By Patty Laushman
Brushing one's teeth is essential to good health, but it can become a really stressful task that is a sensory minefield. Many autistic adults still struggle with this really important component of daily hygiene. If this is you, I hope you find this information helpful.
If you are constantly resisting brushing your teeth, try playing detective and figure out why you're resisting. Below is a list of the top offenders.
Toothpaste Issues
One of the biggest sensory offenders related to teeth-brushing is toothpaste. Many autistic individuals struggle with the taste or other sensations created by toothpaste because mint flavors and other toothpaste ingredients can cause a burning or tingling sensation in their mouths that their brains interpret as extremely unpleasant.
Taste
Not everyone loves mint, one of the most common toothpaste flavors, but there are are so many other options to try. You just need to know where to look.
There are many other flavors available, including watermelon (here or here), bubble gum, grape, orange mango, orange creamsicle, strawberry, and even flavorless. I've even heard rumors of Oreo cookie-flavored toothpaste, but I haven't been able to find it, so if you locate this mythical product, please share!
Texture
Regarding textures, if paste or foam creates an unpleasant sensation, you can try a gel or go foamless. Also, this tooth powder is highly recommended.
Toothbrush Issues
Sometimes the toothbrush itself is the problem, but fortunately, there are options.
Bristle Stiffness
Some autistic adults experience unpleasant sensations related to the firmness of the bristles. They may be too hard or too soft. I've heard from autistic adults that extra soft bristles sometimes do the trick.
Electric Vibrations
Personally, I can't put an electric toothbrush near my teeth because the vibration sensation is intolerable for me, but some people report this is actually pleasurable for them. If you are one of these people, an electric toothbrush might be worth trying. This inexpensive option includes six brush heads, five modes, and a handy two-minute timer built in.
Temperature Issues
Is the water temperature too hot or too cold when you rinse your teeth? This is an easy thing to adjust. Before you begin brushing, start the water running and make sure it's at the temperature you want before starting the process.
Executive Functioning Issues
Next to sensory issues, executive functioning issues are probably the second most common challenge with teeth-brushing. To successfully brush your teeth, you need to:
Transition your attention from another activity that is probably more fun, rewarding, or interesting, because – let's face it – brushing your teeth is just really unpleasant.
Perform a sizable sequence of tasks and focus long enough to complete them.
Overcome anything that is sensorily offensive.
This is a huge challenge if your executive functioning skills are not where you'd like them to be.
Teaching executive functioning skills is beyond the scope of this blog post, but I will provide some tips. If you need more help, an occupational therapist or autism life coach like those at Thrive Autism Coaching can help.
Transitioning
The easiest way to overcome your resistance to transitioning is to make brushing your teeth part of a routine you do every day without really thinking about it. Then you just do it when that part of the routine is up. To get started with this, try habit-stacking it to something else you do every day without fail.
You can also try doing it without thinking about it. Have everything ready when you first wake up, and immediately upon rising, go straight to the bathroom and do it before you're even aware of the resistance. If you're concerned about brushing before you eat breakfast, keep in mind that it's better to have brushed before eating than to not have brushed at all.
You can also set an alarm as a reminder. I know, I know! Everyone tells you to do this. Try it this way, though.
Pick a time to brush your teeth.
Set an alarm on your phone for 30 minutes prior to this time and call it "Brush teeth in 30".
Then set an alarm for 10 minutes prior to this time and call it "Brush teeth in 10".
Finally, set an alarm for the time you brush your teeth and call it "Brush teeth now".
It's important to name the alarms so you know what they are for when they go off. This also gives your brain lots of notice that you are going to transition to doing something you don't care to do that is really important to you.
Sequence
Most people don't think about the number of individual tasks that need to be strung together in order to successfully brush your teeth.
Go to the bathroom.
Find your toothbrush.
Find your toothpaste.
Apply the toothpaste.
Brush top front.
Brush top back.
It goes on and on...all while offending you sensorily!
If you have trouble getting from the beginning to the end of the process, try distributing these disposable mini travel toothbrushes throughout your house and in your vehicle, purse, backpack, etc. to make them easily and frequently available.
They come preloaded with toothpaste, and no water or rinsing is necessary. The other end of the toothbrush has a soft pick you can use to pick food out of your teeth, too.
This minimizes both executive functioning challenges and sequencing or focus issues because you just grab one and start brushing!
Motivation
To increase your motivation, you may want to provide yourself with some sort of incentive or reward for brushing your teeth, at least until it becomes more of a habit that is part of your routines.
This will help with both task initiation and task persistence and will need to be very personalized to you and what you find motivating right now.
I have clients who really love stickers. You can buy some stickers specifically for this chore and figure out how you want to use them. Maybe you reward yourself with a Starbucks or time on a phone app you love or some sort of guilt-free entertainment such as YouTube videos – whatever your thing is.
If you live with someone, you can also try employing a body double. Ask your roommate, partner, or parent to hang out with you while you do this task you despise, or maybe they can brush their teeth at the same time so you are "suffering together." Suffering alone is not fun. Suffering alongside others makes the suffering so much more palatable (pun intended)!
Other Issues
Place
Do you have negative associations with the bathroom? This can be a sensory minefield for autistic adults. If this is a problem for you, try brushing at the kitchen sink or some other place that works for you.
Time
Is the time of day impacting your ability to perform this task? You need to be relaxed and not too exhausted to take on this stressful demand. If you take medication for ADHD, when you first wake up in the morning may not work for you. You may need to brush after your medication kicks in.
Duration
If you struggle with sense of time as many people with executive functioning challenges do, obviously, you can set a timer for two minutes using your smartphone, home assistant like Alexa, or watch. Some electric toothbrushes even have this built in.
This may be over the top, but sand timers are particularly helpful because they make the time elapsed visual. This is what we've actually used in my house. These are adorable and obviously designed for kids, but the happy faces on them are kind of fun.
Getting Started
If you are not brushing your teeth regularly right now, figure out what your minimum expectations are that you can live with. You need a goal that is achievable so you can experience a sense of success, which then becomes self-reinforcing. I would start with no more than once a day, and make sure to pick a time that is not too stressful for you, and then work up to two times per day.
In the interim, if nothing is working, you can try using mouthwash, which is better than nothing. Our household has used this one. I know, I know! It's designed for kids, but the bubblegum flavor overcame the negative association with mint toothpaste. I've also heard good things from autistic adults about Listerine Total Care Zero Alcohol, and it even comes in a TSA-friendly travel size.
That's what I've got! I really hope this has been helpful. If I've forgotten any tips that have worked well for you, let me know! I want to add them so they can help others. It also makes my day when people tell me they've had success because of something they've learned here on my blog, so don't hesitate to send me an email through this site and let me know!