Teaching the Functional Skill of Tooth Brushing

This task analysis supports instructors in teaching functional skill success

Father helping his son.
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Tooth brushing is both an important functional life skill and an appropriate skill for school intervention.  Other functional life skills like showering may be appropriate in residential settings, but it's necessary to remember that only a small minority of students are in residential placements  In that way, tooth brushing is a pivotal skill in a way that will lead to success in other task analysis based skill programs. Once a student understands how completing one step leads to the next, they will more quickly acquire new skills. 

Tooth Brushing Task Analysis

First, you need to start with a task analysis, which lays out the discrete steps that a child must complete in order to complete the entire task. These need to be operationalized or described in a clear way that any two observers would see the behavior and identify it in the same way. Below is a straightforward task analysis.

  1. Remove toothpaste and toothbrush from the drawer
  2. Turn on cold water
  3. Wet toothbrush       
  4. Remove cap from toothpaste     
  5. Squeeze 3/4 inch of toothpaste on bristles      
  6. Place brush with toothpaste into the top right side of the mouth
  7. Brush up and down
  8. Place brush into the left top side
  9. Brush up and down
  10. Repeat on right bottom
  11. Repeat on left bottom
  12. Brush front top and bottom teeth
  13. Rinse mouth with water from water glass  
  14. Rinse your brush in the sink
  15. Replace brush and toothpaste
  16. Turn off water

Instructional Strategy

Once you have a task analysis that fits your students need, you have to choose how you will teach it.  Students with a significantly disabling disability may need either forward or backward chaining, teaching one or two steps at a time, mastering each before moving on, or your student may be able to learn the "whole task," using visual prompts, or even a list, for students with strong language skills.

Forward Chaining: Forward chaining is recommended for a student who is capable of learning multiple steps quickly, over a short span of time. A student with good receptive language may respond quickly to modeling and some verbal prompting. You will want to be sure that the student exhibits mastery of the first two or three steps without prompting before moving on, but you will be able to expand the steps quickly.   

Backward Chaining: Backward chaining is recommended for students who do not have strong language. By performing the early steps hand over hand while naming them, you will be giving your student repeated practice in the steps for tooth brushing while building receptive vocabulary, and as you get closer to the end, you will withdraw prompting for the last steps, while keeping the reinforcement for completion closest to successful completion of the task. 

Complete Task: This is the most successful with children with high functional skills. They may even be able to complete the task with a written checklist. 

Visual Schedule

In each of these strategies, a visual schedule would be helpful. Creating a picture schedule with the student completing each step (heavily edited, of course,) is a very effective way to support student success. The visual schedule can be reviewed before you brush teeth or can be placed on the counter. Try using laminated pictures with a hole punched in the corner, bound with a binder ring. You could also make a "flip book" using two rings at the top of the pictures, having the students lift and flip each page. 

Evaluating Success

In order to determine whether your student is making progress, you'll want to be sure you are not "over prompting" which may easily lead to prompt dependence.