Practicing good hygiene, including brushing his teeth regularly, has been a major challenge for Dave. He would rather do anything else. He did not keep his teeth clean in the early years of living on his own, and, as a consequence, had up to three cavities each time we visited the dentist. But we have not needed to worry about regular brushing for many years. This post explains why.
What Will Motivate Dave to Brush His Teeth?
This question was on my mind a lot in the early years of Dave’s independence. Dave’s staff, who come once per day, can address most of his hygiene issues. They can make sure he takes a shower and uses the right shampoo, for example. But he needs to brush his teeth twice a day.
I thought about this challenge quite often for several years, but struggled to come up with a good solution. Could his staff check his toothbrush to see if it was wet? Maybe Dave and I could Facetime so I could watch him brush his teeth in the morning. I even thought, fleetingly, about installing a video camera in his bathroom! That’s how desperate I was. We never did that, of course!
The methods I was considering were all external forms of motivation. But we had experienced the power of internal motivation in solving other seemingly intractable problems. Most notably, he began to regularly use his CPAP once he took responsibility for recording the number of hours he slept, which was previously a task done by his habilitation aides. How might we replicate that kind of internal motivation for toothbrushing?
We eventually found an answer to that question, and it came in an unexpected way.
Technology Saves the Day
In a book I was reading one February, I learned that one definition of creativity is the ability to combine ideas in novel ways. I was thinking that idea when two of my co-workers came into my office to show off their new Fitbits, which I had never heard of at the time. The Fitbit tracks movement (“steps”) and displays the results on an app. I wondered, what if you (somehow) connected a toothbrush to a Fitbit? That would allow you to track the “movement” of the toothbrush on an app. I was so excited about this idea that I discussed it with an engineer!
Later that spring, as I sat in the dentist chair during my own regular check-up, I glanced over at a shelf, and was surprised and delighted to see that Oral-B had the same idea I had! Of course, they also had the necessary expertise and resources to produce a blue-tooth enabled electric toothbrush, which would do exactly what I wanted.
I bought one immediately. Dave connected it to his prized iPod Touch that his father had given him. When he brushes his teeth, the device produces a visual representation of when and how long he spends brushing. I could check the app each week and easily see how many times he had brushed each day. We set up an external reward structure to encourage him to brush twice per day. After six months or so, I no longer needed to look at the app, or reward him, because internal motivation had kicked in, and the habit had became solid.
A Little Overboard
Dave has become obsessed with brushing his teeth twice per day. He knows that, if he brushes after midnight, the app will record it on the following day. But he doesn’t have a good grasp of when midnight is. He is sometimes reluctant to go out in the evenings because he worries that he won’t get home in time to brush his teeth, even though any activity he would do in the evening would not go past 9pm. One time, when he went out with friends after work, he was so worried that he would not be home in time to brush his teeth that he took the toothbrush with him!
We also ran into difficulty on one cross-country flight after a visit with his sister. The connecting flight that would take us home was delayed, making it impossible for us to be home before midnight. But Dave’s toothbrush was in his checked luggage! It took a lot of effort to calm him down and encourage him to accept that the world would not end if he skipped brushing his teeth for one night.
Dave doesn’t often get cavities anymore.