Just as every smile is different, every brain is too. Neurodivergent individuals, including people with Attention-Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and learning differences, have unique strengths and experiences. They also face distinct challenges that increase their risk of poor oral health and developing dental disease. Below, MDA dentists present some common oral health concerns and offer tips for helping our neurodiverse friends, family, and loved ones maintain their healthy smiles.
What Is Neurodiversity?
Neurodiveristy is not a medical diagnosis; it’s a term created by a sociologist to promote equality and inclusion of neurological minorities¹. Neurodiversity research and education helps clinicians to view and address the unique needs of those with certain disabilities and neurological conditions.
Embracing & Understanding Neurodiversity
People think, learn, and interact with the world in many different ways — there isn’t just one “right” way. Differences in how our brains work and how we perceive the world make us who we are, and they’re an important part of human diversity2.
When someone thinks or behaves differently than what is generally expected, or neurotypical, they may identify as neurodivergent. But, it’s up to each person to choose how they describe themselves. Advocates encourage using inclusive language and creating accessible spaces that make everyone feel included.
Many different syndromes and diagnoses are common among the neurodiverse community. Some of the most well-known include:
- Attention-Deficit Hyperactivity Disorder (ADHD)
- Autism Spectrum Disorder (ASD)
- Dyslexia/Dyspraxia and learning difficulties
- Down Syndrome
- Fetal Alcohol Syndrome (FAS)
Neurodivergent individuals have unique ways of processing information and interacting with the world around them. This includes how they approach everyday tasks, including daily oral care routines.
Linking Neurodiversity & Oral Health
Positive daily oral care habits are essential for maintaining optimal oral health. These include daily oral hygiene practices like brushing and flossing and regular dental checkups with an MDA dentist and their dental care team.
Without strong at-home oral hygiene habits and routine dental visits, it’s easy for anyone to fall into poor oral health. Neurodivergent individuals may be even more susceptible, as maintaining daily oral care routines and attending regular dental visits present additional challenges3.
Some barriers to achieving optimal oral health that disproportionately impact the neurodiverse community include:
- Executive functioning challenges. Neurodivergent individuals may have difficulty with certain types of executive functioning – the ability to plan, organize, and follow through on tasks. This can make it difficult for many to remember to brush, floss, and use good oral care habits daily.
- Sensory processing challenges. Sensitivities to certain textures, tastes, and sounds are common among neurodivergent individuals. The impact of these sensations can far exceed what a neurotypical individual might expect. Things like the feel of a toothbrush on sensitive gum tissue, the taste of toothpaste, the vibrations from dental instruments, and the sounds in a dental office can cause distress and pain. These sensory challenges make it difficult for many to tolerate daily oral care and attend dental visits.
- Learning challenges. Dyslexia and other learning difficulties can make processing and retaining new information challenging. This can impact everything from remembering new steps when they get added to a daily oral care routine to following specific recommendations from the dental care team.
- Physical challenges. Brushing and flossing require fine motor skills and coordination. Getting to those hard-to-reach places, flossing between molars, and gripping a toothbrush can bring added difficulty for those with physical limitations.
Neurodiverse children may have difficulty developing lasting positive daily oral care habits. Among neurodiverse adults, fear of visits to the dentist can undermine even a well-regulated at-home oral care routine. Regardless of age, maintaining good oral health is possible with the right personalized approach. It starts by understanding each person’s unique challenges and involves working closely with a dental care team that can address those specific needs4.
Common Dental Challenges Among Neurodivergent Individuals
Neurodivergent individuals often face additional challenges and risks regarding their oral health. While everyone’s mouth is different, some specific dental complications are more likely to impact the neurodiverse population, including:
- Poor Oral Hygiene. This may be due to motor coordination difficulties, sensory sensitivities, or challenges in following daily oral hygiene routines. As a result, poor oral hygiene habits put neurodivergent individuals at higher risk for cavities and gum disease (periodontal disease).
- Teeth Grinding (Bruxism). Some neurodivergent individuals—especially those with ASD or ADHD5—may be prone to grinding their teeth. This can lead to tooth wear and tear, jaw pain, cracked teeth, and other painful and lasting dental issues.
- Oral Dyskinesia. Involuntary oral motor activity such as lip smacking, tongue protrusion, and cheek puffing is habitual in some neurodivergent individuals. Over time, these subconscious behaviors can wear down teeth, leading to dental complications like occlusal wear and fractured dental enamel6.
- Gastroesophageal Reflux Disease (GERD). GERD, a severe form of acid reflux, is prevalent in individuals with Autism Spectrum Disorder (ASD). This painful disorder causes digestive acids to travel up the digestive tract, even reaching the mouth, eroding tooth enamel and increasing the risk for cavities and other oral illnesses. Easing GERD symptoms often requires diet and oral care habit modifications like prescription fluoride toothpaste and oral rinses, which can be challenging for those with ASD.
