a neurodivergent spoonie's guide to having teeth
LEGAL DISCLAIMER: This blog is for educational and informational purposes only. This does not constitute providing medical advice or professional services. Information on this blog should NOT be used for diagnostics or treating a health problem. Always seek the advice of your doctor or other qualified dental health provider regarding diagnosis and treatment of a dental condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.
this is as close to a comprehensive guide to dental care as i can make. i'm autistic/adhd/ocd/chronically ill and i've worked in dentistry for several years. i want to use my knowledge to help other spoonies struggling with dental care. i know it can be really hard, but dental health is so important and we deserve healthy mouths just as much as NT/abled folks!!
being neurodivergent and/or chronically ill can make personal care tasks incredibly difficult. so many of us struggle with washing our hair, getting dressed, and cleaning up. but remember: hair will grow back if it's damaged, clothes can be washed when they smell bad, and a dirty house can be made clean again, but we only have one set of teeth to last our whole lives. those pearly whites are worth taking care of!
these tips are based on feedback/questions i've gotten from ND folks on tumblr and facebook, patients at the practices i've worked in, and my own experience. standard disclaimer that this information will not be applicable to every single person, just take what works for you and pass the rest on to the next person. i am also a resource for further information. this is going to be pretty rapidfire, so if you want me to elaborate on anything or have a question about something i didn't address in this post, my askbox is open and anon is enabled. i love talking about teeth and i would love to help my fellow spoonies take care of theirs!
any dental professional will tell you that having good oral health starts at home. taking care of our teeth can be incredibly difficult when our spoons are low, so i've made a list of strategies to make it easier.
best practice is to brush twice per day and floss once per day. this may not be realistic for those of us who struggle with habits and/or executive dysfunction. if you can only remember to brush once per day, brushing at night is the most important.
the ideal order of operations is floss, tongue scrape, mouthwash, then brush. but flossing and brushing are the most important steps in the routine.
brushing your teeth in the shower is perfectly acceptable! personally, i keep one toothbrush in the shower and one on the sink to maximize my opportunities to brush.
if you don't have the energy to floss, a toothbrush with fine bristles like this one is a good compromise.
you should replace your toothbrush or electric brush head every three months. the bristles get worn down and become less effective over time. set a recurring event on your phone calendar to keep track!
if you find it difficult to brush your teeth at all, use a washcloth to gently scrub your teeth until you feel that you've gotten the film off, then use a fluoride mouthwash. they also make single-use waterless toothbrushes like these. i like to keep them on my nightstand for really bad days when i can't even get myself to the bathroom to brush.
this is an excellent guide on proper brushing technique.
an electric toothbrush is an excellent investment. even a cheap one at the grocery store is a huge step above a manual toothbrush. personally, i love quip because they're more affordable than brands like sonicare, and they send you replacement brush heads on a regular basis.
be careful not to brush too aggressively; your brush should glide gently over the surface of your teeth. if you feel a lot of friction, lighten your pressure. brushing too hard can wear away your enamel and damage your gums.
if the mint flavor in toothpaste triggers sensory discomfort, try kids' toothpaste! it has less fluoride than adult toothpaste, but it's still miles better than not brushing at all.
mouthwash is used to neutralize bacteria on soft tissues. use an antibacterial or fluoride mouthwash for healthy gums and strong enamel. listerine original is the best, but they have lots of varieties including gum health, alcohol-free, and many more.
whenever possible, use a straw to drink soda or coffee so it doesn't touch your teeth, and rinse with water after you drink it. try to not sip sugary drinks throughout the day. switching to sugar-free beverages will make a huge difference in cavity prevention.
if you have any gaps between teeth, an interdental brush will help you keep the areas between those teeth clean and prevent decay.
i like to keep a package of floss picks in the living room so that i can floss while i watch tv. the best time to floss is right before you brush your teeth, but there is no bad time to floss.
this video shows proper flossing technique. this video shows proper technique when using floss picks.
dry mouth is a lesser-known cause of cavities. saliva protects your teeth from decay, so when you don't produce enough of it, you're at higher risk. dry mouth rinses like this one are a great defense against this!
remember, something is always better than nothing. brushing once a day is better than not brushing at all. flossing once a week is better than not flossing at all. be gentle with yourself.
on finding a dental provider:
finding a new provider and making an appointment can be confusing and overwhelming when we have low executive function. there are some ways to make it just a bit easier.
if you have insurance, they likely have a tool on their website to find providers in your network. you can usually find this information on your insurance card. this should narrow down your options considerably.
the absolute best thing you can do is find a supportive provider who you can open up to about your struggles with dental care. look up your options on google reviews and ctrl+f "anxiety". if these anxious patients have a good experience, it's more likely you will too.
you can ask for recommendations in your local community's facebook group or subreddit, both of which offer anonymity. specify your needs in your post. chances are, other people in your community have similar needs, and can help you find the right people to meet those needs.
a few people expressed that they avoid the dentist because of a family history of poor dental health, and the fear of having the same problems. i want to assure you that, while dental health does have a genetic component, it is far from the only factor. the most effective thing you can do to prevent dental issues is to go in for regular maintenance. prevention is the gold standard in dentistry.
