Dyspraxia & Oral Health
I am a sensory integrative occupational therapist and work with individuals all across the lifespan. My speciality is dyspraxia, and oral hygiene is a common area of struggle due to the many steps, difficulty knowing how to coordinate your tongue with the toothbrush, holding and manipulating oral hygiene materials, and finding alternatives, especially when gum sensitivity increases from lack of effective daily brushing.
Here is what I have found effective for many individuals:
Practical strategies for brushing and flossing with coordination difficulties
When learning to brush, group together similar motor plans. For example: Brush the inside bottom teeth on the left. Then move to the inside bottom teeth on the right, flip the brush, then repeat on the top (inside top left, inside top right). Count to 10 for each side as you brush. Then push the brush into your cheek, close your mouth, and scrub while counting to 10 on the left, then right. Take a moment to spit at the end of each sequence so the foam doesn't build up. The final two steps are holding your elbow out to the side while closing your mouth and brushing the front teeth and then opening your mouth while keeping your elbow out, flipping the toothbrush to face out and brushing behind the upper and lower teeth.
Making your routine easier:
It's a LOT of steps to remember and think about so if you are too focused on managing the toothbrush, have someone record themselves verbalize the set up (ex: unscrew the toothpaste cap and squeeze the tub while lining it up with the brush head and then saying each of these steps and counting to 10. Then play back the recording as you brush your teeth to remember the order. Make another recording for flossing if it helps. This reduces the cognitive demand of trying to remember everything. Each person experiences tasks at varying levels of difficulty so when it comes to my advice, take what you need and leave the rest so you feel as independent as possible.
If your tongue gets in the way or tries to touch the toothbrush, practice just holding the brush in your mouth and then moving your tongue to the opposite side so that it doesn't block the brush. This takes a lot of practice but needs to be the first step before ever trying to learn the sequence of brushing.
Advice for children or adults who struggle with fine motor skills
With flossing, it's best to use a single-use flosser, following a similar sequence as above. Slateflosser.com or Goflaus.com have large handled flossers similar to a toothbrush that may work for people who struggle with fine motor skills. They even have electric ones for those who can tolerate vibration.
There are many differently-sized toothbrush handles available. If you need a larger grip but don't like vibrating toothbrushes, TePe Extra Grip Ergonomic Toothbrush Holder available at Kleenteeth.com fits over a regular toothbrush. If you need a designated spot to help you place your thumb correctly on the brush, Radius makes brushes for right and left-handed people that are angled for easier use and have an easy-gripping shape available at madebyradius.com
Anyone who struggles with significant coordination and sequencing difficulties as well as tooth sensitivity, may be better served by a U-shaped toothbrush. Autobrush makes U-shaped brushed for both children and adults with a combination of silicon and regular bristles. Sonicbrush uses only silicon. Amazon has a wide variety of fun options for kids as well. They come in both child and adult sizes, and some also have a UV light feature to kill germs.
If you are able to actively brush but struggle with the sequence, then there is a version available with a long handle that brushes all the teeth at once. However, if you prefer to just hold it in your mouth and let the vibration and UV light do the work, choose from the brands above. These are also great solutions for those who struggle to keep their mouth open while brushing or get easily frustrated trying to brush their teeth because there are no sequencing demands.
Tips for building manageable oral hygiene routines
For sequencing your routine, I would recommend getting a sink top organizer where you can line up each tool in sequence and work your way down the line. Some people even like to add number labels to each slot to keep things organized. All routines have a beginning (set up), middle (the activity), and end (clean up). Making sure you consciously practice set up and clean up will build the neural networks for sequencing.
For those supporting children or first learning these skills, visual picture sequences, picture flip books of the child "doing" each step, or making a picture album on your ipad/phone that can be referenced in sequence are all helpful to build the skills but should be faded as the child attempts to recall what is next in the sequence before referencing the picture to confirm.
How dentists can support neurodivergent patients during appointments
Neurodivergent patients have a variety of needs.
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Realise it may take several appointments of just counting teeth or counting to 10 each time you ask a patient to tolerate putting a tool in their mouth, before tolerance increases. Pacing can help significantly.
- Know that if someone clamps their mouth closed or can't move their tongue away from the tool, it is not necessarily their fault. It's often hard to inhibit reactions to sensory experiences without practice because many people are used to using their tongue to clear food not move it out of the way so the dentist can work.
- If a patient has a very sensitive mouth, the more you can use their flossing tool or avoid intense vibration tools, the better. If it's not avoidable, some patients may need stronger interventions to relax or sleep for more significant work to be done safely.
There is no one-size-fits-all solution, so some people may need more strategies than others. I have seen many people who want to figure out how to build a hygiene routine do it successfully with the right breakdown, training, and support. It does not have to be a daily frustration. Hopefully, the strategies above give you a lot of ideas to figure out what works best for your or for your child.
Author: Aubrey Schmalle OTR/L, SIPT (USA)
Occupational Therapist & Child Development Expert
