My six year old hates brushing his teeth. Is this a sensory problem?

toothbrushing-cartoonQ: My son, who is just six years old, has always resisted us brushing his teeth. Each wash becomes a battle that we often lose. I really don’t want him to have tooth decay. Is there anything we can do to make things go better, and to help him accept that his teeth have to be washed? A friend of mine suggested he might have a sensory problem with things in his mouth and that he might be tactile defensive. Is there any truth in this? How do we go about gettinghelp for him? He is also an extremely fussy eater and hates change to his routines.

A: Lots of young children have specific sensory preferences and sensitivities, and this is often a helpful way to understand their behaviour. Frequently, at the bottom of certain perceived misbehaviours is a sensory experience that the child finds challenging. For example, some children resist getting dressed because they hate the feel of certain clothes or are particularly sensitive to the touch of labels, seams and belts. Or some younger children might be sensitive to excessive noise and so could be easily overwhelmed by busy playgrounds, and act up as a result.

In your situation, it could well be that your son is very sensitive to touch in the mouth area and thus finds the process of brushing teeth very uncomfortable. Professionals often use the term “tactile defensiveness” or, more specifically, “oral defensiveness” to describe such problems, which can be either the result of hypo-sensitivity (reduced sensation and awareness in the mouth area causing anxiety about brushing teeth) or hypersensitivity (being overconscious of oral sensation, making even the slightest touch uncomfortable or even painful).

Before looking at strategies to help your son, it is a good idea to first take him to a dentist to rule out any dental or gum problems that might underpin his behaviour and contribute to his sensitivity.

Getting your son’s co-operation
First, it is important to first try to get your son’s co-operation about overcoming his sensitivity and getting used to brushing teeth. Even though he might find it hard at the moment, help him to understand the importance of brushing teeth and dental hygiene.

Seek out some children’s booklets that explain this in a child-centred way that you can read together. Try to give him as many choices about brushing teeth to increase his co-operation. For example, involve him in choosing the toothbrush and toothpaste: he may be more likely to give things a go if he likes the flavour of the toothpaste, or if the toothbrush has a picture of his favourite TV character.

In addition, be careful to choose an extra-sensitive toothbrush such as those recommended in the online resources below.

Proceed gradually
In introducing the toothbrush, it might work best to proceed gradually and to build up over time. Maybe start with the part of his mouth that is least sensitive, for example his front teeth, and just start with washing these successfully before moving on.

Let him take charge where possible. For example, he can introduce the toothbrush and test the strokes carefully. Give him a good model and show him how you brush your own teeth and even let him have a go at brushing your teeth if that helps him learn and introduces a bit of fun or lightness into the teaching. Give him lots of praise for each small step and be prepared to take a break after a successful step.

To motivate him, you could set up a detailed reward chart that outlines the different groups of teeth – for example front, left, right, top and bottom – that need to be cleaned step by step, and allow him to get a star for each step he takes. Depending on how difficult this is for him, you could start with doing one step on the first night so he experiences success.

Build up a good routine around brushing teeth
Build up a good routine around brushing teeth so he knows exactly what to expect. It can help to wash the teeth in a very specific order so your child knows what is coming and can prepare himself.

Include things that relax him in the time he is brushing, such as playing music or even doing it in a relaxing place outside the bathroom, if that helps. For some children, it can help to do the brushing in front of the mirror so he gets visual feedback and can control the steps better.

For others, it helps to distract them while you brush the teeth, at least in the initial stages, and this can be done by doing the brushing away from a mirror, not commenting on the process and talking about something else while you brush. You could even try telling stories or singing songs.

Vary the person who does the brushing with him: for example, one parent or even another family member might be best placed to do the brushing with him especially if a battle of wills has been built up.

Getting further help

As discussed earlier, you may wish to seek further help from your dentist or you could consult an occupational therapist or speech therapist who specialises in supporting children with sensory problems.

Some therapists recommend techniques such as regular gum massage as a means of reducing a child’s sensitivity and helping them tolerate brushing teeth. There are some good websites that provide suggestions on this approach as well as other tips on managing oral defensiveness: see, for example.

Finally, make sure to be patient and persistent, as such sensitivities generally reduce over time.

Dr. John Sharry, Irish Times Newspaper, January 2014. John writes in The Irish Times Health+Family every Tuesday.