Oral Hygiene

My son does not believe in oral hygiene. Even though he has an intellectual understanding of the necessity, on some gut level, it is something that he thinks should just be eliminated. His interpretation of the nightly routine is an agonizing session of sensory overload. When he was two we let him pick his toothbrush, toothpaste and allowed him to brush however he desired. When he got to the point that was not overwhelming we started brushing his teeth a bit ourselves, with just a regular toothbrush. Finally at four we began touching the electric toothbrush to his teeth for a second or two and gradually building up to a minute of brushing. I am now able to brush and floss his teeth every night, even though flossing creates white knuckles and facial expressions that are usually only seen on torture victims. He will brush his own teeth in the morning, but only with a manual toothbrush. Trips to the dentist have been an exercise in extreme patience on the part of the dental staff. When my son was younger, he usually refused to open his mouth, let alone submit to a cleaning and exam. The hygienist would wait and wait as I tried all my tricks to get him to submit. At one point my dentist suggested we might want to go to a pediatric specialist that could put him out to do the exams and X-rays. I decided not to go that route. Instead, I increased my efforts to help him be comfortable with the process. We played dentist. When I brushed his teeth, I had him lay down and I gave him fake exams and hygienist cleanings. He finally got to the point where he would willingly sit in the chair and open his mouth for an exam, but I had to sit next to him and hold his hands so he wouldn’t grab or push the hygienist’s hands away. As he got older, the check-ups got better, he would open his mouth and let them do a quick cleaning, but X-rays were still problematic. He flat out refused because he felt that they were dangerous. Last year, for the first time, he agreed to let the hygienist do X-rays, until she actually tried to put the too large, uncomfortable contraption in his mouth. After several tries, my son burst into tears and jumped out of the chair. I decided the X-ray wasn’t worth it and we opted to go another year without an X-ray.

Consequently, I wasn’t prepared for the problem that appeared at the next visit. I had a moment of pure dread when our dentist proclaimed that my son had a tooth that needed to be extracted. It had cracked, (nightly anxiety induced teeth grinding I suspect.) The new tooth was ready to come in, but the cracked one wasn’t loose enough to come out on its own yet. So she recommended we make an appointment to have it extracted. My son told the dentist he would pull it himself.  She told him that he could try wiggling it every night and see what happened; but her parting words to me were, “Don’t let it go too long. If it abscesses, it could get ugly.” On the way home I told him that the dentist was concerned that the tooth could abscess if it didn’t come out pretty soon. I casually suggested that we should just go ahead and get his tooth pulled. Armed with our dentist’s suggestion that this could be a DIY project, he replied, “No Mom, I’m not doing that, I’ll pull my own tooth out.” I started to work up my arguments but, in truth, I didn’t want to go through an extraction either. So he wiggled and I waited.

In the vain hope that he would actually pull it off, I let it go too long. Two months later, while brushing his teeth I discovered the dreaded abscess. Filled with guilt and worry, I dug out the referral to the oral surgeon.  They agreed to see us first thing the next morning for an emergency extraction. I spent that evening trying to prepare my son for the visit. I explained to him how dangerous an abscess can be, what they would need to do, and that it would be over pretty quickly. We researched on-line about abscesses and tooth extractions. I tried to reassure him the best I could, given the circumstances. He was nervous but seemed to understand the necessity and was willing to get it done. When we arrived the next morning, I pulled the doctor aside and gave him a quick run-down of my son’s issues. The doctor reassured me that he had lots of experience with kids like my son. “Don’t worry, everything will be just fine.” I had my doubts, but I was willing to give him the benefit of positive thinking.

His twin sister and I followed him back into an exam room. The nurse was able to successfully talk him through standing still for a panoramic X-ray! Hurray, we were off to a great start. Then they took my son to another room next door. I left his sister to wait and went with my son. The doctor sat my son down in the chair and proceeded to explain everything they needed to do. He was kind and reassuring. He told my son that the extraction would take less than a minute and wouldn’t hurt because the nerve would be deadened. Viola! My son opened his mouth, everything was looking good. Then the doctor told me I could go back and wait with my daughter. My first reaction was that I should stay, but the other room was right next door and I knew his sister was worried. I told my son that I would just be right outside and the nurse would come and get me if he needed me.

