You're Not Gross
You’re probably here because you stumbled upon one of my viral posts on TikTok or Instagram about struggling with oral hygiene. Maybe you have a loved one who is struggling with plaque buildup, bad breath, and poor oral hygiene. Maybe that person is you. If so, I hope that you finally feel seen and validated in this battle that you often thought you were facing alone. Many times the ones best positioned to help, like the dental professionals in your life or your family, can be the greatest source of shame in this area. If that has been your experience, I am sorry.
Let me, a dentist, be a voice of encouragement to you today. You’re not alone. You’re not gross. You’re not lazy. *insert big hug* You’re human, and like so many of us you happen to be having a hard time right now. Even dentists have hard times (we have a very high rate of mental health struggles as a profession if we’re honest). I struggled recently with my own oral hygiene postpartum with baby number three in the middle of a pandemic. Hear me: I am a dentist, and I struggle at times with my oral hygiene. Any one of us at any time can go through a difficult season that turns everything we thought we knew about our life upside down, leaving us struggling with self-care. If anyone thinks they’re immune to that, they haven’t lived enough life yet.
Finding a Dentist
I hope that if you haven’t yet, you will share your struggles with your dental team and be met with empathy and kindness. If you’re not, know that you deserve kind care and you should never be made to feel shame by your dental providers. I encourage you to find a dental office that supports you on your oral health journey. Many people find kind offices by polling their community for recommendations through Facebook, Nextdoor, or Reddit. Google reviews can be enlightening as well. In the interim, I’m here to offer some tools, resources, and suggestions that I hope will be helpful to you.
Self Compassion
First, let me stress to you how very important it is that you drop any sense of shame about struggling with your oral hygiene. Be gentle with yourself as you would with a dear friend facing the same issues. Shame paralyzes us and keeps us where we are, tricking us into believing that there is something inherently wrong with us and that there is nothing we can do to change our current situation. Might I encourage you here based on the thousands of comments and messages I’ve received from people struggling over the past two years, that what you need is already inside of you. Your shame is hiding it away in a dark corner. Let’s bring it into the light and dust it off. You are worthy of kindness and care, just as you are, without changing a single thing about yourself; and the most important person you need that kindness and care from – is you. Dig deep into self-compassion and free yourself from shame. It has no place here. You’re on a healing journey now.
But *insert person’s name* always told me I was just lazy
I truly believe laziness doesn’t exist. You’re not staring at your toothbrush and unable to brush because you’re lazy. You’re a good person, a sane, nice, normal person, who just happens to be going through a season of life that is challenging and you need some help. There is no shame in needing help. Let me reiterate that if any dental professional ever makes you feel ashamed for struggling instead of working with you to help you identify your barriers and encouraging and supporting you as you work through them – shame on THEM. Please ask them if they included Motivational Interviewing as part of their curriculum in school and suggest they read the book with that title by Miller & Rollnick. Then tell them you don’t respond well to lecturing and to please note that preference in your chart. Bonus points if you passive-aggressively send them this blog post.
Identifying Your Barriers
When we struggle with care tasks like brushing our teeth, feeding ourselves, or showering, there is often a barrier at play. Many times there are multiple barriers comingling. Let’s review some of the most common ones and some possible workarounds. Keep in mind I am a random internet dentist, so your personal therapist, dentist, or primary care physician will be best able to identify these barriers with you and come up with workarounds for your unique situation.
Executive dysfunction (many facets)
Task initiation (overwhelm, boredom, lack of momentum)
Involves difficulty starting or finishing tasks without procrastinating. If you struggle here, tasks may feel overwhelming, and you cannot think through new ways to tackle a problem or how to break it down into more manageable pieces. You may also feel bored and like you need to be entertained, and may struggle to begin tasks without being directed to do so.
