Establishing an oral care routine at home and visiting the dentist can be challenging for persons with special health care needs. The Canadian Dental Association has developed resources for parents, caregivers and the dental team who care for persons with special health care needs.

If visiting the office for the first time, or an existing patient, consider filling out the Pre-Visit Questionnaire. The questionnaire is intended for parents and children with special health care needs but it can be adapted for adults with special health care needs as well. The Pre-Visit Questionnaire can be brought to the office for a pre-appointment office visit. Contact your dentist for more information. 

Oral health care at home for persons on the autism spectrum

1. Help them feel safe:

Create a safe oral health care environment in your home. First, look for any potential issues in your surroundings that may trigger specific behaviours. For example, if your child reacts to bright lights, dim the lights when possible, or move to an area that is more calming to your child.

2. Show them how it's done:

Consider brushing and flossing your own teeth. Go slowly, and explain what you’re doing, and why. Encourage questions.

3. Practice opening wide:

Help your child open their mouth wide and keeping it open.

4. Get them used to the toothbrush and floss:

Before brushing begins, touch the toothbrush to your child’s lips, gums and teeth. If sudden mouth closure is a concern, consider using two toothbrushes. Use the handle of one brush to prop open the side of the mouth, and the other brush to clean the opposite side of the mouth. Move on to flossing, if possible. If using dental floss is not possible, try using a water flosser. Go slowly and gently as you explain what you’re doing.

5. Use an appropriate toothpaste and the right amount by age:

Children from birth up to age 8 should be helped by an adult in brushing their teeth. Some older children may continue to need assistance. Fluoridated toothpaste provides the best protection against tooth decay. If your child is sensitive to toothpaste textures and flavours, there are other options available. Speak to your dentist or hygienist about alternatives.

6. Let the brushing and flossing begin:

You’ve shown your child how to do it, now let your child take charge of the brushing and flossing at whatever pace feels comfortable.

7. Establish regular routines for brushing, flossing and visiting the dental office:

• Schedule oral care at home twice a day, and always at the same times. This will help set a simple pattern that your child can follow for a lifetime.

• It’s important to have your child become accustomed to dental visits at a young age. Visit the dental office as part of a regular routine, not only for dental emergencies. Doing so can help decrease your child’s anxiety about going to the dentist.

• Talk to your dentist about how often your child should be seen.

• Before going for a dental appointment, it is important to identify what you do to help your child feel safe in new or strange environments. Let the dental team know if there are any issues that may trigger specific behaviours. Examples include strange smells, specific sounds, bright lights, or specific ways of touch that either feel better or create negative reactions.

• Fill out the pre-visit questionnaire to capture important details before the scheduled visit. These details help the dental team prepare in making the dental visit as comfortable as possible for your child. Completed forms will contain your child’s personal health information. Since regular email is not secure, do not email completed forms back to the dental office. Please bring the questionnaire to a pre-appointment office visit, drop the forms off at the dental office or send by mail.

8. Help prevent cavities:

Using separate cups and toothbrushes will help limit bacteria that can cause dental disease. Eat healthy, cut down on sugary beverages, and make water your drink of choice! 

Oral health care at home for adults with Alzheimer's, dementia or other developmental issues

1. Be supportive and encouraging:

Start by encouraging the person to come with you to clean their teeth. Explain what you are doing. If they have any concerns, address these as best you can.

2. Find a comfortable position:

Position yourself behind the person as they sit or stand in front of a mirror, so you can use the same motions that you’d use to brush your own teeth.

3. Explain and soothe as you go:

Explain everything you’re doing in a quiet, calm voice and pause if the person seems agitated or overwhelmed. Hum or sing a soothing song.

4. Go slowly and gently:

Use a soft toothbrush and brush gently. Use waxed floss and a floss holder, applying as little pressure as possible while still cleaning between teeth.

5. Don't force it:

If the person becomes too agitated, stop. Do this calmly while praising them repeatedly for how much they’ve achieved. Try again later.

6. Clean complete or partial dentures daily:

All dentures must be cleaned daily. Scrub the dentures with a brush and liquid soap and rinse well. If there are cracks in the dentures, take them to a dentist for repair.

7. Examine the mouth:

Check the person’s mouth for:

i) swelling

ii) red or white patches on soft tissues

iii) parts of the gums that have changed colour

iv) sores that do not heal within 14 days

If the person you are caring for is uncomfortable eating, they should be assessed by a dentist.

8. Clean the mouth:

After your inspection, clean and massage the inside of the person’s mouth with a damp cloth or a soft toothbrush. Finish by gently brushing the tongue.