May 28, 2024
Brushing Technique in Children with Special Health Care Needs

Children with special health care needs (CSHCN) include those with developmental, physical, behavioral, or emotional conditions that require health and related services beyond that required by typically developing children.

These children often face unique oral health challenges that can negatively impact their quality of life. As a pediatric dentist, it is critical to understand these challenges and provide tailored recommendations for maintaining good oral hygiene in this vulnerable population.

Oral hygiene challenges

CSHCN are at higher risk for oral diseases like dental caries and periodontal disease compared to their typically developing peers.

This increased risk is due to both greater disease susceptibility and more difficulty in performing adequate oral hygiene practices.

Some of the key factors that can make oral hygiene difficult for these children include:

  • Physical disabilities: Conditions like cerebral palsy, muscular dystrophy, and arthritis can limit manual dexterity needed for brushing and flossing.
  • Cognitive or developmental delays: These make it hard for a child to understand the importance of oral hygiene and follow self-care instructions.
  • Sensory issues: Tactile defensiveness and oral hypersensitivity may make toothbrushing an unpleasant experience.
  • Medications: Some medications like phenytoin and calcium channel blockers increase the risk of gingival overgrowth.
  • Behavioral challenges: Conditions like autism or attention deficit hyperactivity disorder (ADHD) can impact a child’s ability to cooperate with oral hygiene routines.
  • Lack of comprehension about importance of brushing
  • Side effects of medications reducing salivary flow
  • Caregiver fatigue in performing daily brushing for the child also acts as a barrier.

Assess the child’s abilities

The first step is to conduct a thorough assessment of the child’s abilities. This includes evaluating their:

  • Fine and gross motor skills
  • Ability to follow instructions
  • Tactile sensitivities
  • Ability to grasp objects
  • Visual perception
  • Cognitive understanding of brushing

Based on this assessment, you can determine if the child is able to brush on their own or requires full assistance.

You can also identify any physical adaptations or accommodations that are needed to make brushing easier for them.

Best Brushing Technique for Special Kids – Specialized toothbrushes and dentifrices

When recommending oral hygiene aids for CSHCN, the first consideration should be the child’s individual abilities and challenges.

Some specialized products that can help overcome barriers include:

Power toothbrushes

These are ideal for children with limited manual dexterity. Models with large handles are easier to grip.

Adaptive toothbrush handles

These attach to manual toothbrushes for easier grasping. Options include large, soft grips or vertical handles.

Floss holders

These help guide floss between teeth for children who lack fine motor control.

Low-foam dentifrices

These minimize sensory discomfort from foaming action in children with tactile issues.

High fluoride toothpastes

These provide additional protection against caries in high-risk children.

Behavioral techniques

  • Positive reinforcement
  • Visual schedules and images
  • Task analysis – break down brushing into smaller steps

Environmental adaptations

  • Brushing in a quiet setting
  • Soothing music during brushing
  • Positioning aids if needed

Incorporate adaptations

Additional tools and adaptations can facilitate easier brushing:

  • Mouth props help keep the mouth open
  • Toothbrushes with suction cups can be stuck to a surface for easier grasping
  • Place toothbrush in a foam tubing for an easier grip
  • Use an elastic band around the wrist to hold toothbrush
  • Try a triple headed toothbrush to increase efficiency

What You Can Do as A Caregiver

For many CSHCN, caregiver supervision or assistance will be necessary for brushing to be fully effective. As a pediatric dentist, it is important to educate both the child and caregiver on proper technique. Demonstrations during office visits can be extremely helpful.

Some tips for caregivers assisting with brushing include:

  • Adopting a calm, patient approach and making it a pleasant experience
  • Using tell-show-do technique to explain each step
  • Brushing all surfaces – outer, inner, chewing, and tongue
  • Allowing the child to help as much as they are capable
  • Providing positive reinforcement
  • You should develop a habit to visit pediatric dentist for prevention

It is also vital for caregivers to monitor brushing effectiveness and spot check for plaque build-up.

Professional cleanings & fluoride treatments

In addition to daily home care, CSHCN should have professional cleanings and fluoride treatments on a schedule tailored to their disease risk. More frequent dental visits allow for:

  • Removal of plaque build-up beyond patient/caregiver capacity
  • Monitoring for signs of disease progression
  • Re-education on brushing and flossing techniques
  • Fluoride varnish/gel application for added protection

For children at very high risk, application of antimicrobial chlorhexidine may also be helpful between dental visits.


Achieving good oral hygiene for CSHCN requires selecting specialized aids matched to the child’s needs, educating caregivers on adapted techniques, and providing professional cleanings. With a supportive dental team, an at-risk child can attain better oral health and quality of life. As pediatric dentists, we play an integral role in overcoming barriers and promoting health in this vulnerable population.

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