Introducing Brushing in Autistic Children

Oral health in children is a very important aspect that must never be neglected. Children are not equipped to perform this complex task, and parents therefore step in to perform it till the child reaches an age when he can do it himself. While it can be difficult for any child to get used to the process of brushing and oral hygiene, it is particularly distressing and challenging for a child with Autism Spectrum Disorder.

Autism Spectrum encompasses a wide variety of neurodevelopmental conditions, characterized by difficulty in communication, socializing and interaction across multiple contexts. It is also accompanied by repetitive behavioral patterns, impaired functions in certain cases with heightened skills in others.

Given the nature of this condition and the fact that autism is often detected within the first year of birth, it becomes essential to handle these kids, and their special needs using a softer, more considerate approach. Autistic children are hypersensitive, do not allow anyone to touch their mouths, are oftentimes unresponsive and also non co-operative. Brushing and other oral tasks when introduced gently will enable them do their tasks themselves.

Below are a few tips that will make it easier to introduce brushing to autistic children-

• To begin with, choose the right kind of toothbrush. Since there are many sizes, colors and styles, it is important to choose a brush that is just the right size for the mouth, and also one in a color that the child will love.
• Since the children experience heightened sensitivity which makes them uncomfortable, it helps to touch the brush to the child's lips or inside of the mouth for a few days to desensitize them.
• Giving the same instructions repeatedly, such as 'open mouth wide', 'show your teeth', ensures they get used to the them as a daily practice.
• It also helps when parents set an example. Brushing, gargling and flossing can become a shared activity which the child will come to learn and love.
• Brushing the teeth of an autistic child works when there are a repetitive set of procedures to follow. This will familiarize them as well as help them open up to the ritual over time.

Below are a set of steps that can be followed for brushing the child's teeth;

1. Stand behind the child with their head resting on the front of your chest

2. Put a small pea sized amount of paste on the brush

3. Use the brush as you would on your own teeth

4. Follow this 6 step procedure for brushing

- Brush the bottom back teeth inside, out and top 5 times

- Brush the top teeth inside and out 5 times

- Brush bottom front teeth inside, out and top 5 times

- Move to the opposite teeth and brush bottom teeth inside and out 5 times

- Brush the top front teeth inside and out 5 times

- Brush the top back teeth inside  and out 5 times

5. Although brushing is normally done in the bathroom, it is advisable to brush the teeth of autistic children wherever they seem comfortable. It could be either on a couch or on their bed and gradually progressed into the bathroom.

Just as with every other activity, getting the child to look after their teeth independently is the ultimate goal of a parent. When it comes to autistic kids, it needs a little more effort and attention.

Do read our next blog to understand how to ensure how teeth brushing can be made a regular task in such children.

9 Ways of Handling Your Child's Thumb Sucking Habit

As adults, all of us have our ways of relaxing. While we may indulge in reading or a sport, our children have their own ways of unwinding. Of the many things we observe in our babies as they learn and grow, Thumb Sucking is one of the commonest habit that is also the way for them to cope and relax.

Thumb sucking signifies so many things; that the baby is feeling hungry, that he or she is teething, and often it also shows insecurity. This is a normal and healthy part of an infant’s growth.

Infants often suck on thumbs, fingers, pacifiers, toys and even food during play and sleep. Sucking on an object gives them a sense of security and comfort. This habit usually lasts till the age of 4, often even up till 6 years.

If thumb sucking continues beyond 6 years, especially at the time permanent teeth are beginning to be formed, then it is a cause for concern, since the habit often leads to a whole host of dental problems.

Often after 5 years, children develop language skills that help them cope. Therefore the habit when continued beyond this age, may indicate children’s inability to cope or convey what they feel.

Depending on the intensity of the thumb sucking, frequency and duration, teeth can gradually get pushed out of their original position, can become misaligned, making them protrude and resulting in an ‘overbite’, a condition in which teeth don’t clamp down properly.

In addition, the misaligned teeth don’t close the mouth fully, causing malformed jaws as the years go by.

Thumb Sucking therefore has to be observed and stopped before it becomes a habit that causes harm and irreversible dental damage. If your child is approaching preschool and still shows signs of not overcoming the habit, then parents will have to intervene to know why it I so.

Below are 9 ways that you can help your child wean themselves off this habit;

•      DO try to gradually limit the time and place where your child sucks their thumb, either to the bedroom or house itself. Try to prevent them doing it outside in public. Explain that the activity must be restricted only to bedtime.
   
•      DON’T make it a tussle of wills. Thumb sucking is an involuntary habit, so ordering the child to ‘Stop’ won’t get you anywhere. He or she may hide and do it or turn hostile which doesn’t solve the problem. Try to praise them whenever you see them not doing it, rather than criticizing when he is. This is positive reinforcement. 

