How to Get Autistic Kids to Brush Their Teeth (Works for Adults Too!)
Updated: Nov 7
By Patty Laushman
Brushing one's teeth is essential to good health, but it's a deceptively complex process. For autistic kids, it can become a stressful part of daily hygiene as a non-preferred activity that requires many steps. Teeth brushing can be a sensory and motor skills minefield as well. Many autistic adults still struggle with this really important component of daily hygiene. If this is you, I hope you also find this information helpful.
If you are constantly reminding your kid to brush their teeth and still getting boatloads of resistance, the first thing you need to do is play detective and figure out why they're resisting.
Here is the formula for success:
Find the sensory stressors and reduce them.
Find the skill deficits and teach them.
Give them as much control over the process as possible. Just like adults, the more control kids feel, the less anxiety they tend to have.
The suggestions below help you do all three of these. Let's dive into the details...
Toothpaste Issues
Taste
Many kids 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.
There are so many other flavors to try, 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.
You can give your kid control over this and make it fun by having a toothpaste-sampling party to pick their favorite type. Just don't let them swallow too much of the toothpaste, especially if it's fluoridated.
Toothbrush Issues
Bristle Stiffness
Some kids and 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 for kids or adults.
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 or your kid are one of these people, an electric toothbrush might be worth trying. This inexpensive option can enable the whole family to experiment. It includes six brush heads, five modes and a handy two-minute timer built in.
Letting your kid pick out their own toothbrush either in the store or online is one really easy way to give them more control.
Temperature Issues
Is the water temperature too hot or too cold when your kid is rinsing their teeth? This is an easy thing to give them total control over. Start the water running and let them test the temperature before they get started brushing.
Motor Issues
Fine Motor Skills
If your kid struggles with motor issues, thicker toothbrushes are easier for some kids to manage, building confidence. The electric toothbrushes, if your kid likes them, tend to have thick handles. Also, toothbrushes designed specifically for kids tend to have thicker handles.
You may need to gently guide the toothbrush for them by placing your hand around theirs and brushing their teeth like you are brushing your own. Just make sure you don't push the toothbrush back too far and trigger a gag reflex. Nothing will derail your efforts faster!
Toothpaste Packaging
If you're aiming for total independence with teeth brushing, make sure the toothpaste packaging is easy to use. Your kid needs to both open the toothpaste and dispense it successfully.
Executive Functioning Issues
Next to sensory issues, executive functioning issues are probably the second most common challenge with teeth brushing. To successfully brush their teeth, kids (and adults) need to:
Transition their attention from another activity whether it's preferred or non-preferred
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 they need 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, ABA therapist, or autism coach can help.
Transitioning
I recommend two things to make the transition go more smoothly. The first thing you can do is set expectations. Let them know in advance that you are going to practice teeth brushing and when. If appropriate, communicate what their reward/incentive will be for completing the task.
Then make sure to use a countdown. Start at least 15 minutes before the new task begins. I would actually mention this the day before or in the morning if it's a change from the regular routine.
Here is an example: "Don't forget, today is the day we are going to practice teeth brushing after dinner, and when you finish, you get to watch YouTube videos for half an hour."
Then during dinner tell them, "Don't forget that after dinner in 15 minutes, we are going to practice teeth brushing." Then give them 10- and 5-minute warnings. Then say, "Okay, it's time to practice brushing teeth."
Note: This script is just an example. If mealtimes are challenging, just choose another time. You will want to separate teeth brushing from other stressful activities.
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. Parents may simply make the demand, "Go brush your teeth," and then when the kid heads in the general direction of the bathroom, they think everything is taken care of. When the parents go to check, rather than getting busy with their toothbrush, the kid is in the bathroom or somewhere else in the house picking their nose.
The best way to tackle this is with a task checklist. I've created a free download to get you started, and you can edit and print it to meet your own needs. You may need more or fewer steps. Once you have something you like, you can laminate it to use over and over.
In the beginning, you will probably need to verbalize each step in the checklist. Then check off the step or let your kid check off the step to give them a sense of accomplishment.
Soon you will want to give them an opportunity to string together multiple steps. Maybe start with the verbal announcement that it's time to brush teeth. Then ask, "What's the first step?" See how far they can get on their own before giving them a reminder of the next step. Soon, instead of a verbal prompt, you can start to fade those out by giving them a visual prompt by pointing at that step on the checklist.
If they are just not able to follow the instructions you may need to provide physical assistance. Don't do it for them though. You can help them use their hands to manipulate the toothpaste dispenser or use your hand to guide their motion while they are brushing their teeth. Make sure to tell them what your intention is before you do it. For example, "I'm going to take your hand and help you get those teeth in the back."
Motivation
Now that you have a plan for reducing stressors and teaching lagging skills, to increase motivation and consequently focus, you may want to provide some sort of incentive for brushing teeth.
This will help with both task initiation and task persistence and will need to be very personalized for your kid and what they find motivating right now. Some kids are motivated by stickers. When we were working on teeth-brushing in my house, AA batteries were king because my son was blowing through an outrageous number of them via his remote control car collection. Maybe you can offer a favorite board game for completion. Older kids may work for video, movie or television time, or if it's allowed in your household, video game time. If focus starts lagging during teeth brushing you can remind them, "Your video game is waiting for you when your teeth are brushed."
Whenever I mention rewards or incentives, parents always worry about having to provide these for the rest of their kid's childhood. Let me assure you that this does not happen. As your kid acquires the skills to perform the tasks, you will be able to fade the rewards. I also point out that even we adults reward or incentivize ourselves to do things we don't want to do, like doing the dishes after dinner before sitting down to enjoy television or in my case, enjoying a glass of wine when I complete my bookkeeping (a seriously non-preferred task)!
Other Issues
Place
Do they have negative associations with the bathroom? This can be a sensory minefield for kids on the spectrum. You can give them control over the location they brush in by asking if they'd like to brush their teeth in another bathroom or in the kitchen. You can even be silly and brush outside with the hose if this is available!
Time
Is the time of day impacting their ability to perform this task? They need to be relaxed and not too exhausted to take on this stressful demand (as do you)! For families that don't have mealtime challenges, after dinner has been a reasonable time to work on this. For families without bathing challenges, right after an evening bath can be a good time. For kids who like book a bedtime, you can use a book-reading as the reward for teeth brushing.
Duration
Are they not brushing long enough or thoroughly enough? You can use a timer set for two-minutes. Some electric toothbrushes have this built in. You can buy dedicated timers, and sand timers are particularly helpful because they make the time elapsed visual. These are adorable, and if sand timers are your kid's thing like they were mine, you can buy them in different time intervals. This is what we had. You can also just set a timer on your smartphone, home assistant like Alexa, or watch.
Getting Started
If your kid is not brushing their teeth independently at all, figure out what your minimum expectations are that you can live with. I would start with no more than once a day, and make sure to pick a time that is not too stressful for them or you, and then work up to the appropriate number of times per day.
In the interim, if nothing is working you can try using mouthwash, which is better than nothing. We used this one early on. 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.
Good luck. If I've forgotten any tips that have worked well for you or your child, please let me know!