Cleaning my pre-schooler's teeth is incredibly stressful

[CopperSeahorses]

Let me start by saying this is not your average pre-schooler. He has no head control, weak trunk control, can't sit unaided, has dystonia (involuntary muscle contractions and spasms) that is not well controlled despite medication, epilepsy and is blind. He also has very limited understanding and uncoordinated swallow to the point he needs medication to dry up his secretions so he can manage them better, he is nil by mouth. Tooth brushing leads to him biting down on the toothbrush and quite frequently I need to suction his airway so he doesn't aspirate on his own saliva. I do clean his teeth twice a day, every day but not for anywhere close to two minutes because it is just so distressing for him (and me). Does anyone have any magical suggestions I can try? I do warn him what is about to happen I always place the toothbrush on his lower lip and let him feel and smell it and I do wait until he opens his mouth but his arms and legs spasm, his jaw clamps and he back arches so it is hard to keep him safe as I only have one pair of hands. He has some plaque build up on his molars but getting to them is difficult and I don't know what else to try.

Hopeful bump for some ideas. Please?

That sounds incredibly stressful OP - might be worth posting in the SN section if you haven't as I suspect you need specialist advice.

Does he like to chew things? My eldest liked these as a baby with a bit of toothpaste when brushing was a battle, you could maybe even use them once a day if you don't feel like they are good enough for cleaning?

https://www.jojomamanbebe.co.uk/style/ST519132/535985?gclid=Cj0KCQjw2qKmBhCfARIsAFy8buKXaWR7VknNvl-P_tyxQjtbVCPL0kTtaZIcVRT5vEnGlrLxTtZ-Q5AaAurjEALw_wcB&gclsrc=aw.ds#535985

Thank you. I will ask for this to be moved, sadly he hasn't yet figured out how to hold a toy but it is something I am working on with him.

Would he chew it while you hold it? Just thinking if he bites a normal toothbrush maybe something designed to be chewed might work better? Very much a shot in the dark though!

Yes he might do and it has to be worth a try, thank you.

Is DS under the special care community dental service? If so, it is worth asking them for advice. If not, ask to be referred.

You could try this or this type of brush. DS may still try to chew but you would get more brushed in the same amount of time.

You could try these as well. DS can bite down on them whilst you brush.

Have you tried low foaming toothpaste?

Has DS had a sensory OT assessment?

I asked our dentist to refer him to the community service but was refused, I will ask again when we go for his check up (they refused because although he didn't cooperate or understand the directions he did open his mouth so they could see his teeth). No sensory OT assessment, I will ask his OT when I next see her. Those mouth rests look perfect! We do use Oracare and one of those toothbrushes, I managed to find an electric one with six sides to optimise the amount of cleaning I can do.

In some areas, you can self-refer to the special care community dental service. If you can’t self-refer and your dentist refuses, ask your HV, GP or another professional involved if they can refer you.

If DS has an EHCP sensory OT provision should be in there. You can request an early review in order to amend F to better meet DS’s needs. If DS doesn’t have an EHCP, you should request an EHCNA.

His EHCP is just being finalised so I will chase that up.

You will receive a draft of the EHCP that you can comment on/name your preferred placement. Provision in EHCPs is taken from the evidence, so if there hasn’t been an OT assessment covering sensory needs (this could have been part of the EHCNA) there won’t be sensory provision in section F, unfortunately. Once the EHCP is finalised, you can appeal if the provision doesn’t meet DS’s needs.

Oranurse unflavoured toothpaste

it's an Amazon and it's amazing for my asd son. It's not foaming and no smell or taste