Brushing is hard for many autistic children because of sensory, motor and communication differences, not stubbornness. The way through is to find out which of those is the obstacle, make the routine predictable, and teach the skill one small step at a time with praise along the way. That is how applied behavior analysis (ABA), the teaching approach we use at Building Block Resolutions, treats self-care skills, and it is a method you can bring into your own bathroom starting tonight.

TL;DR

• Find the “why” first: bristles, toothpaste taste or foam, motor control, communication, or simply sticking with a boring task. Each has a different fix.
• Make brushing predictable: same time, same place, same brush and paste, a visual schedule and a timer.
• Teach in small steps. Break brushing into parts, model it, teach one part at a time and reward progress.
• Start gently: a soft, small-headed manual brush, a pea-sized amount of paste, and gradual exposure instead of a full two minutes on day one.
• If brushing stays a daily fight, parent coaching with an ABA team can build the plan around your child.

Table of Contents

• Why brushing is so hard for many autistic children
• Why it matters: oral health risks
• Set up a predictable routine
• Adapt the brush, the paste and the setting
• Teach brushing step by step
• Prepare for the dentist
• A sample two-week start
• Where ABA support helps
• Perspective
• Ready to build a routine that fits your child?
• FAQ
• Sources

Why brushing is so hard for many autistic children

Parents often describe brushing as a battle. In a 2024 qualitative study in England, parents used that word because their children found brushing unpleasant or even painful. Some children also struggled with the loss of control that comes when another person cleans their teeth, and with someone being so close to their face.

The reasons fall into a few groups. Knowing which group your child is in saves weeks of trial and error.

Sensory sensitivity. The University of Utah Health guide for parents lists uncomfortable sensations from the bristles, and texture or taste sensitivities to toothpaste. A 2025 peer-reviewed review adds that the foaming of toothpaste, the feel of the bristles or the hum of an electric brush can set off distress and lead to resistance or refusal. In the England study, children said they disliked the feel of bristles, found electric brushes too noisy or too vibrating, and struggled with mint toothpaste in particular.

Motor differences. The same 2025 review notes that poor hand-eye coordination or low muscle tone can make brushing and flossing physically hard. A child who looks defiant may simply be unable to angle the brush or keep it moving.

Communication. A child who cannot say “it stings” or “that’s too much” may show it by clamping their mouth shut or pushing your hand away. For more on how sensory differences show up across a child’s day, see our guide to sensory challenges in autism.

Anxiety and change. Autism Speaks’ Dental Tool Kit for caregivers lists anxiety or a general fear of what might happen alongside sensory and fine motor issues. The 2025 review adds that even a new toothpaste flavor can provoke anxiety in a child who resists changes in routine.

Sticking with a dull task. Natalie Buerger, PhD, clinical director of the Autism Spectrum Disorder Clinic at the University of Utah, says the first job is to work out whether the problem is sensory, motor, communication or simply staying with a boring task for a set time. In her view, finding the “why” is the most important thing.

A quick way to find your child’s “why”

Watch three or four brushing attempts and note what happens right before the refusal:

• Does the child pull away the moment the brush touches the mouth? Think sensory.
• Does the child accept the brush but cannot move it, or drops it? Think motor.
• Does the child melt down when the paste appears, or when the routine changes? Think taste, foam or predictability.
• Does the child brush happily for ten seconds and then wander off? Think attention and duration.

Write down what you see. These notes are exactly what a behavior team uses to build a plan, and they make any conversation with your child’s dentist more useful.

Why it matters: oral health risks

The National Institute of Dental and Craniofacial Research (NIDCR) practical oral care guide for people with autism says the risk of cavities rises with a preference for soft, sticky or sweet foods, damaging oral habits, and difficulty brushing and flossing. It recommends preventive measures such as fluoride and sealants, and asks caregivers to watch for medicines that reduce saliva or contain sugar. Ask your child’s dentist and prescriber about those.

The same guide names oral habits that deserve a dentist’s attention: teeth grinding (bruxism), tongue thrusting, picking at the gums, biting the lips, and pica, which means eating non-food items. If a mouth guard can be tolerated, it says one should be prescribed for children who grind their teeth or hurt themselves. Mention any of these at the next dental visit.

Set up a predictable routine

Predictability lowers the amount of effort a child spends bracing for what comes next. The University of Utah guide recommends:

• Brushing at the same time each morning and night.
• Using the same toothbrush and toothpaste.
• Brushing in the same place each day.
• Adding brushing to a visual schedule if that helps your child.
• Using a timer so your child can see how long brushing will last.

