On Monday, our sweet Nater Tater will be admitted to a hospital and put under general anesthesia in an operating room to get his teeth cleaned. While he’s sleeping, he’ll also have one cavity (that we know of) taken care of and sealants will be put on all of his teeth to help guard against future decay. More kids than you would think have to go through this but, in Nate’s case, it’s autism at its finest. The whole dental experience is overwhelming for Nate: the bright light, the masks on the hygenists’ faces, that medicinal smell of the office. It just freaks Nate’s freak.
Our whole dental drama started last spring. Up until that point, Nate was a champion tooth brusher. He’d stand still, open his mouth, and let me and Chad get every tooth squeeky clean. One day, he decided that wouldn’t do. Suddenly, it was an incredibly overwhelming experience complete with kicking, screaming, and toothbrush throwing. With the help of his Birth to Three OT Ms. Katy, we started re-introducing the toothbrush in therapy sessions but we were nowhere near a socially acceptable level of cleanliness. Toothbrushing was cited as one of our family goals at our very first PPT and has been one of Nate’s daily programs ever since he started public school. (In fact, it turns out all his classmates could use the practice. So Nate, his classmates, and his teachers all practice brushing their teeth in the middle of the day!)
After Nate turned three, we realized we better get him to the dentist. So we found two practices in Connecticut that specialize in pediatric dentistry and working with autistic kids. The first dental office sent us a kit to help Nate prepare for his first trip to the dentist. It came with a mask and a dental pick for pretend play and a social story explaining the whole experience. The social story made it out to be such a lovely experience. (Click on the picture to see how lovely it should be.)
Instead, our story went like this. Nate arrived at the office and was overwhelmed with the amount of kids in the waiting room, who were playing loud video games. Nate freaked out at the hygienist’s room, which had really cool and colorful chairs. Nate swung incessantly at the hygienist, who couldn’t get Nate’s mouth open. With the help of three hygienists, myself, and the dentist, we managed to restrain Nate to have a look in his mouth. This was done by having each of Nate’s legs straddling my belly as we held him upside down with his head in the dentist’s lap. She managed to get in his mouth long enough to discover a cavity and called it a day. There was no point in proceeding any further as everything could be done under sedation in a hospital. Nate got his treat (and could have cared less) and we were done. Or so we thought.
Two weeks later, we find out that our medical health insurance, which covers the operating room and the anesthesia portion of the procedure, was out of network for this dental practice so we had no coverage. They suggested we contact the other pediatric dentist in our community and go there, as they were in network. (This is when I’m wondering why no one checked before we went through all of this.) The second pediatric dental office had Nate’s records from the first visit but could not book an OR for Nate without doing their own examination. So Nate needed to go through the whole experience for a second time just so a dentist could book an OR. Seriously.
The new dental practice was a little easier for Nate to take in. We went first thing in the morning so no one else was around and we were greeted by a sign that said “Welcome New Friend Nathan!” when we arrived. The office was designed to look like the inside of a cabin and, like the last practice, had video games for Nate to play. He decided to just sit and take it all in.
The visit to the dentist’s office went better, too. Nate was willing to get in the chair (which had a television above it) but only when we were alone in the room. Once the hygienist and dentist arrived, all bets were off. We wrestled Nate into the upside down position, the dentist confirmed the cavity, and we set about booking an OR. Nate scored a water bottle and balloon and we went home.
This was in November. The earliest OR appointment we could get was in January but it was on a date that Chad couldn’t take a day off of work. So our next earliest option was Monday, February 25. Because Nate’s going under general anesthesia he needs to have a physical by his pediatrician, which we completed this week. On the morning of the dental appointment, Nate has to fast. His appointment is at 7:30AM, the first of the day, but we need to be at the hospital by 6:30AM. How we will get through the early morning with no food or soy milk or water is beyond me. But we’ll do it, I suspect, with help from Curious George and Nate’s iPad.
In the meantime, we’ve been continuing on Nate’s toothbrushing program. After about a month or so of the program being implemented in school, Nate suddenly showed a desire to brush his own teeth at home. It’s a very specific routine, which Nate created himself. First, someone has to let Nate into the bathroom. (We keep the door closed otherwise he wants to brush his teeth all the time.) Second, Nate climbs up on the toilet and turns on the light. He gets down and stands on his stool in front of the sink. Someone gets him his Winnie the Pooh toothbrush with rootin’ tootin’ fruity toothpaste. Nate sucks all the toothpaste off of it, brushes his front teeth (sort of), imitates you brushing your own back teeth (sort of), and gets his reward: a dixie cup of water. He drinks the water, dumps out what he doesn’t drink, climbs down from the stool, throws the cup away and runs off to play. Because he’s been so keen on doing this himself, we’ve been loathe to do the two-person upside-down wrestle to really clean his teeth. Instead, we’re keeping it positive and fully realize that there are likely more cavities that will be discovered on Monday. But we feel, for the meantime, that establishing a positive experience is more important and will help establish good habits in the future.
This past Tuesday, there was a huge toothbrushing development at school. At our last PPT, OT was added to Nate’s roster of school services. Ms. Jen (his school OT) wrote to say she finally got Nate to allow her to brush his back teeth! It took body brushing (Nate’s body is brushed with a plastic brush to calm his nervous system), deep pressure with lotion, and joint compressions — but he finally let her do it!!! Jen’s using a special toothbrush (which we bought a case of ) called Dentrust. It’s a three-sided toothbrush that gets the top and both sides of a tooth in one swipe. They’re made in pediatric and adult sizes. Once it arrives, we plan to use this instead of Nate’s Winnie the Pooh toddler toothbrush for better (and faster!) cleaning.
So dear friends, think good thoughts for our Nater Tater on Monday. We’ll post updates on Nate’s Facebook fan page throughout the day. In the meantime, we wish you all good oral health!