

• Providing visual feedback (brushing in front of a mirror) 

• Creating a calming, distraction- free environment 

• Experimenting with different water temperatures, toothpaste flavors, or toothbrush types (vibrating, weighted, or soft-bristled) 

Preparation is Key 

Within this routine, the first step should be to prepare. This is where a visual schedule can be particularly helpful, as it facilitates a smooth transition into this task. The transition into an aversive activity can be very difficult for some, so allowing notice beforehand can be helpful, whether it involves a visual routine or simply using statements.  

Tips for transitioning and preparation: 

• Use visual schedules or verbal reminders to prepare your child 

• Allow time for transitions before beginning the task 

• Offer calming sensory input like gentle pressure on the arms, legs, or face 

• Try using a damp washcloth to rub their face, or have them bite on it while you gently tug 

• Keep preparation consistent and predictable to promote desensitization 

During Brushing 

Continuity and predictability are essential in this process. When a child knows what to expect in scenarios such as this, it runs much smoother, as change and surprise can be very aversive. This can include techniques such as: 

• Using built- up or adapted toothbrush handles 

• Using small steps 

• Have your child hold the toothbrush and stand behind them in the mirror, gently guiding their hand according to their level of comfort 

• Use visual timers and countdowns  

Having your child adapt to the duration of toothbrushing is also significant in this process. Methods include: 

• Singing a short song, and when the song ends, so does the toothbrushing 

• Count to a specified number that is consistent every time they brush their teeth, so they know to stop when that number is reached 

• Sand timers or another visual timer 

Oral Motor Play  

Ways you can build the skill of toothbrushing is by using oral motor play, as brushing your teeth involves several movements and parts of the mouth/ face. 

• Blowing:  

• Blow objects across the table 

• Blow bubbles 

• Using whistles, pinwheels, and party horns.  

• Chewing & Jaw Strength: 

• Tug- of- war with a damp washcloth 

• Tongue movement:  

• Sing “la la la”  

• Blow “raspberries” with the tongue 

• Use the tongue to brush along the teeth, the floor, the roof, and the cheeks in the mouth 

• Lips: 

• With their lips in front of a mirror, they can tightly seal them to say “mmmm” 

• Puckering their lips and smiling in a continuous motion 

• Sealing their lips around a straw or kazoo 

• Whistling 

• Humming 

• Sucking:  

•  “Fish faces” 

• Suck in cheeks 

• Using straws 

• Desensitize their teeth:  

• Use a vibrating toothbrush on the cheeks or in the mouth 

• Counting their teeth in the mirror 

Motivation and Reinforcement 

Motivation and reinforcement are crucial in succeeding with toothbrushing. Ways to achieve this include: 

• Using a reward/ token system 

• Playing their favorite songs or videos 

• Allowing them to play with their favorite toys afterward 

• Encouraging independence 

• Having siblings or parents’ model desired behaviors 

• Give them a toothbrush that looks exciting to them, such as one featuring their favorite TV show characters or one that plays music.  

Using social stories can be another powerful tool. It should include a clear description of a situation or activity, use simple language, step- by- step guidance, and have illustrations or visuals as a bonus. This may build your child’s comfort, associating brushing their teeth and going to the dentist with a positive experience.  

Working with Professionals 

It is crucial that your child receives regular dental check- ups, and it is highly recommended to work with dental professionals who are familiar with special needs. As most visits typically begin around 18 months to 2 years old, it can be helpful to practice knee- to- knee sitting, with you and your child sitting across from each other, at home first. You may want to consider working with speech and occupational therapists. You should also periodically reassess tools and strategies.  

Progress, not Perfection 

Although it may be difficult at times and you may encounter obstacles with toothbrushing, remember to celebrate progress. Those small steps mean so much more than you may see in the moment, but they come a long way. The praise and encouragement will also make it much easier for your little one. Every child is different, so even if someone else is at a different stage than your child, that does not mean their progress is any less significant. Every child is unique, and what works for one may not work for the other, and that is okay. The best thing you can do as a caretaker or a parent is to focus on the exciting moments, knowing that you will have some bad days, but remaining patient because there will also be many good days.  

Be sure to check out our programs calendar on our website to register for the next Family Speaker: Parent University Program night. This program is every fourth Wednesday of every month from 7:00- 8:30pm. It is held both virtually, as well as in- person at the Tampa Playhouse. https://gigisplayhouse.org/tampa/sfcalendar/