a lot of us struggle with making phone calls. luckily, it's becoming increasingly common for practices to allow online booking and communication via email. look for these options on a practice's website!
if fear or executive dysfunction is getting in your way, phone a friend for help. sometimes things that are hard for us aren't as difficult for others. maybe your roommate can call the office for you. maybe your sister can drive you to your appointment. don't be afraid to lean on your village.
a big issue with dental offices is that they are basically a sensory nightmare. while it's never going to be fully comfortable, there are some things you can do to make your experience more tolerable.
be open and honest with your dental providers. if you smoke, tell them (this includes cannabis; they cannot report you for cannabis use even if you're not in a legal state). if you've never flossed before, tell them. their job is to help you, not shame you. if a provider makes you feel ashamed, stop seeing them.
so many people have mentioned they're embarrassed about their anxiety and sensory struggles in the dental office. let me assure you that your providers see so many anxious patients every single day. they're used to it, and they're not going to be judging you. to help illustrate this, i'm going to cite some examples of patients from my practice and the ways we help them manage their anxiety and sensory struggles.
probably the most common concern among patients in our practice is a fear of the numbing injection. i have a pretty severe phobia of needles myself. our dental assistants are well-trained to manage this fear. they distract patients during the shot, and help them breathe through the anxiety before and after. this training is part of the dental assistant certification process, so it should be relatively universal.
you can bring a comfort item with you. be it a stuffed animal, a video game, a book, even a comforting person who can sit with you.
you know that lead vest that they lay on you when they take xrays? you can ask to wear that during your whole visit. it acts like a weighted blanket and it feels so nice and comforting. we have a few patients who do this at my practice.
headphones or earplugs are a lifesaver to drown out all the horrible sounds. i literally refuse to get a cleaning without them. there's even a hygienist at my practice that wears earplugs while she's working because the sound of the cavitron bothers her. there's no shame in it whatsoever.
if your practice offers it, nitrous oxide is a great option for anxiety. most people know it as laughing gas. it puts you in a dreamlike state so you're more or less unaware of what's going on. no joke, this stuff had me so relaxed i fully fell asleep while getting a root canal. you can even get it when you get your cleanings!
a lot of our patients request a specific doctor, dental assistant, and hygienist for their appointments. this is incredibly common. if you find someone that makes you feel safe, let the scheduling staff know that you'd like to see that person each time you come in.
dress comfy. there's no dress code for the dental office; show up in sweatpants if you want.
remember at the end of the day, your dental providers are not there to judge you if you don't have perfect homecare. their ultimate goal is to get your mouth healthy no matter your starting place. i can't speak for every dentist obviously, but the dentists at my practice are incredibly patient and sympathetic and have nothing but their patients' best interests in mind.
again: if you feel disrespected or shamed by your provider, find a new one who will be compassionate with you. you don't owe any provider loyalty, even if you've been going there since you were a toddler.
one of the hardest things to do is build healthy habits when you're starting from an unhealthy place. if you're dealing with poor dental health, getting your mouth healthy again can seem impossibly daunting. i'm here to tell you it is possible, but it takes work.
it starts in the dental chair. your provider should communicate what treatment is the highest priority, and they will start there. rather than overwhelming yourself with the big picture, focus your attention on the next step.
things like root canals, crowns, and periodontal treatment can be very expensive. unfortunately, in the united states at least, dental insurance is quite lacking across the board. if expenses are a concern, dental schools are a great option for having treatment done at a low cost. keep in mind that treatment will often take significantly longer due to the dentists being supervised students.
my job in the practice is treatment coordinator. this means that i work one-on-one with my patients to help them understand their treatment plans and make the process as easy and comfortable as possible for them. ask your practice if they have a treatment coordinator. if they don't, suggest that they create the role, and reach out to me here. my dream is to be able to help people manage their oral health. i will be a resource to anyone that doesn't have a treatment coordinator available to help you navigate your course of treatment.
any restorative work (fillings, crowns, etc.) that you have done has to be cared for, just like virgin teeth. cavities can still form underneath fillings and crowns. make sure you are keeping your regular hygiene appointments, and use the above strategies to effectively care for your restorations at home.
if you have a lot of treatment to work through, it may take a long time. we have patients that have spent 2-3 years working through their treatment plans with us. this can feel daunting and depressing. but remember, it's not forever. the majority of these patients who continue to see us for regular visits only have 1-2 new cavities at a time, if anything, once we finish their initial work.
there are very few dental problems that cannot be fixed. cavities can be filled, crowns placed, root canals done to save teeth that are severely decayed. gum disease cannot be cured, but it can be very effectively managed. i see patients all the time that come in expecting to lose all their teeth and need dentures, only to be relieved when we tell them only a few teeth are truly not restorable.
my job revolves around patient education, and it's always shocking to me how little we are taught about caring for our teeth. please be kind to yourselves; it is NOT your fault for not knowing or having the resources to take care of them yourself. once again, my askbox is open and anon is enabled if you have more questions after reading this guide.
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