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Protocol to aid in desensitizing mouth

The idea behind this is the same as behind the Wilbarger protocol of sensory summation. Pressure touch can override uncomfortable feelings such as pain or tickliness. By applying pressure to the oral area (in and around the mouth) before eating, toothbrushing, or dental exams, more touch and different textures may be better tolerated. You might also try pressure touch to the head, shoulders, and back before and/or during oral tactile experiences.

BY THE WAY-- Another idea to decrease oral tactile defensiveness is to use vibration touch either through an electric toothbrush or various sorts of oral vibrating tools for just this purpose, available at Professional Development Products, www.pdppro.com. A final idea, mostly for older children who can both tolerate and report on how its working, is to use cold food items such as popsicles before unfavored oral tactile experiences to decrease sensitivity.

Here is how I learned to apply pressure touch to the oral area. Proceed in stages, respecting the child's tolerance for it. Once you are comfortable and familiar with this sort of touch, you can often work so quickly that the child (especially younger children) don't even notice what you are doing before you are done. Use firm but gentle touch. Try it on yourself first. You can use gloves if you are following universal precautions, but keep in mind that rubber gloves can taste yucky and make for more light, tickly touches than bare fingers. They do make flavored gloves. Consider washing (and rinsing off any taste of soap really well) hands before and after the process. Some children prefer a washcloth wrapped over fingertips. Either way, make sure your fingernails are short enough that they won't snag or poke.


Preparation:
Particularly if you are working with a child who has some defensiveness, don't go right for their mouth with touch. Instead, work your way from more distal and less personal body areas. For example, you can start by lightly squeezing their hands rhythmically, then squeeze arms, then shoulders, then cheeks. If the child starts to recoil or looks uncomfortable with this sort of touch, back up until they look comfortable again. You need to do a bit of this every time you start working around the mouth. Make it a playful approach to increase comfort. Another idea: before putting your hands on or around the child's mouth, let them bite down on a washcloth and play "tug-o'war" with it, where you try to pull it out of their teeth. This gives some nice proprioceptive input to the mouth, which readies it for touch.


Stage 1:
Massage around the mouth area. Rub firmly 3-4 times with pads of thumbs and fingers from cheeks towards lips, then from nose and chin towards lips. This is also useful to "wake up" the muscles of the mouth for children who have low tone or apraxia in oral motor.




Stage 2:
Gum massage. Use index and thumb, starting in a pincer position. Start above front teeth. Quickly, firmly, but carefully slide index finger back along the upper gums on that side. Then move index right down to the bottom gums and slide back to the front. Now use the thumb to do the same thing along the upper and then lower gums on the other side. If you're brave about not getting bitten, press the pad of your thumb against the palate, right behind the front teeth, and push up firmly but gently 3 times.


Stage 3:
Now you have a choice of two ways that I have learned from two different sources about applying proprioceptive (muscle work) to the jaw. Both of them require being brave about getting bitten.  The OT who prefers the first way says that if you work quickly at the back of the teeth, you will never get bitten. But I'm not guaranteeing it! Go between teeth at your own risk!

First method: with index and middle fingers at opposite sides of bottom teeth (one finger outside of back teeth on one side, the other outside back teeth on the opposite side), hook fingers right over the very back teeth and briefly and firmly tug downward and slightly forward 2-3 times. It's kind of hard to describe in words. Try it first on someone you trust and who doesn't have an overly sensitive mouth.

Second method: just hook index finger over the front bottom teeth and tug forward 3 times.


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