- Medication Side Effects. Some medications commonly used by neurodivergent individuals can have adverse side effects on their oral health. For example, many medications cause dry mouth, increasing tooth decay and gum disease risk.
- Difficulty with Dental Visits. Sensory challenges, difficulty with unfamiliar situations, and communication differences can make dental visits very stressful. Bright fluorescent lights, loud sounds, strange smells, and unfamiliar procedures can all be barriers to care for highly sensitive individuals7.
- Poor Diet/Nutrition. Some neurodivergent individuals may have restricted or selective eating habits, which could affect their oral health. For instance, foods high in sugar and refined carbohydrates feed oral bacteria and increase the risk of tooth decay and cavities.
It’s important to note that not all neurodivergent individuals will experience these specific oral health challenges. The severity of these issues can vary greatly from person to person. Close collaboration with an MDA dentist to create personalized oral hygiene strategies and coordinate regular dental visits can help manage and treat oral health complications before they impact overall health.
How Sensory Challenges Can Impact Oral Health
Sensory challenges are among the most common obstacles neurodivergent individuals and caregivers face in working toward good oral health. Sensory input that may seem harmless to some can be unsettling to the point of being physically painful for neurodivergent individuals. Such taxing situations can lead to sensory overload and shutdown.
Due to the nature of oral health care, there are a range of sensory considerations to contend with, including:
- Brushing or flossing. Those with sensory challenges may find the feel of the toothbrush bristles or the taste of toothpaste to be unpleasant and even painful. This can make it difficult for many to tolerate brushing their teeth for the recommended two minutes twice a day.
- Sound and vibration from dental tools. Electric toothbrushes and instruments in the dental office all give off sounds and vibrations. For those hypersensitive to noise and sensation—including many children and adults with ASD—these tools can cause anxiety responses, painful physical sensations, and sensory overload.
- Oral appliances (braces or nightguards). Anything that interferes with how the mouth typically feels can potentially trigger sensory stimulation that’s uncomfortable or even painful. Nightguards designed to protect the mouth from grinding during sleep can actually make it more difficult for many with ASD to feel comfortable enough to sleep.
Because oral care spans all major senses—sight, sound, smell, taste, and touch—it’s important for neurodivergent individuals and their caregivers to create positive associations with these stimuli. That might mean using a soft-bristle manual toothbrush or a flavorless, low-foaming toothpaste at home. When it comes to a visit to the dentist, choosing an MDA dentist familiar with these considerations makes all the difference.
MDA Dentists & Personalized Care
MDA dentists are medically trained to provide the highest level of care. That includes treating those with additional needs and considerations. Depending on someone’s unique needs, an MDA dentist may refer them to a colleague specializing in high-risk and medically vulnerable individuals.
With the right support, most neurodivergent children and adults can achieve and maintain good oral health. Even for those with hypersensitivities and anxiety over receiving dental care, some interventions can help make tolerating dental care easier.
- Choose an experienced MDA dentist. MDA dentists are understanding, and many are experienced in treating neurodivergent patients. When choosing a new dentist, ask about their confidence level and approach to treating patients with unique needs. Together, they can help create a personalized oral health care plan that considers sensory concerns and other specific challenges.
- Utilize assistive resources. Visual aids and technologies that help with executive functioning can make daily care easier. Checklists, timers, and even gamified apps can help neurodivergent individuals maintain a good daily oral care routine. They also help build positive associations with brushing and flossing.
- Recognize specific challenges. Some neurodivergent individuals may find it helpful to use different toothpastes or toothbrushes. Others may prefer brushing their teeth in a quiet room or with calming music playing. Often, it comes down to minimizing stimulation and maximizing comfort.
- Work with an OT. For individuals with ASD, collaboration with an Occupational Therapist (OT) can make oral care more manageable. An OT can help caregivers connect and communicate with those who need specific oral care interventions8.
MDA dentists understand that the best approach to care is always a personal one. That’s why they work with patients to provide the right options and treatment plans to accommodate their unique needs.
MDA Dentists’ Tips for Stress-Free Dental Visits
No matter how good a daily at-home oral care routine is, it’s just the start. Maintaining optimal oral health involves regular dental care from a qualified dental care team. That includes routine dental cleanings and preventive visits that help stop oral disease before it impacts systemic health.
MDA dentists understand that while visiting the dentist can be stressful for anyone, it’s often even more stressful for neurodiverse patients. Here are some MDA dentist-approved tips for managing that anxiety and preparing for a stress-free dental visit:
- Talk to the dentist and their care team well before the visit, ask questions, voice concerns, and manage priorities together before the day of the visit.
- Know what to expect at the appointment – ask a member of the dental care team to provide a walk-through, step-by-step picture of what to expect on the day of the visit.
