Oral health

Lots of children and young people find looking after their teeth difficult. This resource aims to give you guidance on how to look after your child’s mouth, particularly if sensory difficulties are getting in the way.

Why does mouth care matter?

Keeping our mouths and teeth healthy as children helps set us up for success. When our mouths are healthy, it protects us against serious infections, improves our chewing and speaking ability, and means we can enjoy eating or using sensory toys with the mouth.

Having good teeth improves confidence and self-esteem when we get towards teenage years and older. Even if someone does not take food and drink orally, their teeth still need to be looked after to protect their lungs, gut and heart.

What are the signs of a problem with the mouth?

Many children will find it hard to tell us when they are having mouth or tooth pain. They might show it with more meltdowns than usual, or different behaviour. It could be more subtle such as no longer eating some foods that they previously enjoyed.

If they already have seizures, these might happen more often.

A more serious problem might show up as someone drooling who does not usually, swelling, or a temperature. If this happens, a doctor and a dentist might both need to look in their mouth. This will probably be at hospital if they are unwell.

Bleeding when brushing or flossing shows that the gums are inflamed. This will improve with more brushing, so please do not be put off. It means the gums need more cleaning, not less.

My child cannot cope with toothbrushing. How can I look after their mouth?

There is something that can be done for nearly everybody to look after their mouth. Many children will be able to tolerate things better as they get used to them or as they get older, and it can be very empowering for some children and young people to clean their own teeth.

There are 3 main areas that we need to focus on for healthy teeth:

• fluoride
• a low-risk diet
• removing plaque

Plaque is a layer of bacteria that builds up constantly on the teeth. The bacteria make acid, which goes onto the teeth and wears them away, causing decay and cavities. This happens even in children who do not feed orally (tube fed children). Remember, any plaque removal is a win!

Fluoride

Fluoride is an element that occurs naturally and helps your body make strong teeth. There is a very small amount in water, but in Sheffield there is no extra fluoride added to the tap water.

Ways to deliver fluoride include:

• Using a high fluoride toothpaste
• Fluoride varnish treatment (applied every 6 months by a dentist) if your child can manage

Do not wet the toothbrush before applying the toothpaste. Do not wash the fluoride away, just spit it out at the end rather than rinsing their mouth.

Try to wait 20 minutes before eating or drinking again for extra tooth protection. This also means that if your child can manage mouthwash, it needs to be used at a separate time.

If your child does not like the taste or sensation of the toothpaste, you can look for unflavoured or mild toothpastes.

Toothpastes that do not have ‘sodium lauryl sulphate’ (SLS) will produce much less foam, which might also make things easier.

Low risk diet

If your child cannot cope with cleaning their teeth, it is even more important to aim for a low sugar diet and avoid fizzy drinks completely. Try only to offer them milk or water.

Frequent small amounts of sugar are more harmful as the teeth do not get time to recover. If your child is eating things like crackers, bread, or sweet things, try to stick to mealtimes. Constantly sipping on a fizzy drink, for example, will do a lot of damage.

Avoid foods that can get stuck in their teeth if you can. Foods like raisins, crisps, popcorn are all hard to remove from between teeth without toothbrushing

Try a piece of cheese or some dairy at the end of a meal to neutralise the acid and support the teeth.

Plaque removal

If your child does not like the toothbrushing try wiping the teeth with wet gauze or cotton wool.

The next step up might be silicone brushes. These are available from lots of online retailers and chemists under ‘silicone toothbrush’, ‘chewable toothbrush’, ‘whole mouth toothbrush’ or ‘autism toothbrush’. Aim to move on to a traditional toothbrush when you can.

Top tips

Biting

Allow your child to keep biting on the toothbrush while another using toothbrush to clean their teeth.

Gagging

Start from the back teeth and work forwards. Use a small amount of non-foaming toothpaste (one without sodium lauryl sulphate). Also consider using unflavoured toothpaste (which is available online).

Tongue getting in the way

If your child’s tongue gets in the way can use a cloth or flannel wrapped around your finger to push tongue back gently. This can be tricky and it takes perseverance.

Drooling

Support your child’s head upright. Usually there is the right amount of saliva, it is just going the wrong way. Saliva helps protect the teeth.

Dry mouth

This can be due to medicines that your child might be taking. Speak to their doctor. Do not just stop or change medicines without checking as this can be dangerous.

Unsafe swallow or tube feeding

Look for non foaming toothpaste and use a small amount.

Distraction and rewards

A cool toothbrush, distraction techniques, or a sticker chart are also worth a try. Some kids will enjoy getting involved and prefer to be in control. It can be very empowering for children and young people to do their own personal care.

Some children benefit from a social story or a preparation visit before going to the dentist. They might like to have a photo or video taken while they are there, to remind them that it was a good experience before the next visit. If the waiting room is a source of stress, speak to the receptionist as they may be able to let you wait in the car or another safe space until you are called in.

Further help

Any mouth care you can do is worth it and will help protect your child’s teeth. We know it is not easy and we are here to help, as is your dentist.

Community dental services are also available for children who are struggling with the dentist. Speak to your child’s dentist if you feel they would benefit.