Frequently asked questions

Rather than forcing the toothbrush in the mouth, try to gradually introduce it. Some parents find it useful to give their child an extra toothbrush. This means they can place it in their mouth while you go in with another brush. Using something to gently prop the mouth open, such as another toothbrush, a chew toy, a foam mouth prop or a clean flannel can make it easier to get a second toothbrush inside the mouth. You can use finger protectors if your child usually bites your fingers during toothbrushing.

Make it a positive experience and avoid turning toothbrushing into a negative experience. If the child becomes distressed, take a break and try again later.

There are several reasons why your child might be biting together on the toothbrush. Think about the following:

Are they seeking calming deep pressure?

Consider whether this can be given in a different way. It may also be necessary to evaluate the environment to see whether any of the other stimuli can be reduced such as light, sounds or smells. This would then reduce the demand on the child and allow them to conserve energy for brushing their teeth.

Are they using their jaw to try and find postural stability?

This can be helped by making sure the child’s body is well supported and they have enough feedback regarding where their body is in space. Allowing your child to lean on you for support may help with this.

Is clamping down on the toothbrush an escape behaviour?

It is important to identify what in the toothbrushing experience is not working for them and seek to modify it.

If needed, professional guidance from a dentist or an occupational therapist with experience of sensory processing challenges could be beneficial.

When brushing with the right amount of toothpaste, it is ok if your child swallows a small amount. Parents have described how this happens a lot and it is usually not a problem. It is much better for them to use toothpaste and accidentally swallow some than to not use it at all because they (or you) are worried about swallowing.

To have maximum benefit, the fluoride in the toothpaste needs to stay on the teeth for as long as possible. It's best to wipe away any leftover toothpaste from outside the mouth and don't rinse.

Top tip: If spitting out toothpaste is tricky for your child, try having them lean over the sink with their mouth open. This way, extra toothpaste can be dribbled out without the need for spitting.

This could be because their core muscles are not strong enough yet, or they might struggle with body awareness or balance. Positioning the feet flat on the floor and ensuring the child’s bottom is well back on the chair can be helpful. The use of a stool or step to rest their feet on can also be beneficial. If the chair is too deep, a cushion behind the child can provide support. If your child slips around on the chair, you could try placing a piece of non-slip matting on the chair. It may be easier to sit on the floor with the child sitting between your knees, or to sit on a beanbag chair. If you are using a mirror to support brushing, make sure that this can be seen from wherever the child is sitting. See the "safe ways to brush: importance of positioning" video to see what this looks like.

Sensory preparation before toothbrushing can be beneficial. You can read about sensory preparation here. Brushing after a period of active play may also be helpful. Whilst brushing the teeth, you might incorporate controlled movement whilst still supporting your child, such as rocking or swaying. This may be easier when sitting down as having increased body contact with the floor will increase stability. Music with a tempo that matches the rocking or swaying may be helpful. [Link back to safe ways to brush]

You will need to think about why your child is struggling to sit still. It may be because they find it hard to balance and hold themselves upright. If this is the case a more stable, seated position may help.

Moving around whilst brushing may help your child feel more regulated. They could wriggle in a beanbag whilst having their teeth brushed or be hugged and rocked gently in your lap. Some children like to move on the spot to music and you could mark the places to stand on the floor with tape.

Kneeling on the ground can give more deep pressure input, or your child might like to use a foot roller whilst they sit down and brush. (It is possible to make your own which would be just as effective as a more expensive version). A raised texture play mat can be fun to explore with the feet.

Other ways to gain sensory input include placing the child’s feet on a slightly inflated wobble cushion whilst standing or sitting. It is important to keep their back well supported whilst doing this. The same effect can be achieved by using a wobble wedge on the chair. You could also try a wobble wedge on the chair. This can improve posture whilst offering the option of some movement. It is important to make sure the child’s feet can rest on the floor. See the "safe ways to brush: importance of positioning" video above to see what this looks like.

Some children become disorientated after a change in head position, which can make them feel unsteady or sick. You may have noticed them avoid tilting their head in other activities. Sitting securely with added deep pressure can help to overcome this. Your child will need information about where their body is in space. They could gain this by leaning against your body or against a beanbag. They could place their feet on the floor or let them push their feet against a wall for stability. Your child might like to wrap a towel firmly around their body and shoulders. Some children like their knees (and arms if they are not helping to brush) tucked inside a stretchy, oversized top to make a personal ‘tent’. Other children have enjoyed sitting in laundry basket or box so that they can feel the edges of their body. Work slowly and take a small break whenever the child shows discomfort. It's important to show you are working with them. This may mean having a pause and it’s important to let them control the pace of brushing. See the "safe ways to brush: importance of positioning" video to see what this looks like.

Think about whether your child finds it hard to keep their balance in other activities. When standing, you could give your child something to lean against, such as your body, or hold on to, such as the edge of the sink. You can encourage your child to stand with feet flat on the floor with their legs hip-width apart. If your child likes to use a step, then this needs to be non-slip and wide enough for their feet.

Think about whether your child prefers to be bare-foot or wearing shoes. The floor should be dry, and any bathmats should be non-slip. Your child may prefer to be seated. A mirror positioned at the correct height for the child may be helpful, so that they can see themselves without stretching. You may find the video below helpful.

Once a day is better than none, so this is a good place to start. When trying to introduce brushing twice a day, one time could be led by the child and the second time by the adult. Alternatively, the child could brush first on both occasions and the adult could finish the brushing afterwards. You might find the information about building routines helpful.

If needed, professional guidance from a dentist or an occupational therapist could be beneficial. They can provide personalised strategies and tools to help make tooth brushing a more positive experience.

You can also look at this link here about how you can speak with your school or nursery about eating and drinking to support their overall tooth care.