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Karen Wang
BY Karen Wang

A Special Needs Guide to Dental Hygiene

True confession of an autism mom: I waited until my son was 5 years old before I attempted to take him to a dentist’s office.

Between his oral defensiveness and severe anxiety, I couldn’t figure out how to make it work before then.  The only reason I made that appointment was my concern over an adult tooth that erupted at an unusual angle with the baby tooth still on top of it.

The Screamer

My son was the kid who screamed uncontrollably every time he entered anything that looked like a doctor’s office.  My son was the kid who wouldn’t let me look inside his mouth when he was teething or when he had injuries.  I used to seize the opportunity to try to get a brief glimpse at his teeth whenever he was laughing at a joke or in the middle of a tantrum.  Brushing his teeth was challenging at best, and there was no way he would rinse and spit.

Eventually my husband and I were able to reduce our son’s oral sensitivity enough so that we could take care of his teeth, and we approached his anxiety from several angles to make that first visit to the dentist a success.

Here’s how we managed our son’s dental hygiene:

Establish a daily ritual

1. Be Creative

The National Institutes of Health have a guide for caregivers emphasizing the importance of creativity and a daily oral hygiene routine – and those were the keys to my family’s success.  Finger toothbrushes for infants only encouraged my son to bite my finger.  Instead, I offered him a clean, wet washcloth to chew on for a few minutes in the morning and before bedtime.  I helped him move the washcloth around his mouth so that all of his teeth were scrubbed.  Then I offered water to drink, since he didn’t know how to rinse and spit yet.

2. Brush Together

The next step was to allow my son to chew on a child-size toothbrush while I brushed my own teeth.  This desensitized him to the toothbrush’s texture while I modeled appropriate dental hygiene for him.  Sometimes it’s necessary to try several different types of brushes, such as a spin brush.  After many months, when he was accustomed to the texture, I added non-fluoride toddler toothpaste to his toothbrush so that he would get used to the idea of flavoring on the brush.

3. Don’t Miss A Day

It was important to continue with the brushing ritual every morning and evening – if I accidentally skipped one morning, my son would be uncooperative the next time I tried to clean his teeth!

4. Slow Transitions Are Better

A few years later, my son was allowing me to brush his teeth and he had finally learned to rinse and spit.  Then we switched him to Kids’ Crest fluoridated toothpaste, because the flavor is milder than adult toothpaste.

Know the causes of tooth decay

In recent years, medical studies have documented a clear connection between oral health and overall physical health.  Tooth decay is now considered a preventable infectious disease.  The bacteria that cause tooth decay are typically transferred from one person’s saliva to another person’s mouth.  Sugary foods feed the bacteria and promote decay.

Many children with special needs continue to bottle-feed until they are 4 or 5 years old because of delays in oral-motor skills, which is another risk factor for tooth decay.

5. Prevent Cavities

To reduce the risk of cavities, I gave my son a drink of water after his bottles and made sure his teeth were brushed immediately before bedtime.  I also gave him probiotics, the beneficial bacteria that balance out the harmful bacteria in the human body, mixed into his milk.

Find a dentist who has experience with special needs

6. Referrals From Families 

The best way to find a dentist is to ask for a referral from other families in the special needs community or from your child’s therapy team.  The Special Care Dentistry Association also provides referrals.

7. Referrals From Therapists

I asked my son’s occupational therapist for a referral to a pediatric dentist who had experience with special needs.  She recommended a dentist whose office was next door to a pediatric therapy clinic – this dentist had worked with hundreds of children with all types of special needs.  The office staff was ready for us when we arrived.

8. Accessible and Sensory Friendly

Not all dental offices are equipped for special needs – some offices do not have enough space for a wheelchair transfer, other offices may have a harsh sensory environment.  Ask the office staff about their experience with your unique needs.

Get friendly with the dentist’s office

9. Make practice visits

Consider visiting the dentist’s office several times before attempting any type of examination.  One time I had my husband bring our son in to see me get my exam and cleaning.

10 Make a Social Story

Ricki Robinson, author of Autism Solutions, suggests taking photos of the equipment, staff and waiting room – then using those photos to make a storybook about going to the dentist.

11. Prepare With Books

I got a bunch of books about the dentist from the library for my son.  The only books that interested him were those that had photos of actual dentists’ offices, not cartoons or drawings.  He liked clear, concise narratives that showed him exactly what to expect.  He also liked simple, scientific explanations about the importance of oral hygiene.

12. Divide & Conquer

Keep in mind that most dentists can bill your visit in three separate parts: cleaning, exam and x-ray.  If a child becomes anxious during the cleaning, you can reschedule the exam and x-ray for a different day.  Or you can schedule each of the three parts on different days.

13. Bring Their Favorite Toy/Blanket/Object

Ruby Gelman, DMD, advises in the book 1001 Tips for the Parents of Autistic Boys, “If your child has an object that he particularly loves (a music player or a clock, for example), bring one with you to the dental visit so that the dentist can incorporate that into the appointment.”  Familiarity with the dentist not only reduces anxiety during the visit, but it also increases compliance with dental hygiene at home.

What If Nothing Works?

On top of the increased risk for tooth decay, individuals with special needs often have damaging oral habits such as grinding teeth, picking or biting inside the mouth and tongue thrusting.  For individuals who have a high anxiety level and need long dental procedures, it may be necessary to consult with the dentist about anesthesia and restraint options.

14. Say No To The Papoose

Instead of anesthesia, some dentists still use a “papoose,” a tight swaddle that immobilizes the patient during procedures.  Many parents report that the papoose actually heightens their children’s anxiety and makes future dental appointments much more difficult.

