Paediatric Dentistry and Neurodivergent Children: How Can I Make My Child’s Home Oral Care Routine More Comfortable?

Establishing new routines, such as toothbrushing, becomes more challenging as your child grows older. That is why it is important to start early. Caring for the oral health of neurodivergent children requires a sensitive, structured, and personalised approach.

While many children may avoid toothbrushing in favour of other activities, neurodivergent children may find toothbrushing overwhelming due to heightened sensory sensitivities, communication challenges, or anxiety about unfamiliar routines.

Hence, the toothbrushing routine for your neurodivergent child may require adaptations in a gradual and patient manner. It is all about taking small but progressive steps, and being kind to your child and yourself along the way. We are here to help support your journey to transform your child’s oral care into a positive, confidence-building experience that will benefit them for life.

Importance of sensory adaptations

Sensory adaptations can make a big difference in helping neurodivergent children tolerate and even enjoy brushing. This includes preparing the environment for brushing, preparing yourself and your child for the routine, as well as selecting appropriate tools for brushing.

Be prepared that brushing can be challenging especially in the initial stages. At times, it may need two people to do the task, with one supporting the head and brushing for the child, and the other distracting or hugging the child.

Here are some tips that might improve the process:

1. Preparing the environment for toothbrushing

You may need to adjust the environment to ensure the space is comfortable and not overwhelming with sounds, smells, or sights. Remove or reduce as many sensory triggers as you can. You may consider including some of your child’s sensory preferences, e.g. favourite song.

Brushing does not always have to be in the toilet or bathroom. Some children may feel sensory overwhelmed due to lights or sounds (e.g. water gushing down the pipes, or toilet flushing), the smells (e.g. cleaning agents or toilet freshener), or wetness of the floor in the bathroom. You may find it easier to brush your child’s teeth when they are lying down on the sofa, during bath time, or while they are watching television. Just remember to prepare a wet cloth to wipe away excess toothpaste or have a cup ready for them to spit.

Brushing also does not have to be the last activity before bed. Your child just needs to avoid eating, and drink only water after brushing. Consider establishing other fun routines, which your child can look forward to, such as bedtime storytelling, cuddling, or a massage before bed, instead of using a milk bottle to put your child to sleep.

2. Preparing your child and yourself

Be mindful of your emotions when brushing your child’s teeth. Your emotions and sentiments towards toothbrushing are often picked up by your child. Be aware of your child’s sensory preferences and challenges. Avoid introducing toothbrushing for the first time when there are big shifts in routine (e.g. while away on holiday), when they have lower energy levels, or are feeling unwell (e.g. unable to breathe well).

3. Sensory preparation and oral motor activities to help get ready for brushing

Helping your child prepare their mouth and mind through sensory regulatory activities may help them to feel more comfortable and prepared to accept new learning activities. You can play oral motor games with your child, such as blowing bubbles, blowing into water through a straw, puffing cheeks and popping them, or making exaggerated funny faces.

If your child uses oral sensory tools such as chews or vibratory tools, you can let them practice this before brushing. You can also consider doing a facial massage using your fingers or vibrating toothbrush if your child is able to tolerate them, followed by gums massage to prepare your child for toothbrushing.

4. Play and familiarisation

Turning oral care into play helps children feel more relaxed and in control. It also encourages participation and reduces fear. Some children do well with watching an older sibling or parent brush and can be encouraged to adopt similar habits.

Let your child brush a stuffed animal’s “teeth” first, or take turns pretending to be the dentist, where you and your child take turns to keep the mouth open and count each other’s teeth. Make the session engaging by incorporating a toothbrushing song, or use online brushing apps and small rewards to make brushing enjoyable.

5. Structured routine and predictability

Many neurodivergent children feel safer and more cooperative when they know what to expect. Establish consistency by brushing at the same time, by the same person, and in the same place each day to build predictability. Keep communication simple and use calm, consistent language and tone. Have all the materials you need for introducing a toothbrush or toothpaste ready.

Avoid rushing or making sudden changes, which can heighten stress. Use visual aids such as step-by-step picture cards to show what is coming next. This provides a sense of accomplishment when each step is completed. You can also use a brushing chart with stickers to help establish a routine, track your child’s progress and reward them at the end of the week.