WORKAROUND: Getting started is half the battle. You want to get going so that momentum is on your side. Try incorporating brushing with other habits you consistently complete like going to the bathroom, eating, changing clothes, or showering. You can also start small, telling yourself you only have to brush for ten seconds. What you’ll likely find is that once you’ve begun, you’ll be able to finish the task. If the task seems boring, try using a fun app like Pokemon Smile, listening to a podcast, or listening to your favorite song. Getting moving is sometimes the key to finding momentum that will propel you forward toward a task, so try playing a song that gets your dopamine flowing and just smile, then move your feet, then wiggle your whole body, then. . . dance to the bathroom!
Flexibility
Involves the ability to adapt to changes in routines. If you struggle here, you find it difficult to adjust to changes in your routine. It may also be difficult to transition from one activity to the next, including moving on from a disappointment or setback.
WORKAROUND: Focus on consistency in the areas you’re able to control, such as using the same brush and paste or brushing at the same location or time of day. If you find it hard to move from one task (watching TV or laying in bed) to brushing, try setting an alarm for yourself five minutes before you want to move to the next task. And instead of thinking of the task as a big insurmountable thing, consider only the next small step: standing up and walking to the toothbrush. Take it one step at a time from there. Rewards such as a brushing app with points or a fun toothpaste flavor (cannot more highly recommend Tanner’s Tasty Paste vanilla bling, which tastes like cake icing) may also help. If a recent disappointing dental visit got you down and crushed your motivation, start a query in a local community group for a kind dentist that focuses on collaborative care. Know that having cavities or gum disease is morally neutral, so don’t beat yourself up if you have a checkup with such findings. Work to find out the causes and address them with your dental team. Did you know that even dentists get cavities and have bleeding gums? True story. One’s writing this blog post.
Self-Reflection
Involves the ability to monitor yourself. If you struggle here, you may have trouble identifying when you need help and how to ask for help. You may struggle to recognize your weaknesses and strengths.
WORKAROUND: This may be when trusted friends or dental care providers can help you see areas where you’re struggling and offer specific tips and tools to help you address those areas. Say for example you struggle with flossing, and as a result, your gums bleed often; they may suggest proxabrushes or picks as an alternative to string floss. Water flossers are also helpful for many people who struggle with flossing (I use a cordless one in the shower).
Working memory (organization, forgetfulness, distraction)
Involves the ability to use stored information from memory to complete a task. If you struggle here, you may have trouble focusing for extended periods of time in order to finish a task or to follow multi-step directions or processes. You may have a hard time staying on task and be easily distracted and find yourself having difficulty remembering what you were doing.
WORKAROUND: Break the task of toothbrushing into small, manageable steps. You can even write the steps on a post-it note and stick it to your mirror. Step one will be getting yourself to the toothbrush in the first place (see task initiation for more). Then pick up the brush, place your favorite paste on the brush, and brush one quadrant of your teeth (all three sides of the teeth, tops, backs, and biting surfaces). Then repeat 3 more times for the other quadrants. An electric brush with a timer can help with keeping you on track time-wise. Many apps can also visually show you where you’ve brushed and where you still have left. If you forget to brush, set alarms on your phone and place toothbrushes throughout your house in strategic locations (the shower, every bathroom, the kitchen, by the garage door, your nightstand) so that when you suddenly remember to brush, you can. Prepasted brushes are a great option for this. I call them my toothbrush army.
Planning and time management (overwhelm, anxiety)
Involves the ability to form steps that lead to the achievement of a goal in a timely manner. If you struggle here, you may begin tasks without sufficient time to complete them. You may also find yourself easily overwhelmed by large multi-step tasks or tasks with lots of rules or details.
WORKAROUND: Establish a routine that includes toothbrushing. Tag it on to tasks you already complete consistently and in a timely manner, such as feeding a pet or going to the bathroom. If you feel overwhelmed by the task, work on breaking it into smaller steps (see working memory section), starting small and building up to the full two minutes of brushing time. If you panic or experience anxiety around toothbrushing, there may be some past trauma at play, and it may be helpful to explore these feelings with a therapist.