15. Laughing Gas

A doctor may prescribe a mild sedative before the appointment so that the patient is relaxed and sleepy during the procedure, or the dentist may use nitrous oxide (laughing gas) during the procedure.

16. Anesthesia

If the individual is still distressed, then general anesthesia may be required to get the job done.  In these cases, parents usually request that all cleaning, x-rays and repair be completed while the patient is under anesthesia.


The last time I took my son to the dentist, he confidently went into the exam room without me.  Afterwards he couldn’t wait to show his dad how clean and shiny his teeth were.  I could hardly believe this was the same child who used to protest so vehemently every time I tried to touch – or even just look at- his mouth.  Repetition, desensitization, persistence and familiarity helped him learn a new life skill.

Photo Credit:

Karen Wang

Written on May 16, 2012 by:

Karen Wang is a Friendship Circle parent. You may have seen her sneaking into the volunteer lounge for ice cream or being pushed into the cheese pit by laughing children. She is a contributing author to the anthology "My Baby Rides the Short Bus: The Unabashedly Human Experience of Raising Kids With Disabilities"
  • Afpaofficer

    Our doctor recommends avoiding nitrous oxide and fluoride.  In place of fluoride, toothpastes and mouthwashes containing xylitol are good because xylitol helps harden the enamel.

    • Sorensonks

      Xylitol is a natural sugar substitute and if used consistantly at theraputic levels (6-10g/day) can help battle the bacteria that causes decay. It does NOT harden the enamel, however. 

      Be careful to keep it away from pets – xylitol can be toxic for dogs, even at low levels.

  • LisaSpiral Besnett

    I continue to use baby friendly xylitol based toothpaste because I still can’t convince my now 23 yr. old son to spit rather than swallow.

  • Meadowmouse

    My daughter was great until the last couple of months when she has regressed with a lot of things – saying that her brain overheats, and that all of the toothpastes taste horrible and that all of the toothbrushes taste like soap when she uses them with just water….  We are headed to the Specialist child psychologist on Tuesday – but have been to see him before and don’t like him – so I am hoping he will send us on to ‘the big city’ to see other specialists….  

  • I found this ( guide was pretty helpful for relieving some of the anxiety of what to expect at a dental visit with my 5yo Aspie kiddo.  He asked them lots of questions about the tools before they used them too.  He complained about a few of them, but braved through it pretty well.  I took his weighted blanket in to keep him calm during the visit.

  • Benjy Maor

    As discussed in this blog, many factors contribute to the experiences of children with special needs during dental hygiene and visits to the dental office.  One of these factors is sensory processing.  The bright lights, sounds of the drill, smells, taste of the paste and fluoride treatment, and touch in and around the child’s mouth may be extremely noxious to some children and may contribute to the child’s negative behavioral responses during dental cleanings.  Thus, addressing the child’s sensory needs may be an effective intervention. Occupational therapists have expertise in sensory processing and may contributing to enhancing oral care for children with disabilities, as illustrated below.

    Dr. Michele Shapiro, an occupational therapist and Director of the Multisensory Environments at Beit Issie Shapiro in Israel, conducted a pilot study in which she adapted the sensory characteristics of the dental environment for children with developmental disabilities.  The study found that children demonstrated decreased anxious behaviors during a dental cleaning when in a sensory adapted environment.  Dr. Sharon Cermak, an occupational therapist and professor at the University of Southern California in the Division of Occupational Science and Occupational Therapy, in collaboration with colleagues at Children’s Hospital Los Angeles, received a grant through the National Institute of Dental and Craniofacial Research (NIDCR) of NIH to further explore the effectiveness of a sensory adapted dental environment in children with autism spectrum disorders.  Utilizing sensory adaptations strives to safely alter the environment rather than use interventions such as anesthesia that pose some risk to the child.  Exploring sensory adaptations to the environment seeks to make dental care a better experience for children with special needs and their parents. 

    For more information, see:
    Shapiro, M., Sgan-Cohen, H. D., Parush, S., & Melmed, R. N. (2009). Influence of adapted environment on the anxiety of medically treated children with developmental disabilities. Journal of Pediatrics, 154, 546-550.
    Stein, L. I., Polido, J. C., Mailoux, Z., Coleman, G. G., & Cermak, S. A. (2011). Oral care and sensory sensitivities in children with autism spectrum disorders. Special Care Dentistry, 31(3), 102-110.

  • You’re lucky you child is interested in knowing the importance of going to the dentist. Not all children are interested in the science involved. Instead, they dwell more on the fear that they’ve developed. I can’t blame any child for that. The part where the child has to open his/her mouth for a long time and have someone else probe it isn’t exactly comfortable. However, prior knowledge of what’s going on during all the procedures lessens the anxiety of the child.

  • You’re lucky you child is interested in knowing the importance of going to the dentist. Not all children are interested in the science involved. Instead, they dwell more on the fear that they’ve developed. I can’t blame any child for that. The part where the child has to open his/her mouth for a long time and have someone else probe it isn’t exactly comfortable. However, prior knowledge of what’s going on during all the procedures lessens the anxiety of the child.

  • Mindy

    I was so relieved to read this post. I guess misery loves
    company 🙂 Finding the right dentist is key! Unfortunately, we’ve had to go
    through a couple before finding someone with enough patience.

  • A must read to all the moms who has a kid with a special needs. Brushing together, don’t miss a day and finding the right dentist really works. To all give a try to visit and read this blog. It’s worth reading.


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