•      DO take time every now and then to talk to them about the habit. Help them understand why the habit isn’t good, and tell them you will be there whenever they want to stop. 

•      DON’T prevent them from thumb sucking after a stressful time or when they are injured. The child usually does it to seek comfort, and preventing them from doing it will traumatize them further. 

•      DO practice self-awareness with your child. If they are sucking their thumb, make them aware of what they are doing. Try to make them find other ways to soothe themselves, like hugging a stuffed animal or a toy.

•      DON’T replace the thumb sucking habit with handing them chocolates or lollipops. It is cruel to remove one habit and replace it with something worse.  
   
•       DO practice role play to make your child understand that he/she is growing up and there are some habits he cannot carry with him as he grows. Showing them how other grown-ups like their uncles and aunts, or the neighborhood policeman behave, can help them process whether they want to continue with the habit. 

•      DON’T try shoving a glove or mitten into their hands, whenever you catch them sucking their thumbs. When this is done as babies, it might not matter much, but when older, this will frustrate them and cause them to suck on their fingers more. 

•      DO remember, that although thumb sucking is worrying, the child will eventually grow out of it when he is ready. You may have tried everything you can, and yet do understand that your kid will grow out of it.

Thumb Sucking is a habit practiced by every child, but it starts to get worrying when it causes dental problems which can last a lifetime. Ensuring the child gets positive reinforcement to let go off the habit, rather than a harsh approach will help them understand and get rid of it sooner. It will also help in preventing some common dental problems that can develop later in life.

If you are seeing some teeth problems in your child due to this habit, please don't delay showing your pediatric dentist at the earliest, or reach out to the Small Bites Dental Clinic at
+918041256715 or +918025272614.

Bruxism - Teeth Grinding Isn't Always Harmless

When children are growing, there are several things you need to be aware of, their weight gain, their food intake and the general state of their health. Often parents tend to ignore the mouth, assuming that as long as teeth are brushed and general mouth hygiene is maintained, everything will be alright.

Teeth brushing and observing the regular milestones of milk and permanent teeth aren’t the only things that need to be observed, since there are many other problems that point out to underlying issues in children, which if not treated affect teeth and their physical health, as well as add to the stress as they grow up.

One such condition that many parents tend to overlook, is Teeth Grinding or Bruxism. Although not a symptom, it points to an underlying .

Teeth grinding, teeth gnashing, or the unconscious act of clenching and unclenching teeth is present in most kids, with 2-3 out of 10 children having this problem. Most children grow out of it by the age of 7 years, but many others carry this habit well into adulthood. 

 Although the reasons are unknown, experts have given a few reasons for this condition,

• Stress induced teeth grinding, especially when children aren’t able to cope with a new situation, such as a test at school or meeting new people. An argument with parents or siblings or arrival of a second sibling is also seen as a probable cause
•  Mal-aligned top and bottom teeth which causes irritation and subsequent teeth gnashing
•  Pain anywhere in the face is also a cause, whether earache or appearance of new teeth 
•  Hyperactivity and restlessness
•  Kids with medical conditions ( such as cerebral palsy) or who take certain medication.

 How does one whether your child is grinding their teeth?

Have you heard your child’s jaw moving continuously or regular sounds from their mouth during bedtime? If you hear them grind their teeth while asleep, without being aware of it, and they experience a painful jaw or mouth on waking up or pain when chewing, it indicates they suffer from the condition.

What harm can it cause?

Bruxism as such is a temporary harmless condition, and children most often outgrow it. In those children where this condition persists, symptoms of headache or earaches are often complained. 

What harm can it cause the teeth?

A side effect of bruxism is the harm it can do to the child’s teeth. Nightime grinding, gnashing and clenching the teeth, can wear down tooth enamel, gradually chip off teeth, make the tooth temperature sensitive and also cause lingering jaw and mouth problems and pain.

It is important to take the child to a pediatric dentist, before the condition causes severe irreparable damage to the teeth in the long run. A dentist will examine the child’s teeth for chipped tooth enamel, and any other wear and tear.  In addition questions related to stress or tension will try to be discerned.

All these observations will give the dentist information on whether the cause for bruxism is psychological (stress induced) or structural (misaligned teeth) and treat the child accordingly. 

 Treatment

While the condition is outgrown by most children, some kids who have severe pain and wearing out, are prescribed a mouthguard; a thin protective mouthpiece moulded to the child’s teeth that acts as a barrier between the opposing sets. This can take care of the major problem.

