Sunday, October 6, 2013

It's The Big Ones That Count!

Brushing Erik's teeth has always been a challenge.  We manage to do it, but even from the outset, it has evolved much differently to the girls.  These days, I need to practically get him into a headlock with one arm, fighting off (or desperately trying to hold down) his arms with that same hand and brush his teeth with the other!  It is very difficult - fast becoming impossible - for me.  I have considered employing the use of a straight jacket at times.....

As a toddler, getting anything into his mouth was extremely difficult, and to be honest, dental care was not high on my priority list in those early days.  Toilet training and speech development was.  I had a lot to deal with at that time:  A new diagnosis and a newborn baby - both those things are enough all on their own.  So teaching Erik to brush teeth was not hugely important.  I never expected him to have sensory issues around it.  There was a lot I had yet to learn about Autism and it's many manifestations.

But it didn't take long for me to recognise that Erik had sensory issues to do with his mouth.  The first and most apparent thing, was his aversion to anything rough, crunchy, chunky - basically anything other than smooth and uniform textures.  This first became obvious with his eating habits, and later, with the things he would choose to mouth on.  He never chewed things at first, he would just lick smooth surfaces.  Basin rims, windows, table tops, smooth plastic toys...soap.  No wonder he couldn't stand having a toothbrush in his mouth!

I began the process of desensitising him a few months after diagnosis.  With advice from our speechie at the time, I began by rubbing a wet finger along his gums, being super careful to stay away from any biting! (This was no problem at first though, he never did go for a bite).  What he did do, was vigorously push my hand out of his mouth and away.  But it didn't take long before he would tolerate this - maybe a couple of weeks?  I started very, very small... only a couple of seconds at a time.  As much as he could handle.  As soon as he resisted it was over.  I didn't want to make it an unpleasant experience.  

I was supposed to then advance to using a face washer to rub over this gums, but I found this to be very impractical.  He didn't open his mouth wide, and the washer would really limit movement around his gums and was just too chunky to fit in there.  So I scratched that idea.  As chance would have it, this was the time he started picking up items to mouth on as he was playing.  I grabbed this opportunity with both hands!  Using a baby toothbrush - the silicon kind with a few little bumps on it - I introduced him to a new toy to mouth on.  At first, he didn't take to it - he is always initially averse to new ideas - but it wasn't long till he did.  

As he mouthed on this object, I would come along and move it gently around his teeth once in a while.  After this, we graduated to the silicon 'brush' - just like a regular toothbrush, but the bristles are silicon, so much softer than the normal bristles.  And of course after this, came the normal, toddler toothbrush.  At this point, he was allowing me to brush his teeth for him - an amazing achievement!  He would have been about 3 1/2 at this point, so it took the better part of a year to get there.

Introducing toothpaste was no big deal!  I was very lucky that Erik didn't have a problem with the taste of it - but then, I'm not sure I should have expected differently when he would happily eat soap, just for the texture!  But we started with the thinnest swipe over the bristles anyway- he did notice the difference, but it didn't deter him at all.  So I was able to increase the amount to the right size within a couple of weeks.  There was, and still is, no such thing as 'rinse and spit'.  Erik cannot spit.  Or blow bubbles - a similar activity from a motor planning perspective.  So, reminiscent of the very first finger swipe, I wet my fingers and swipe them around his teeth to wipe off as much of the toothpaste as possible.  These days, I have to be very careful of a bite - and it has happened more then once!

All went well for a while...Erik would allow me to brush his teeth, and then he would have a turn.  He would only ever brush the left bottom side though, and getting him to try other areas was a problem.  I think mostly because of motor planning.  But as time went on, instead of getting better, it just got worse.  

I don't know if his sensitivities increased, or what exactly it was that caused it, but little by little, he began to fight me as I tried to brush his teeth.  He would push my hands away and press his mouth shut so I couldn't get the toothbrush in.  But it was strange, he would do this at random.  That is, at first, he was fine with the idea and would allow me to get started, but in the middle of brushing, he would just suddenly rebel.  I could never pinpoint what it was that prompted this - whether it was brushing a certain spot, or length of time, or what.  It was a mystery.  He also stopped trying to brush his own teeth - playing with the brush instead and never actually getting it into his mouth.  Eventually, I skipped that part altogether and just insisted on brushing them myself.  Time constraints came into this too, having to get all children ready for school/daycare in the morning, I just didn't have time to diddle around waiting for him to be ready when he might not be for hours.

And so at this point, things are still pretty much still there.  Occasionally, he will try to brush his own teeth (for a little bit).  He comes willingly to the bathroom to get his teeth brushed - partly because of routine, and partly because, I guess,  he really doesn't mind too much.  It's almost an automatic or involuntary reaction for him to push the brush out of his mouth.  Although it's frustrating, I still think he does well to allow us to brush his teeth at all.  Some days are better than others - on some days, he can barely tolerate a swipe across each side.  Other days are much better.

I have learned now that he does best with the lower jaw.  The upper jaw he struggles with, and the top front incisors on the outside are the worst.  He fights me every time, he can't stand it.  I feel so sorry for him.  But we must be doing something right, because a dental checkup by the school dentist revealed that his teeth are in very good condition with no work needed.  Win!

Check out those pearly whites :)   I just wish he'd stand still for a minute so I can take a non-blurry photo!

This year, I expect to see him lose his baby teeth.  That will be interesting!  I have no idea whether he will spit them out or swallow them!  And I am concerned about the effect the loose teeth will have on brushing.  I guess we'll cross that bridge when we come to it.  He is getting bigger and stronger, and it is becoming very difficult for me to hold him steady enough to brush his teeth.  I really hope that the habits we have worked hard to instill will take over so that we can continue care of his adult teeth when they come through.  No holes so far, but they are just baby teeth.  It's the big ones that count!