Frequent snacking, inefficient removal of biofilm, and a high cariogenic food intake contribute to the higher rate of caries in individuals with autism. Food is often used as a motivator in therapy and in the home environment. Often these foods are highly cariogenic such as small candies, sugary drinks or fruit snacks.
Brushing and flossing are particularly difficult because the activity involves so much sensory input. The taste of the toothpaste, however mild it may seem to typical individuals, may be too strong for someone with autism. The feeling of the bristles on the gingiva and the floss interdentally may actually feel itchy or painful to someone with ASD. Many individuals with ASD do not like to be touched and even those that are comfortable with touch have a difficult time having their head touched by another person.
Individuals who lack speech may also lack fine muscle coordination. This makes self-cleansing, rinsing, and expectorating difficult or impossible for many individuals. Think about eating popcorn or something sticky. After swallowing the tongue is used to clean occlusal surfaces and vestibules. The self-cleansing of the tongue following eating will be absent in many of these individuals. It is not uncommon to see food packed away in vestibules, in between the teeth and even the occlusal surfaces. This will contribute to caries and halitosis (Figure 5).