Why children with developmental disabilities "have trouble brushing their teeth" and what to do about it.

 Many people see a child who doesn't like to brush his or her teeth and wonder, "Why does he or she hate it so much?" Many of you may be thinking, "Parents are responsible for their children's tooth decay..." Many of you may be thinking, "I don't understand why my child is so reluctant to brush his or her teeth.

As you gain a better understanding of your child, you will learn how to treat him or her, "This is why he or she doesn't like toothpaste! and you will be able to understand how to treat your child, which will help reduce stress.


A Child with "Difficulty in Brushing Teeth" Characteristics

 Difficulties caused by the characteristics of developmental disabilities differ for each child. Even if we say that a child is "not good at brushing his/her teeth," there are various types of "difficulties," such as reluctance to brush or be brushed, inability to brush teeth well, etc. First, it is important to know what the child feels "difficulty" with.

First of all, let's start by finding out what your child feels "weak" at.

Here are some examples of disability characteristics that may cause "difficulty in brushing teeth. Please check if any of them apply to your child.

Please note that the type of disability is listed here, but some cases are comorbid, so please check for reference only.


[Typical example] Disability characteristics and reasons for poor toothbrushing.

ASD: Autism Spectrum Disorder / ADHD: Attention Deficit/Hyperactivity Disorder / DCD: Developmental Coordination Disorder / Other Disorders


- Sensory sensitivity (hypersensitivity with tactile touch sensitivity and intolerance to stimulation). ASD

They dislike the toothbrush going into the mouth itself, feel strong pain even though it is only touching, try to prevent brushing by biting the toothbrush, and dislike having their face touched, such as when finishing brushing.


- Has taste sensitivity and has difficulty with certain tastes. ASD

He doesn't like the taste of toothpaste and spits it out, or doesn't like the stimulation of menthol and can't hold it in his mouth.


- Perfectionist (obsessive). ASD

Brushes teeth for an excessive amount of time.


- Has sensory insensitivity and is unaware of pain. ASD

Unable to notice pain or discomfort from tooth decay, delaying detection, rubbing gums hard until they bleed.


-Hyperactivity and inability to sit still. ADHD

Flapping of arms and legs, inability to sit or sleep in the same position.


-Has difficulty maintaining concentration. ADHD

Gets bored and stops before brushing all teeth.


-Has difficulty with body sensation. DCD, ASD

Cannot control the force of the toothbrush, or cannot do the scrubbing motion (moving the toothbrush in small increments from side to side).


-Has developmental challenges with functions around the mouth. Other Disorders

Runs water out of mouth, drinks water, cannot gargle.


 There are two types of cases: those in which the patient refuses due to trauma from past "painful or unpleasant experiences," and those in which the patient is uncomfortable with stimulation due to sensory sensitivity or other characteristics. In some cases, there is a combination of both.

Strategy and Tactic for Disability Characteristics

Here are some ideas and tips to help your child overcome "difficulty in brushing his/her teeth" based on the characteristics of developmental disabilities.

Depending on your child's situation and developmental stage, it may take time or be difficult to see the effects. It is recommended that you consult with welfare services for children with disabilities (child development support, after-school day care services, etc.) or a dentist before proceeding.

Remember to always praise them after they are done!

It will make it easier to establish good behavior and what can be done.


Case: Your child doesn't like having a toothbrush in his/her mouth.

Aim to gradually get your child accustomed to using the toothbrush by taking small steps according to your child's needs.

The key is to say in advance, "Now I'm going to do ●●" when you touch it or put your finger on it.


1] Help your child understand that it is safe to put something in his/her mouth.

If the child is resistant to the idea of putting a toothbrush in his or her mouth, the first step is to have the child get used to the sensation of a foreign object in his or her mouth by putting the parent's finger in the mouth. Next, practice just putting the toothbrush in the mouth. The first step is to place the toothbrush in the mouth.


2It will help them become accustomed to weak stimulation.

Use toothpaste or gauze to provide less stimulation than with the toothbrush.

This will help relieve tension by slowly touching the cheeks, then the lips, then the inside of the mouth.


3When they become accustomed to the stimulation, try brushing their teeth.

Do not try to brush all the teeth, but start with the front teeth first, and gradually work your way up to the back teeth.


 In addition, we also recommend using toothpaste (such as gauze or finger brushes) and toothpaste (such as sweet flavored toothpaste for children) that are less irritating.


Case: Developmental issues around the mouth prevent the child from brushing teeth well.

Practice how to move the mouth ("oral functions" including teeth, lower jaw, tongue, cheeks, and palate). Check for areas of difficulty during the toothbrushing process, and practice accordingly. For children who are about to start toothbrushing training, we recommend practicing in order from the top to the bottom.

 - Difficulty in closing the mouth

Practice breathing through the nose. 'A-I-U-AE exercise" (developed by Dr. Kazuaki Imai, director of Mirai Clinic) is a training method to switch from mouth breathing to nose breathing. The exercise exercises the muscles of the lips and tongue while performing the "'[a]-[i]-[u]-[ae]" mouth movements.

It is said that if you do one set of 10 times, three times a day, you will see results. Another way to practice the "mouth-closing exercise" is to use gum or balloons.

Once you are able to do this, practice actually containing water. We recommend practicing in the bathroom or other places where water can be spilled.


- Difficulty moving water from in the mouth.

Learn how to move your cheeks. Do not try to do it all at once, but practice step by step.