Remember to praise your child for each step forward no matter how small it may seem.

6. Using a sensory-suitable toothbrush

Build familiarity by letting your child hold, explore, and play with the toothbrush before using it. This helps them feel in control and reduces anxiety. You can start by using a wet cloth to wipe your child’s teeth.

Silicon-bristled finger toothbrushes is also a good start to help introduce a toothbrush into the mouth. It can also be used for oral massage of the gums for your child to get used to the sensation of having an object touching their gums and teeth. However, these methods are less efficient for removal plaque (bacteria and food debris), and you should aim to move towards using brushes with nylon bristles for more effective brushing.

If your child has oral sensitivity, consider using toothbrushes that have:

1. Soft or extra soft bristles
2. Smaller heads which are easier to manipulate and reach the back areas of the mouth
3. There are also three-sided toothbrushes, which are useful if your child can only tolerate brushing using the back and forth movement for a very short period of time, bite the toothbrush, or has a strong gag reflex

If your child is sensory-seeking, does not mind vibrations and enjoys pressure on their gums and teeth, then an electric toothbrush may be suitable for them. Some electric toothbrushes come with additional features like smaller brush heads, timers, apps that track brushing, pressure sensors, and vibration reducing settings, which can allow customisation of their preferences. All these may help make brushing more engaging, allow more independence during brushing, and get to difficult to reach areas in the mouth.

For children who are highly sensitive, use gradual desensitisation and start by brushing a few teeth at a time to them help increase tolerance over time. When brushing, agree on a definitive number of strokes (e.g. 5 or 10) and count each stroke. Break down the brushing into several areas, e.g. brush all the biting surfaces first, then the outer surfaces from left to right, bottom to top.

Tell them that you are moving on to the next section, and get them to spit or rest in-between. Some children find having a timing helpful to visualise when they need to brush. This helps you pace the toothbrushing session, and allows the child to know there is an end-time and that tooth brushing will not last long.

Some children may find it helpful to look into a mirror when brushing, as it allows them to visualise their mouth movements and see where their toothbrush is reaching. If your child tends to clamp down on the brush, you can use another toothbrush, a chew toy, or some cloth wrapped around ice-cream sticks to open their mouth gently.

Remember to bring your child’s toothbrush when visiting the dentist, so the dental team can demonstrate proper brushing techniques and ensure the toothbrush is suitable for your child.

7. Introducing toothpaste

Strong flavours, foaming sensations, or minty tastes can be overwhelming for some children. If your child has not yet started using toothpaste, introduce it gradually to help them get used to its taste and texture. For children who are sensitive to strong flavours, choose a mild or fruity toothpaste. If your child struggles with different food textures, a non-foaming toothpaste may be more comfortable.

To introduce toothpaste:

1. Let your child smell the toothpaste from a distance
2. Let your child touch the toothpaste with their bare fingers
3. Dilute the toothpaste with a few drops of water to make a thin paste
4. Introduce a small dab on their lips and promptly wipe it off so they can smell but not taste it
5. If they are ready to taste it, you can dab a bit on their tongue, before moving towards putting a dab on their upper front tooth, and wiping it off.
6. Finally put a smear on their toothbrush and brush the front teeth, wiping as you brush.

Always have an adult dispense toothpaste for your child so that the appropriate amount is given. Ask your dentist how much toothpaste you should give to your child. If your child has difficulty in spitting, have a wet cloth ready to wipe away excess toothpaste, or get them to lean over the sink with their mouth open so extra toothpaste can flow out.

Use a toothpaste with at least 1000ppm fluoride to help prevent cavities. If in doubt, please check with your dentist on a suitable toothpaste to use.

Conclusion

Take things one-step at a time. Remember that these habits take time and energy. You do not have to do everything at once, and neither are you expected to get things right the first time. Make it a point to celebrate small wins, because it means you have moved one more step forward.

By blending patience, structure, and creativity, caregivers and dental professionals can make oral care more accessible, positive, and empowering for neurodivergent children. Every small success can help build trust and confidence, paving the way for a lifetime of healthy smiles.