Sensory Part 3: All Things Teeth

Sensory-sensitive kids can have such a difficult time with all of the sensory input of a dentist or orthodontist appointment. And then in the day-to-day as well. If you have difficulty getting your child’s teeth successfully brushed, know that you are not alone in this struggle. Our kids are not just being stubborn little meanies. These things are harder for some kids than others. I love psychologist Dr. Ross Greene’s philosophy: Children do well if they can. When they can’t, the behavior is a sign of an unmet need or lagging skill. You can follow the pattern and clues to pinpoint the unmet need. As you offer the right support, often the behavior will change. If you want to hear more about the “why” of sensory needs, start with the Sensory: Part 1 here and then come back to All Things Teeth.

I’m going to share what we have learned, plus possibilities that have worked for other families. Hopefully you will find some ideas that work for your family.

All things toothbrush, paste, floss.

When it comes to tooth brushes, toothpaste and floss, involve your child as much as possible. They can pick the Mickey Mouse tooth brush, or if they are not into characters and themes, the blue, soft-bristle brush. This gives your child some autonomy and buy-in. We all appreciate choices in life. If too many choices are difficult, then pick two or three options and offer for your child to select from those.

Toothbrush and floss alternatives

*Note: with all of the tooth brushes and flossers that are electric, expect to take a month allowing your child to get accustomed to it. I discuss that below in the Electric toothbrush desensitizing process.

• Consider an ultrasonic u-shaped tooth brush such as this one.
• A water pik can help so much. It lets you floss with a stream of water. This is especially helpful if your child has braces or any kind of permanent appliance.
• An electric tooth brush. There are lots but this is the one we own. Keep in mind you can purchase softer bristle heads for it. I also often see it at Costco.

List of toothpastes for sensitive kids:

• Tanner’s Tasty Paste
• Tom’s of Maine- Silly Strawberry
• Tom’s of Maine kid’s natural mouthwash, Silly Strawberry
• Tom’s Strawberry (non kid version)
• Boka Brand toothpaste (mild flavors)
• Colgate Kids Toothpaste- Strawberry flavor
• Fluorimax 5000 – no link as what I found was a prescription
• Kiss My Face: Obsessively Natural Kids
  *For a child who is nervous or sensitive to demands, consider purchasing a few options initially and setting them out as options at the sink. Casually mention these are options some kids like. You are basically “strewing them” but not making the child sample them all unless they are ready to try.*

In preparation of an appointment:

• Get referrals from other people about recommendations of sensitive, collaborative and caring dentists/orthodontists. A local parents or local neurodiversity Facebook page could be a place to ask.
• Call ahead– ask questions, give them a heads up about your child’s needs. Let them know things that could help your child. Discuss the support ideas below. If the child doesn’t like being touched, explain what will help, such as explicitly asking permission to touch the child, or using firm pressure rather than very light. Share what has been difficult in the past. Would it help to wait for a second appt to do x-rays? Would it help to skip polishing the first appt? Let them know to warn about noises and try to silence machines when possible. Green flag: they have suggestions and are eager to help. Red flag: they are inflexible to support your child.
• Have the dentist give child a symbol that means things are good, and another symbol that means “i need a quick break.” It could be thumbs up and thumbs down. This can make not being able to speak during cleaning or oral exams less scary.
• Schedule a “meet and greet” appointment. No actual procedure.
• Ask them to make the first appt a little longer so there is a time to answer questions or narrate procedures. Let child touch things if and when possible, or try (with permission) flipping the “on” switch or stepping on the pedal to turn on a noisy dental tool. It is less scary when you are in control. Explain all the why’s: why the hygienist wears a mask: why do we need our teeth cleaned? Why do they need pictures of my teeth? Why do the clip a napkin around my neck?
• Watch a “trip to the dentist” video.
• If needed, talk to your doctor about taking Tylenol ahead of the appt.
• Do a pretend run-thru at home. Use dolls, puppets, Lego minifigs, or have older siblings help to give an enactment with you.