- Don’t be afraid to ask for more information, including video, visual aids, or text to explain procedures.
- Take time to visualize a positive, comfortable, relaxing experience at the dentist.
- Bring an ally—like a friend or family member—to the appointment to help encourage relaxation and help with communication needs.
- Listen to calming music or wear noise-canceling headphones to block out sounds.
- Get a good night’s sleep before the appointment and wear comfortable clothing.
For those with dental care anxiety, every positive experience at the dentist helps build positive associations with dental care. Preparation can play a big role in reducing anxiety and increasing comfort. Work with the MDA dentist and their team before an appointment to address any specific concerns so there are as few surprises as possible on the day of the visit.
Parents & Caregivers: Building Positive Oral Care Associations
For parents and caregivers, there are several strategies that can reduce anxiety about oral care for young children and individuals who identify as neurodivergent9.
Start by establishing a routine for daily oral health care with the help of an MDA dentist and their care team. When it’s time to put this into practice at home, take the time to explain every step and make sure the sequence remains the same every single time. It also helps to tie oral health care to other established routines, such as brushing after breakfast and right before bedtime. Familiarity and predictability make these habits easier to internalize.
When it comes to sensory issues or specific anxieties, there are many dentist-recommended tools and products available to help make at-home oral care easier. Extra-soft toothbrushes, low-foaming and mild-flavored toothpastes, zero-alcohol mouthwashes, and flavorless floss are all recommended for those with sensory concerns.
Finally, it’s important for parents and caregivers to talk about the benefits of good oral care and even make it fun10. Positive associations can help form good habits and make oral health care something to take ownership of—rather than something to fear or avoid.
Neurodiversity-Informed Dental Care
Neurodivergent individuals face unique challenges when it comes to oral health care. Thankfully, with a personalized approach to at-home oral care and collaborative effort from an MDA dentist, it’s possible to maintain happy, healthy teeth and gums.
Use the MDA’s Find-A-Dentist tool to find an MDA dentist near you. When choosing a dentist, be open about any special needs or concerns ahead of time. The more prepared they are, the better care they can provide.
- Baumer N & Frueh J. What is neurodiversity? Harvard Health Publishing: Harvard Medical School Blog. November 23, 2021. Accessed online: https://www.health.harvard.edu/blog/what-is-neurodiversity-202111232645
- Murphy J, Andrews F, Morgan M. Embracing neurodiversity-informed dentistry. Part one: Raising awareness. BDJ Team. 2023;10:22–26. Accessed online: doi:10.1038/s41407-023-1785-6.
- Murphy J, Andrews F, Morgan M. Embracing neurodiversity-informed dentistry. Part two: Oral health considerations. BDJ Team. 2023;10:18–21. Accessed online: doi:10.1038/s41407-023-1864-8.
- Ward LM, Cooper SA, Hughes-McCormack L, et al. Oral health of adults with intellectual disabilities: a systematic review. J Intellect Disabil Res. 2019;63:1359–1378. Accessed online: doi:10.1111/jir.12632.
- Begnini GJ, Brancher JA, Guimarães AT, de Araujo MR, Pizzatto E. Oral health of children and adolescents with Attention Deficit Hyperactivity Disorder. Int J Clin Pediatr Dent. 2019;12(6):543-547. Accessed online: doi:10.5005%2Fjp-journals-10005-1691.
- Loughlin AM, Lin N, Abler V, Carroll B. Tardive Dyskinesia among patients using antipsychotic medications in customary clinical care in the United States. PloS One. 2019; 14(6): e0216044. Accessed online: https://pubmed.ncbi.nlm.nih.gov/31163035/
- Chase I & Baumer N. Making visits to the dentist easier for people with Autism Spectrum Disorder. Harvard Health Publishing: Harvard Medical School Blog. June 29, 2021. Accessed online: https://www.health.harvard.edu/blog/making-visits-to-the-dentist-easier-for-people-with-autism-spectrum-disorder-202106292513
- Como DH, Stein Duker LI, Polido JC, Cermak SA. Oral health and Autism Spectrum Disorders: A unique collaboration between Dentistry and Occupational Therapy. Int J Environ Res Public Health. 2020;18(1):135. Accessed online: doi:10.3390/ijerph18010135.
- Zerman N, Zotti F, Chirumbolo S, Zangani A, Mauro G, Zoccante L. Insights on dental care management and prevention in children with autism spectrum disorder (ASD). Front Oral Health. 2022;3:998831. Accessed online: doi:10.3389/froh.2022.998831.
- Hage SRV, Lopes-Herrera SA, Santos TF, et al. Oral hygiene and habits of children with autism spectrum disorders and their families. J Clin Exp Dent. 2020;12(8):e719-e724. Accessed online: doi:10.4317/jced.56440.