Skills gap
Many people act like toothbrushing and flossing are skills that we naturally acquire, but like many complex fine motor skills, we need instruction and time to master them. If no one ever taught you how to brush and floss properly, then of course you struggle with that care task! This isn’t a topic routinely covered in health class (although it should be) and many people are raised in homes where oral hygiene isn’t a point of focus. Although many of us visit the dentist regularly, sometimes the hygienist or dentist assume you’ve already been taught the basics of home hygiene, and so they do not teach you proper brushing and flossing technique.
WORKAROUND: Check out my tips/demos videos on social media to help you master the proper brushing and flossing techniques. I'll embed a couple below from my TikTok. Whitney, a dental hygienist as @teethtalkgirl also has wonderful extensive videos on YouTube.
Physical disability
Many people struggle with medical conditions that limit their motor skills. For some, it is fine motor, and for others, it is more a gross motor issue. Occupational therapy can be invaluable in helping you adapt your routines, and many OTs have products and specific modifications they recommend. These are some modifications I’ve discovered over the years, and my patients have found helpful:
WORKAROUND: One of my favorite modifications for toothbrushes is to cut off a piece of a pool noodle or foam pipe insulation, slit it down the center lengthwise, place the toothbrush handle inside, and then use a velcro strip to wrap the brush-noodle combo around the hand and hold it in place. A slitted tennis ball can be used in a similar way. Another modification is to include a stool wherever you brush your teeth and allow yourself to sit down. Flossing tools like proxabrushes or the perpendicular-angled Listerine sticks can be helpful, too, for those with dexterity issues.
Depression
Depression is a serious medical illness involving chemical imbalances in your brain. It often requires professional help. If you struggle to get out of bed, find yourself unable to take care of basic hygiene needs, or feel hopeless, please don’t suffer alone. Reach out to your doctor or therapist and form a plan together. Just like you cannot white-knuckle your way to walking on a broken leg for long, you cannot white-knuckle your way out of a chemical imbalance. There is no shame in seeking therapy or medication for a medical illness.
WORKAROUND: Invite others in and seek help. A new toothbrush and a fun brushing app won’t cut it when your body is working against you.
Trauma
Dental and medical trauma is real. Many forms of abuse can involve the oral cavity. The dental chair places patients in a vulnerable position and many patients feel a sense of a loss of control when at the dentist. Even well-meaning dentists could create traumatic experiences for their patients if a procedure were particularly painful or difficult. Some people have traumatic childhood experiences related to toothbrushing or visiting the dentist. If you find yourself going into flight-or-fight mode when you think about toothbrushing or visiting the dentist, you may have past dental trauma.
WORKAROUND: Talking to a therapist can be helpful in discerning the root causes of these feelings related to dental work and oral health care and addressing them. For people with dental PTSD, desensitization therapies like EMDR may be helpful and worth exploring.
Sensory
Many people experience sensory aversions with toothbrushing or dental care. The physical sensations of the toothbrush or toothpaste can be overwhelming, as can the sounds created in your head from the toothbrush or the dental instruments, the tastes and flavors, the smell of a dental office or products, or even the visual of saliva, blood, or foam or the bright dental office light.
WORKAROUND:
- Feel – manual toothbrushes can clean well with proper technique (you don’t “have” to use an electric one), ultra soft-bristled toothbrushes like Curaprox, low-foam pastes that are free of SLS (many pastes are now SLS free – I sort several via categories on my shop page for you) or even brushing without paste and using fluoride rinse after or dipping your brush in a fluoride rinse instead of toothpaste. If you hate the “tug” of floss, try proxabrushes or a water flosser.
- Taste – flavorless paste (Oranurse (completely unflavored) or Dr. Bob (no flavor but still sweet)). Adults can also use fun-flavored kids pastes as well (especially in the US where both adult and kid pastes contain the same level of fluoride, 1000ppm) – so ditch the mint if you don't like it!