If the cause is emotional or psychological, the underlying cause needs to be found out by talking to the child, understand reasons that are upsetting them, and try and resolve the issue. If it seems more complicated, then their fears will need to be eased by counseling.

Bruxism usually stops when the milk teeth are lost. In few cases the condition might continue well into teenage years. The condition cannot altogether be avoided, because most often, it is a coping mechanism in children, and their natural reaction to growth and development. It can however be avoided by talking to children frequently, letting them open up and ensuring regular visits to the pediatric dentist are carried out for optimal dental health.

Fillings for baby teeth

Maybe you have just found out that your child has one or more cavities in their baby teeth?

It is normal for parents to have concerns and questions. 

In this blog, we hope to give some answers and reassurance about fillings for baby teeth.


Children can develop tooth decay soon after their baby teeth come through. Prolonged bottle feeding with sweetened drinks, or frequently falling asleep with a bottle of milk or whilst nursing are the most common causes of decay in babies. Cavities usually do not cause pain in the early stages and young children may be reluctant to open wide to let their parents see or brush their teeth. So, it can come as a surprise to find out that your child has a cavity at a young age. 

Why should we fill baby teeth, won't they fall out later anyway?




Baby teeth are important for normal eating and speech development. A healthy smile is also beneficial for a child's self-esteem once they reach school age. 





Once a cavity has formed it usually progresses resulting in pain and infection. If an abscess on a baby tooth is not properly treated the infection can spread to and affect the developing adult tooth underneath.



Baby teeth also maintain the spaces for permanent teeth to erupt into. Although front baby teeth can start to fall out from around 6 years old, the back teeth need to last until around 12 years old. If baby teeth are lost too early other teeth may tilt or drift into the vacant space, forcing the adult teeth to come through crooked. 

If my child has a cavity what are the treatment options?

Fillings

If the decay is in the enamel or dentine layer only (not close to the nerve of the tooth) the decay can be removed and a filling placed in the cavity. 

Basic procedure:

• Smaller cavities in baby teeth can often be cleaned without using local anaesthetic. If the cavity is deep or the tooth is particularly sensitive, a small injection may be required to numb the tooth. For more information, see this blog post: Questions about local anaesthetic
• The decay is removed and the cavity is washed. There will be some mild vibrations and noise at this stage. A suction tip is used to remove water from the mouth, or your child may spit out when required. 
• The clean cavity is dried by blowing air onto it and then the filling is placed.

At Small Bites, we keep up to date with the latest filling materials and techniques. The two most commonly used filling materials for children’s teeth are:

Glass Ionomer Cement  

• Bonds directly to the tooth surface and so helps prevents leakage around the edge of the filling.
• Releases fluoride which can help prevent further decay.
• It is relatively quick and easy to place and is therefore popular for use with young children where cooperation for treatment is sometimes difficult.
• It  is quite brittle and prone to wear and so it is usually used in areas which are not under a lot of pressure from chewing.
• Reinforced Glass Ionomers have recently been developed which can be used in higher stress areas, such as the biting surfaces of the teeth.
• Glass Ionomer is white in colour but, unlike composite, it does not come in various shades to match the teeth more accurately. It also available in other bright colours for use in back teeth, if children prefer this.

Composite filling

• Composite fillings come in many shades which match and blend in well with the tooth. Therefore, it may be advised for front teeth where appearance is important.
• Composite is stronger and more wear resistant then glass ionomer.

• A blue etching gel, used to prepare the cavity surface, is painted onto the cavity surface and washed off after about 30 seconds. 
• A bonding agent painted onto the cavity surfaces. This adheres the filling material to the tooth.
• Next, the filling is placed in the cavity.
• A blue light is often used to give faster setting of the filling.
• The filling procedure takes a bit longer than for glass ionomer.

Your dentist will check the filling, and polish it, if required. Please follow instructions for looking after your teeth following treatment. It is usually advisable to wait half an hour before eating and drinking and to avoid hard, sticky and chewy foods on the same day. 

Pulpectomy

If the decay has started to affect the area containing the nerve of the tooth (the pulp), a pulpectomy is often required. For more information, see this link: Pulpectomy - Root canal treatment for baby teeth

Crowns

Teeth which are too broken down to adequately hold a filling or which have undergone pulpectomy usually require a crown to strengthen the tooth. This will be covered in a future post.

At Small Bites, the exclusive dental care centre for children in Bangalore, we have plenty of experience with young children and work to put them (and their parents!) at ease. If you have any questions or concerns, please contact us.



Don't forget to read our other posts for advice on preventing dental decay:

It's Never to Early to Start Preventing Tooth Decay
What Causes Dental Cavities?
Top Toothbrushing Tips