Possible accommodations to make your child comfortable:

• Go in with your child. You need to be able to go back with your child (if that helps them). They shouldn’t force you to wait in the waiting room. However, try to think ahead if you have multiple kids. You probably can’t bring a pack of kiddos with you.
• Dim the lights or bring sunglasses. Fluorescent lights hurt sensitive eyes and also create distracting buzzing for sensitive ears.
• Fidget toys. It wouldn’t hurt to purchase a new, inexpensive fidget ahead of the appt. Or, instead of a fidget, a smooth polished stone to be their little touchstone or talisman reminder that it will be over soon.
• Wear headphones or ear plugs to soften noises. See sensory-friendly options here. You could play music or audiobooks when not needing to talk to the Hygenist/doctor.
• Bring a weighted blanket or weighted stuffed animal (the lead apron can also have a calming effect!)
• No shame: this is a great time to use technology. Try a video game or cartoon on a phone or iPad, but not something new in case that causes unforeseen problems- choose tech your child has already enjoyed in the past.
• Use the restroom before the appt.
• Bring a water bottle.
• Ask dentist/orthodontist to avoid strong odors and flavors. Call ahead and discuss flavor options for polish, etc. For instance, “grape” polish was a nightmare for me as a kid. Once they understood that, they offered me mint which was much better. If a flavor has worked well in the past, find out what brand and make sure you have it for future dentists and appts.
• A towel on the instrument tray will muffle harsh clatter sounds.
• Nitrous oxide for procedures: this is not an option I have personal experience with. I’d suggest you bring it up with your pediatrician to weigh pros and cons, as well as discussing with the dentist in advance.
• Ask for a “bite block,” if it is difficult for your child to keep their mouth open. This will let them rest their jaw.
• Explain everything before they do it.
• Wax to put on braces and rough metal of appliances.

Before starting orthodontics or appliances:

You already discussed options and needs with the orthodontist, (if not, go back to the “In Preparation of an Appointment” checklist. Hopefully the orthodontist is collaborative and insightful. For my highly sensory-sensitive kiddo, the orthodontist recommended we go with Invisalign. This kept all of the pokey metal out of her mouth and was a big success. A drawback: if you have a child who loses everything and is very forgetful, Invisalign or aligner trays may be difficult since you can take them out of your mouth. Consider clear resin retainers over the ones with metal. Make sure they will have wax for you they day braces are put on. It helps to protect the inside of the mouth from scratches and pokes. Order some if for some reason the orthodontist doesn’t have it. If your child is very sensitive to pain, as a mom who has gone through it, I’d consider taking a mild pain med just before or right after the initial appointment where braces or spacers are put into your child’s mouth. This will help you stay ahead of the discomfort.

Don’t forget about including your child and allowing them to have a voice and buy-in. When our orthodontist was ready to start a program for my child, he made a personalized video. In it he pulled up x-rays to show the child’s airway, and he explained all the ways orthodonture was necessary for my child and would give them a healthy bite and promote healthy airway. He pulled up a video that demonstrated the braces and how everything would work.This top-down approach of understanding the importance and value really helped my children be personally on board.

Choices matter. My daughter who was so sensory sensitive but realizing we really did need to do the Invisalign. Her last request: when we needed rubber bands, could she please have colored? The orthodontist normally only had clear, but he promised her colored bands. When we arrived 6 months later and needed to start the rubber bands, I was wholly impressed when they brought out her special pack of ordered colored bands. That is an example of a really collaborative and present orthodontist.

Getting used to an electric toothbrush:

This can be a challenge! Don’t try to force them to brush their teeth with it right away. Here is what worked for me:

• Day 1. Just have them hold it, look at it, touch, turn it on in their hands. That’s it.
• Day 2. Repeat except hold it with the toothbrush on for a few seconds.
• Day 3. Repeat. Then, when it is off, have them touch it to their lips/teeth a couple of times.
• Day 4. Show them with your own what this will be like. Tell them what it feels like. Then, have them turn it on and just touch it once to their lips. If that goes ok then have them touch the bristles once to their teeth. Done!
• Day 5. Now we start touch it to our teeth with the bristles, for a full second.
• Day 6. Two seconds.
• Day 7. Three seconds. From here, try to add a second or two per day but that is it! Not brushing teeth with it, just getting acclimated to the sensation. Ideally, in about a month they will be able to brush their teeth. Tip: Once it is wet with toothpaste, don’t turn it on until it is in your mouth. It is less messy this way.

I hope this gathering of information and suggestions is helpful!! Remember you are doing a great job with your uniquely wired kiddo.

Warmly, Christina