- Smell – place a dab of a pleasing smelling lotion or oil under your nose. Mentholated nose plugs are another great option.
- Sight – use sunglasses at the dentist or brush in the shower where you don’t have to see the foam or saliva and can quickly wash it away.
- Sound – listen to a podcast or music while brushing or at the dentist, use a manual, ultra-soft toothbrush like Curaprox to help with the internal toothbrushing sound.
Exhaustion/Fatigue
This was my struggle postpartum and is what I hear from many new mothers on my social media pages. We give so much of our time and efforts to our families, not to mention sacrificing our emotional, physical, and mental health, that we have little left at the end of the day for ourselves. Finding ways to share the mental load and the burdens of motherhood will help, as can therapy, so please don’t suffer alone. The pandemic left a lot of us suffering alone.
WORKAROUND: Support is key. Reach out to a friend, your spouse, your doctor, or your dentist and tell them you’re struggling and need support. I found that brushing with my kids made me more likely to remember to brush myself. I also kept toothbrushes everywhere (the disposable pre-pasted ones are great for this purpose) – in the shower, on my night stand, in the kitchen, in every bathroom, by the back door, near my desktop, and in the kids’ playroom. I gave myself permission to brush when I remembered rather than at the “perfect” times of day and that made it a much more manageable task to accomplish. A stool in the shower was also a fantastic addition which allowed me to sit and rest (and also brush my teeth with said toothbrush from earlier).
Perfectionism/Rule Following
Many people with OCD struggle with the task of toothbrushing, but it can also be people with perfectionist mindsets who focus heavily on rules. There are a lot of “rules” surrounding proper oral hygiene, but many of them are not as black and white as they seem. For people who struggle in this area, they find themselves completely avoiding a task if they cannot follow the rules and do it “perfectly.” I like to share this mantra on my socials: “Perfection can be the enemy of good enough.” If you don’t like string floss, or you can’t bring yourself to brush before breakfast, or you can’t stand toothpaste – then don’t. Use floss picks, swish with water after breakfast to neutralize the acids and then brush, or brush without toothpaste and use fluoride mouthwash afterward.
WORKAROUND: Identify the ‘rules’ you’re trying to keep and ask your dentist or hygienist for acceptable alternatives. In my practice I love to tell patients that my favorite tool is the one they’ll use consistently. For example, string floss may well be the ideal and gold-standard tool for removing plaque from underneath the gum line, but it does little good just sitting in someone’s drawer. If you’ll use your water flosser every day (pro tip: cordless one for the shower), then that’s the tool you should focus on using for now. Maybe one day you’ll work up to string floss. Maybe you won’t. At least for now you’re getting some plaque disruption and forming a regular hygiene routine.
Mindset Shift
Look at toothbrushing not as a determinant of your self-worth or as some moral obligation to be a “good, normal person” but instead see it simply as a task with a function. Toothbrushing removes plaque and food from your teeth. It helps your food taste better and your breath to be fresh. Routine home care keeps you from getting gum disease and cavities and helps your dental bills stay relatively low. You aren’t a failure if you struggle in this area; you’re just having a hard time and need a little extra support.
WORKAROUND: Set up brushing dates with a friend over facetime or brush with your kids or spouse. Reach out to your dentist and see if they can get you in for cleanings every three months instead of every six months – it’s often very inexpensive ($50ish) for an added cleaning outside of insurance – and work together as a team to get you and your smile through this challenging time.
Onward!
Was this helpful? Is there a barrier I missed? Do you have additional tips and workarounds you’d like me to include? Please reach out at taylor@themamadentist.com
Credit
Many of these ideas were developed alongside my consumption of KC Davis’ TikTok (@domesticblisters) and her book, How To Keep House While Drowning, both of which I strongly encourage you to seek out if you’d like to learn more about kindness to self amidst struggling with care tasks. KC is amazing!
Disclaimer
All The Mama Dentist content is for educational or entertainment purposes only and should never substitute for medical or dental advice from your own personal providers.