(1) Repeat the process of expanding and squeezing the cheeks.

2) Inflate cheeks one at a time, left and right.

(3) Move air to the right and left while inflating one cheek at a time

 One of the game to practice closing the mouth and moving the cheeks is "Mouth Rock, Scissors, Paper". Rock means "puff out your cheeks," Scissors means "stick out your tongue," and Paper means "open your mouth wide. Once your child is able to do this, practice gargling with water.

- If don't like to spit out water

Drink the water first, and practice leaning forward and spitting it out before drinking.

If they don't stick their tongue out when they spit, they won't be able to spit it out cleanly. Yelling "[æ]" it out" or having a caregiver model it for them works well.

Once your child is able to brush their teeth with gargling in just stand, try practicing garlging face up and throat washing. To avoid confusing your child with different mouth movements, wait until they've mastered gargling in just stand before trying it.


Extra Edition: Gargling Practice

This is also done in small steps. Let's proceed in small steps until you are able to do it, without overreacting.

(1) Practice saying "[a]" while looking up without water.

(2) While facing forward, practice saying "[a]" with water in your mouth (water should be in the lower part of your mouth).

(3) Practice looking up with a small amount of water in the mouth

(4) Practice looking up and saying "[a]" with water in the mouth

 To learn the movements around the mouth, it is also effective to use toys such as soap bubbles, balloons, and trumpets. Try to make it fun for your child.

Do not forget to praise your child when he/she is able to do more!


Case: Cannot sit still when brushing teeth

 First of all, it is important not to try to brush all of the teeth, but just a part of it, so that the child does not have a bad image of brushing his/her teeth. Especially for children who have difficulty maintaining their concentration, brushing their teeth for 3 minutes feels very long and painful. If this happens, the image of "brushing teeth = pain" will be attached to them, and they are more likely to refuse to brush their teeth.

When the child no longer feels resistance to brushing his/her teeth, you can count down the three minutes or show him a clock so that he/she can see when he/she will finish brushing his/her teeth. If you do not take such steps and suddenly try to complete brushing the teeth perfectly, it may lead to unbearable outbursts, great stress and "bad experiences" that may cause trauma.

Try to take a break between each tooth brushing, such as between the upper front teeth and the lower back teeth, or say the action of tooth brushing (e.g., "I got the stains off your teeth," "I'm brushing the backs of your teeth," etc.). It is important to have a change in the situation rather than just brushing teeth all the time.

To make it a fun time, sing songs and brush teeth in a playful and enjoyable atmosphere. Showing videos for brushing teeth is also recommended.

Whenever you see an increase in what they can do, such as patience or being able to brush their teeth on their own, be sure to praise them at the time they are able to do it.


Case: Lack of "motivation

 When teaching children to brush their teeth or perform other daily activities, we often teach them one at a time, starting from the beginning of the flow. In order to motivate children, it is effective to start from the opposite side of the flow. This is called "retrograde chaining. (When you want them to learn the correct flow, "sequential chaining" is effective, where they follow the flow.


The flow of brushing teeth can be broken down into the following steps

  1. Prepare toothbrush and toothpaste.
  2. Take the toothpaste and open the lid.
  3. Put the toothpaste on the toothbrush
  4. Close the lid of the toothpaste
  5. Take the toothbrush under the faucet and turn on the faucet
  6. Turn off the faucet
  7. Put the toothbrush in your mouth
  8. Brush the upper right back tooth
  9. Wash the toothbrush
  10. Turn off the faucet
  11. Put the toothbrush on the shelf


First, have the child do only "11. .Put the toothbrush on the shelf"; the parent/guardian should do steps 1 through 10. By having the child do the last step of brushing his/her teeth by him/herself, the child can say, "I did it! Finished!" By doing the last step of brushing teeth by themselves, children can experience a sense of accomplishment by themselves.

The next two steps are "11→10. Turn off the faucet," then "11→10→9. Wash the toothbrush," and so on, starting from the reverse of the process and increasing the number of things the child has to do.

Although retrograde chaining is not very effective in helping children learn how to brush their teeth quickly, it is very effective in fostering motivation.

Remember that this is not suitable for children who have difficulty brushing their teeth due to sensory sensitivity or other characteristics. If your child has ADHD traits such as "boredom and disinterest in things that are bothersome," then by all means give it a try.


Why dislike the dentist?

 Even as adults, many people have a bad feeling about the dentist, saying that it is a place they would not want to go if they could. They often have an image of "the dentist" as "scary and painful," and they may even be reluctant to go to the dentist.

For children with sensory sensitivity, there are many things they "don't like" about the dentist.


- Smell sensitivity, and the smell of disinfectants and other chemicals is too strong

- The lights on the examination table are too bright and painful.

- Don't like the sound of treatment instruments and metal scraping.

- Difficulty with the sensation of the backrest collapsing

Some dentists may be able to provide support and care for children with sensory sensitivities, so it is a good idea to find out in advance.

It is important to "make it a habit" as early as possible.

As children, parents can pay attention, have regular checkups at school, and receive support to avoid tooth decay, but as adults, they must take care of their own teeth themselves. It is important to make brushing teeth a habit and learn how to cope with the characteristics during childhood.



(Note: The translation has been provided to the best, but there may be slight variations or interpretations. Please refer to the original Japanese article for complete accuracy.)


References :  Happy-terrace, Developmental support and support case studies

(発達障害のある子どもが「歯磨きが苦手」な理由とその対処法 (happy-terrace.com)