A visual schedule does not need to be elaborate. Autism Speaks’ Dental Guide suggests photographing each step of your own brushing routine, loading the pictures onto a digital picture frame, and setting each photo to show for 10 seconds, so the bathroom itself prompts the next step. If paper works better for your family, a strip of laminated pictures does the same job. Our guide to visual schedules for autism shows how to start with a single picture and build from there.

The same principle runs through every part of a child’s day, from the bathroom to the ball field. This overview of predictable structure for autistic kids shows how it works in another everyday setting.

Adapt the brush, the paste and the setting

The University of Utah guide recommends a brush sized for your child’s mouth with soft bristles, and starting with a manual brush rather than an electric one. Electric brushes bring noise and vibration, which the England study found some children dislike. Introduce the brush gradually: first let your child hold it and explore it, then gently touch the bristles to the lips, then to the inside of the mouth.

For toothpaste, the same guide advises a pea-sized amount so your child can get used to the taste and texture. Because children in the England study struggled with mint in particular, ask your dentist which fluoride toothpastes come in milder flavors, and change only one thing at a time. The 2025 review warns that a new flavor can provoke anxiety, so a swap works best when you present it as the new normal on a calm day, not mid-meltdown.

A few practical adjustments follow from this:

• Let your child choose within limits. Two brushes, two flavors, or which song plays during the timer give back some of the control the England study found children miss.
• Cut the sensory load around the sink. Dim a harsh bathroom light or turn off a loud fan if those are known triggers.
• Start short. Ten calm seconds that end well beat two tense minutes that end in tears.

For more ideas about easing sensory input before a hard task, see these examples of calming sensory interventions.

Teach brushing step by step

Brushing is a chain of many small actions. Autism Speaks’ Dental Professionals Tool Kit describes the ABA approach: break the skill into specific steps, teach each step separately, and reward the child as each component skill is learned. Its example sequence looks like this:

1. Get the toothbrush.
2. Get the toothpaste.
3. Squeeze toothpaste onto the brush.
4. Wet the brush and paste with water.
5. Brush the front teeth.
6. Brush the upper right teeth.
7. Brush the upper left teeth.
8. Brush the lower right teeth.
9. Brush the lower left teeth.
10. Spit out the toothpaste.
11. Rinse the brush.
12. Put the brush away.
13. Put the toothpaste away.

You do not have to teach all thirteen at once. Pick the step your child can nearly do and work from there, adding the next step once the first is steady.

Model it, then help with your hands

The University of Utah guide recommends live modeling: brush your own teeth beside your child, and go slowly enough that each step looks small and manageable. Instructional videos of children brushing can also motivate a child to copy the routine.

When your child needs physical help, the guide suggests standing behind them and letting their head rest against your chest. Help them practice opening wide enough to reach all their teeth, and brush gently with the same technique you would use on your own teeth. This position also gives your child a little more sense of control than someone leaning over them face to face.

Praise at the right moments

The guide recommends praising or rewarding your child at increments that suit them, such as after each step or after the full routine. It also says not to give up if brushing stays hard. A child who only manages the first three steps today is still practicing a skill that builds.

Here is what that looks like in practice. Your child tolerates the brush on the lips for three seconds, so you say “nice job, brush done” and stop right there. Tomorrow you aim for five seconds. This is slow, and it works because each attempt ends successfully, not in a fight.

What to do when your child resists

• Stop before the meltdown, not after. End on a step your child managed.
• Go back one step, not to zero. If the brush in the mouth is too much today, return to touching the lips.
• Keep the routine the same even on hard days. Skipping the routine entirely teaches that protest changes the schedule. Shortening it teaches nothing wrong.
• Keep your own tone flat and warm. A calm voice is part of the routine.

Prepare for the dentist

Brushing at home and the dental chair are two parts of the same problem. Cirio and colleagues’ 2022 randomized trial found that visual aids, either video or photo-based social stories, helped prepare children with autism for a first dental exam, and that children who watched the video got further through the procedure. The authors concluded that behavioral intervention is an effective way to prepare these children.

The Dental Professionals Tool Kit suggests a first visit when the office is less busy or after hours, with a tour of the office and exam rooms, an introduction to staff, and a review of the steps of a typical visit. For children with significant anxiety it describes desensitization through a series of short visits, each practicing one behavior and ending positively. The early steps include walking into the exam room and then sitting in the exam chair for 5 seconds, 30 seconds, 1 minute, 5 minutes and finally 10 minutes.

Call the dental office ahead of time, tell them your child is autistic, and share what you have learned about their sensory triggers and what helps. A dentist can also check for the grinding, lip biting and gum picking described above, and recommend fluoride or sealants.

