Blog #10: The Tough Teeth Issue

“How can I get my child to clean their teeth?”

…I desperately thought/asked/begged for approximately two long years. The more bloggers I followed, and the more parents I connected with online, I came to realise that, along with sleep and screen time, this is one of the most commonly asked questions by parents of PDA children. 

JJ knew that teeth cleaning was something really important, and for many years just went with the flow and let me clean his teeth. But with the onset of his intense desire for more autonomy at the age of seven, this simple act became more and more of an issue. And as it did, I unconsciously made it more and more of an issue. It wasn’t a good situation.

So why do so many PDAers struggle with tooth brushing? Well in simple terms, it’s a demand. And also, let’s not forget the sensory issues that may be involved. Many children have very sensitive gums, and the taste of toothpaste may also be a factor. Don’t rule anything out.

Ok, so here are my tips which I hope you will find useful:

1. STOP trying to get them to clean their teeth.

Yep, time to face your fears and completely remove the demand. It’s worth mentioning something I learnt from Harry Thompson PDA Extraordinaire which is applicable to many similar situations. If you start with a question like ‘how can I GET my child to…’ you’re basically setting yourself up for failure. You’re focusing on the demand, and not the Why. 

Why should they do it?

What’s in it for them?

Really think about those questions. It’s pretty obvious to us adults. We know what can happen if we don’t look after our teeth properly – decay, yellowing, fillings (which hurt), extractions (which hurt a lot) – so it’s a massive deal! Most of our PDAers will be very aware of this. However, the demand inherent in the act of teeth cleaning builds a huge wall which they may not be able to break through. Don’t forget, it’s CAN’T, not won’t. In order to remove, disguise or distract from the demand, so the child is willing and happy to brush their teeth, there has to be a ‘what’s in it for me?’ factor for them. This could be in the form of choosing fancy new brushes, different flavoured toothpastes, or as with JJ – a realisation that they want to take control and look after their teeth themselves.

I would also say that showing them YouTube videos of rotten and decaying teeth (as was once suggested to me) is most definitely not the way to go. Our children are not stupid, very much the opposite. It became very clear to me that JJ really wanted to clean his teeth but felt unable. Frightening them with horrific pictures will only add to the pressure they are under.

The sooner you remove the demand and relieve the pressure on the situation, the better. Yes, it goes against everything you think you need to do as a parent. But it’s actually going to be your first step to helping your child. This is so, so hard as we are all terrified of our kids teeth going rotten, and the pain they may experience not to mention the judgement from others. But let me remind you at this point, your child has a disability. Everyday things which NT kids accept and even find easy may be incredibly tough for your ND child. The world does not understand or account for this. All your child has is you. So try and relax about it. Or do a very good job of pretending…

JJ did not allow me to clean his teeth for most of 2020. And whilst this wasn’t easy for me to witness, nothing too bad happened. Yes, he’s got a lot of scale which we will have to deal with at some point in the future. But to counter this, I gently cut back on sugar. 

2. Remember, this is just now. It won’t be like this forever.

This is just the situation now. It WILL pass. Believe that your child actually wants to do the right thing, but is currently not capable of achieving it. Disability, remember? Offering them your understanding and support is the best thing you can do. Be on THEIR side, as being on your own side will only push you both further and further away from each other. 

3. Lower your expectations, and try offering choices to help them regain control of the situation.

Ok so you’ve done your best to relax and stop talking to them about it. It should be less of a big thing now. Giving a PDAer some control over HOW they clean their teeth can reap rewards. This also may distract them from the inherent demand. Now letting them take control may not fit your idea of the perfect teeth clean. It will probably be a bit short, and sketchy, but it’s the action of doing it that counts.

The most helpful article I read at this point in our journey time was a blog by @stephstwogirls which suggested loads of practical and inventive ways to get around this massive stumbling block. It’s definitely worth a look.

When Peanut came to live with us, she became the official toothbrush chooser. At one point I was propping her up on the side of the bath, pressing the brush handle between her paws and pretending she was cleaning JJ’s teeth. Not what you would call a thorough brush, but it was fun and he was letting me do it. Job done. So if you have a pet, get them involved. Novelty, invention and surprise are often a really good way of distracting from the demand. 

We tried: 

Electric toothbrushes, various kinds…

Tooth brushing apps…

A selection of kids toothbrushes for JJ to choose from…

Dr Barman’s toothbrushes 

Oranurse, flavourless and foamless toothpaste

We varied the location of the brushing: brushing in bed, in the bath, on the way out of the house, in the car. They all worked for a while. I know of one parent who, after giving this choice, solved her PDA son’s tooth brushing issue. It turned out he didn’t feel that cleaning his teeth in the same room as the toilet was hygienic. She had no idea he felt like this, but by removing the demand and letting him take control, the issue was solved.

What seems to work best for JJ is using a Dr Barman’s toothbrush which has a special head with extra bristles making it more effective to clean a larger number of teeth in a shorter space of time. He has also settled on Oranurse flavourless toothpaste, and he likes to brush his teeth in bed.

And what if you do all this and it doesn’t seem to be getting you anywhere?

Go back to the beginning. Stop everything and remove the demand. The worst thing you can do is push or force the issue. I know it’s not easy, but grit your teeth and have faith that your child will make the choice and get there on their own terms.

According to my dentist, children who have in the past had a decent tooth brushing routine and stray from it for a period of time will do no lasting damage. Of course it’s not ideal, but they have youth on their side and together with diet, the risk can be managed. Definitely give your dentist a call if you’re worried. I did and she really calmed my nerves. There is also a specialist pediatric dentist in many areas. However the one in Dorset is slightly mythical. JJ has been on the waiting list for around 12 months and still no appointment. What would they suggest with a demand avoidant child anyway? Who knows. Anyway like all the other services us SEN parents need, we either never seem to get an appointment, or we do get seen but the professional is not trained in PDA, or we get sent on a parenting course…All a massive waste of our precious time.

So where are we now? JJ is almost ten, and a few days ago agreed to go to the dentist in the next few weeks. It’s remarkable that we have got to this stage, but he got there in the end. In the last couple of months we have been on one brush a day (amazing progress). And in the last few weeks he’s been asking me to brush them twice a day for him. He has a wobbly tooth and wants to look after it. His choice, not mine. And a few days ago, he put the paste on the brush and did it himself. I was utterly gobsmacked, but I hope I played it cool! He got there, on his terms. He wants to look after his teeth, and he is taking control. I couldn’t ask for more. I doubt this will be the end of our toothbrushing issues, but I feel more confident going forward that giving him autonomy is the only thing to do.

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