Smile Proudly: Starting a New Routine for Oral Health Excellence

As parents, we do our best to keep our kids healthy and protect them from activities that may risk their health and safety. One area of health that is frequently overlooked is oral health.

Oral health includes not only keeping your teeth and gums healthy, but also your lips, tongue and all parts of your mouth. It is the leading unmet healthcare need for children with disabilities.

According to the National Health Institute, across all income levels, children with disabilities are almost twice as likely to have an unmet oral health care need than their typically developing peers.

Poor oral health can lead to gum disease, tooth aches, cavities, and eating problems, but also to more serious health problems including endocarditis (an infection of the heart’s chambers), diabetes, cardiovascular problems or pneumonia.

We might not like to admit it, but our mouths are full of germs and bacteria! While most are harmless, sometimes these germs can lead to disease in other parts of the body.

Giving your mouth a thorough clean out, especially before bed, when your mouth will be closed for several hours, can eliminate some of the pollutants that can enter your system.

Image Courtesy of our Facebook Friend Charles P.

Encouraging our loved ones to care for their teeth and mouth can be challenging. Some children struggle with spitting or swallowing toothpaste and fluoride mouth rinse.

Others have sensory tolerance issues with the tactile stimulation of a toothbrush or waterpik. In our busy lives as parents it’s easy to put aside our own oral health and not provide a healthy role model for why regular brushing, flossing and dental visits are so important.

And without the right tools and guidance, brushing another person’s teeth can be very challenging!

Helpful Strategies

Start with your own dental health.

Just as we try to model other healthy habits, taking care of our own oral health. Brushing, flossing and participating in regular dentist appointments informs our loved ones that oral health is something that deserves time and attention. It’s never too late to begin paying attention to oral health even if it’s been neglected for years.

Begin slowly

As with any new physical routine, your body gets stronger as you get accustomed to a new pattern of behaviors. The American Dental Association recommends brushing your teeth for two full minutes twice a day with a fluoride toothpaste. It can be easy to apply too much pressure to your gums, which could result in them being swollen or bleeding. 

You can ask your dentist about proper brushing and flossing techniques, or search for a YouTube video that demonstrates the best way to do it. It is important not to hurry your brushing routine and gradually brush for increasingly longer intervals of time until you reach the 2 minute mark. 

When you have finished your routine, take a minute to notice how your mouth feels. Do your teeth feel smooth? Does your mouth feel fresh and minty? 

Make a verbal comment about what you notice, such as, “My mouth feels fresh and clean and now I’m ready to start my day”. This will help other family members be aware of your efforts and hopefully model them. 

Gather the right equipment 

Standing at a sink is not the only place to brush teeth. For some people with physical disabilities, sitting at a table with a basin might be a more comfortable and practical way to practice oral hygiene. 

Some children may feel more comfortable sitting on a couch or soft chair with a basin or cup. It may be easier to start an oral health routine in a comfortable space like this, especially for children who may not have strong balance skills to stand in front of a sink.

Before brushing, gather the supplies needed for the setting you’ve selected, starting with surgical gloves and a towel or baby wipes. 

Allowing your child to pick out their own toothbrush and toothpaste flavor will increase their opportunities for choice and control. There are many different toothbrush options, including three-sided toothbrushes that brush on inner, outer, and chewing surfaces or a U-shaped toothbrush that gives full mouth coverage. Adaptive grips can make holding a toothbrush easier. 

The American Dental Association (ADA) says that both manual and electric toothbrushes are effective for removing plaque and bacteria from the mouth. 

Electric toothbrushes offer a completely different sensory experience and may take some getting used to if your child isn’t familiar with it. 

Spit happens! Toothpaste does not stain, but can leave a mark on clothing, so be prepared with an apron or towel if you want to protect clothing. 

If brushing is not an option for your child, a gauze pad dipped in fluoride mouth rinse is an alternative. Holding one’s mouth open can be tiring and potentially painful for some. 

A foam mouth rest can prop the mouth open to allow someone else to maneuver around with ease. 

Flossing between teeth, where food can get trapped and cause cavities and gum disease is just as important as brushing. Dental floss comes in different flavors and varieties: waxed, unwaxed, thicker tape, or floss picks. 

There are even floss picks made specifically for children. Experiment with different options and see which one works best for you and your child. 

Time flies when you’re having fun

Regardless of the type of toothbrush, the ADA is firm about recommending two full minutes twice a day, devoted to tooth brushing with a fluoride toothpaste. 

If the two minutes is not part of your usual routine, start slowly and gradually work up to two minutes. Embrace your child’s special interests and find two-minute YouTube videos or songs your child will like that are reserved especially for toothbrushing time.

 If you have a young child, there are many educational books and videos that promote tooth brushing or they might enjoy toothbrushing toy sets. 

Sensory Seeker or Sensory Avoider? 

Each child is unique so they may respond to stimuli differently. Some kids love bright lights, crowds, noise and LOTS of stimulation. But others can be very bothered by stimulation, and become agitated and overwhelmed. 

Oral hygiene including brushing and flossing provides sensation through touch, smell and taste. An electric toothbrush adds noise into the equasion. If your child has a low sensory tolerance, it is important to consider how all of these things may overwhelm them. 

Be sure to provide verbal prompts to let your child know what you are doing. Ask their input on water temperature if they have teeth and gums that are sensitive to cold water. 

An occupational therapist can provide help on how to teach your child to overcome sensory overload and tolerate an oral hygiene routine. These strategies may also be helpful for dental office visits that are full of smells, bright lights, noises, gritty toothpaste and chairs that move up and down. 

Image Courtesy of  PA Autism.org

This can be terrifying for a child who has a low sensory tolerance. If possible, seek a dentist who will allow you to visit the environment before the actual dental exam begins.  Using social stories is a good way help prepare prior to the visit.

You may not have considered the importance oral health plays in your child’s life and that’s okay! Or you may have been too apprehensive or concerned about starting an oral health routine, and that’s okay too! It’s never too late to start a routine for yourself and your child. 

Just remember, start slowly, find the tools and settings that are right for your child and try to brush for two minutes twice per day. Remember, there are always other parents and professionals to call on if you need tips or guidance.

About the authors:  Molly Dellinger-Wray and Dr. Kayla Diggs Brody part of the Partnership for People with Disabilities, a University Center for Excellence in Developmental Disabilities at Virginia Commonwealth University proud mothers of amazing kids. Together, they developed the Smiling Strong Challenge, a fun online challenge to promote oral health. For more information, contact [email protected].