Teaching water flossing to children with and without autism spectrum disorder

Oral hygiene is an important self-care skill that some children may lack, especially children with autism spectrum disorder (ASD). Although some studies have evaluated procedures for teaching toothbrushing, no previous studies have demonstrated procedures for teaching flossing, which is essential for oral hygiene. This study evaluated an intervention for teaching water flossing to two children with ASD and two children without an ASD diagnosis. The intervention package included backward chaining, video modeling, and reinforcement, with some components implemented by a caregiver and some components implemented by an experimenter via telehealth. Behavioral skills training was used to train caregivers prior to implementation of the study. Results indicated that the intervention package was effective in teaching all participants to independently floss their teeth with a water flosser. Effects maintained for all participants 1-week after completion of teaching. Questionnaires given to caregivers, participants, and dental professionals indicated high social validity.