A sample two-week start

This plan puts the pieces together. Adjust the pace to your child.

Days 1 to 3: Make it predictable. Choose a time, a place, a brush and a paste. Add a picture of brushing to the visual schedule and set a short timer. Brush your own teeth while your child watches.

Days 4 to 7: Explore the tools. Let your child hold the brush, touch it to their lips, and smell or taste a pea-sized amount of paste. End each session with praise.

Days 8 to 10: Add one step. Bring the brush into the mouth for a few seconds, ideally with your child leaning back against you. Increase the time only when the current length feels easy.

Days 11 to 14: Link the steps. Use a photo strip so your child can see the order. Reward after each step, then after the whole sequence once it is steady.

If you hit a wall at any stage, that tells you what to work on, not that your child cannot learn this.

Where ABA support helps

A home routine works best when everyone who brushes your child’s teeth does it the same way. That is where parent coaching comes in. At Building Block Resolutions, our parent coaching brings caregivers into the process so that the supportive environment extends to home, and our ABA autism therapy builds individualized treatment plans around each child’s own challenges, including daily living skills. If your family would rather work from home, we also offer remote ABA therapy. To understand what the process looks like, our guide to ABA therapy for parents walks through it.

Perspective

Parents often come to us after months of brushing struggles, convinced they are doing something wrong. They are not. A child who pulls away from a toothbrush is telling you something real, and our job is to help you hear it.

What we have built over more than 20 years is a way of turning a big, frightening task into small wins. We start with the child, not a script: what they can already do, what hurts or overwhelms them, and what motivates them. Then we write an individualized plan, and we coach the family so that the plan lives in the bathroom at 7 p.m. and not only in a session. We say that over 90% of the children in our programs make significant gains, and the reason we point to is the same every time: the plan is tailored and the family is part of it.

If brushing is the thing keeping your household up at night, it is a very good place to start. Self-care skills build confidence, and confidence carries over into communication, social interaction and daily living.

Jennifer

Ready to build a routine that fits your child?

If brushing has become a daily struggle, we can help you work out the “why” and build a plan your whole family can follow. Our team writes individualized plans and coaches caregivers to carry them out at home.

Talk with our team through our services page, or start at the Building Block Resolutions home page to book an appointment.

FAQ

At what age should an autistic child start brushing independently?

Autism Speaks’ Dental Tool Kit says children can begin learning to brush their own teeth, and why it matters to do it twice a day, from age 2. For many autistic children, independence arrives in steps, and you will likely help for longer. Teach one step at a time and keep assisting with the parts your child cannot yet do.

Should I use an electric toothbrush for my autistic child?

The University of Utah guide suggests starting with a manual brush, because the noise and vibration of an electric one bother some children. The England study heard the same from children. If your child later seems drawn to the sensation, ask the dentist whether to try one, and introduce it as slowly as you did the first brush.

What if my child refuses to open their mouth at all?

Go back to the earliest step: touching the brush to the lips, or letting your child hold it and explore it. Keep sessions short, end on something your child managed, and praise it. Do not give up on the routine. If refusal continues for weeks, a behavior team can observe the routine and adjust the steps.

How do I know if my child’s mouth hurts?

A child who cannot tell you may show it through clenching, pulling away, refusing certain foods or touching the face. The NIDCR guide lists grinding, lip biting and gum picking as common in autism. Book a dental visit to check for pain or decay, and tell the dentist what you have seen.

Can visual supports really help with dental visits?

Yes. In the 2022 randomized trial, children who prepared with video or photo-based social stories were better prepared for their first dental exam, and the video group completed more steps. Start the preparation a few weeks ahead and review the pictures on a regular schedule.

Sources

• Helping Children with Autism Brush Their Teeth: A Guide for Parents (University of Utah Health, 2026)
• Practical Oral Care for People With Autism (NIDCR)
• Caregivers and autistic loved ones: Dental Tool Kit (Autism Speaks)
• Challenges and solutions in managing dental problems in children with ASD (PMC, 2025)
• Factors Influencing the Oral Health Behaviours of Autistic Children (PMC, 2024)
• Dental Professionals Tool Kit (Autism Speaks, 2018)
• Dental Guide (Autism Speaks, 2018)
• Use of Visual Pedagogy to Help Children with ASDs Facing a First Dental Examination (MDPI, 2022)

Recommended

• Safety Skills for Autistic Children: A Parent’s Guide
• Parents Can Start Toilet Training for Autistic Children in 48 Hours
• Sensory Challenges in Autism: What Parents & Teachers Do
• Community Outings and Autism Safety: A Parent’s Plan