About a minute later the nurse came and got me. I walked into the exam room to find my son wild-eyed with panic, a male nurse holding his hands, and the doctor with a very large shot needle hidden behind his back. When he saw me, my son tore his hands loose, ripped the cotton packing from his mouth, and jumped out of the chair. “I don’t want a shot!” he shouted. I hugged him and tried to calm him down. I reassured him that the shot is just a quick pinch and it would deaden the nerve so it wouldn’t hurt when they pulled the tooth. I tried to get him to sit back in the chair. I promised I would hold his hand and stay with him. He wasn’t having any of it. I could tell the doctor was getting impatient. Finally the doctor asked me to step outside. He told me that he had other patients waiting and wouldn’t have time to do anything more that day. He said he wanted to put my son on antibiotics for the weekend and then reschedule on Monday. His plan was to give my son a sedative he could drink, and once he was semi-conscious they would give him the shot and pull the tooth. I asked the doctor to tell me everything they would do, step-by-step, so I could prepare my son and give him time to process it all.

On the way home I told him everything the doctor had told me. I reassured him how easy Monday would be. He would come in, drink some medicine, get sleepy, and when he woke up it would all be over. My son just kept repeating that he wasn’t ready. I’m ashamed to say that I scolded him. I was frustrated that we weren’t able to just get it taken care of that morning and afraid of what the abscess might do. I was worried about the extra expense of another visit and prescription. I told him that he was old enough to take responsibility for his health and that sometimes we have to do scary things to make sure we stay healthy. My son started to cry and said he would cooperate on Monday. He said he hadn’t been able to do it that morning because everything was unfamiliar and happened too fast. Then I felt even worse. I had let my own fears and frustrations get us into a situation that was doomed from the start. I added to the problem by not following my instincts and staying with him. When we got home, I gave him a hug and told him I was sorry for being cranky. I reassured him that we had all weekend to prepare and by Monday we would be ready.

Finally, Monday morning arrived. Despite the early wake up and not having food or drink for 8 hours, my son seemed remarkably calm. My stomach was in knots and my head was pounding, but I hid it well as we drove to the doctor’s office. We had a nice discussion with the receptionist about the merits of various chess moves and then headed back to the exam room. My son seemed ready to go. I was even starting to feel my blood pressure decline. Then the doctor walked in with a shot needle in his hand. He turned to me and said, “You know, I have been thinking about this all morning and I really feel he would do better with a shot of ketamine.” My son shot out of the chair, “I thought I was going to drink something to make me sleepy,” he shouted, panic rising. I stepped toward him, “We have to do this, your tooth is abscessed and it can be really dangerous if we don’t get the infection cleared up!” Too late for reason, he bolted for the door. I grabbed him and tried to pull him back into the room. By now he was wild-eyed and struggling like a trapped animal. No amount of calming or comfort was going to help.

The doctor motioned to a bed in the hallway and I dragged my son to it. A nurse helped hold my wild boy down while the doctor quickly administered the shot. As the medication began to take hold, his fighting slowed and he began to droop. I rocked him and fought back the tears. “I’m sorry we had to hold you down, but you have to get this done,” I told him. He looked at me with panic in his eyes, fighting the anesthesia. The doctor patted me on the shoulder, “Don’t worry about it thing. It will all be just fine.” I wanted to shout at him, “No, it won’t be just fine! I have betrayed my son’s trust. I will be dealing with the fall-out from this for a long time!” Instead, I smiled numbly and nodded. While we waited for the anesthesia to take effect, I tried to comfort my son. The doctor told me that he was in a dissociative state and even though he seemed conscious, he really didn’t understand what was going on, “He’s not really hearing anything you say. You can go to the waiting room, this won’t take a minute.”

“But I promised him I would stay with him,” I told the doctor.

“I’m sorry, I don’t operate with parents in the room,” he replied as he firmly escorted me out the door.

I sat in the waiting room feeling sick about my role in this mess and sad for what my son was going through. About fifteen minutes later, the nurse came to get me. The smiling doctor came out of the operating room and told me that everything had gone very well. “Don’t worry about a thing, he won’t remember any of it,” he assured me.

I brought my groggy, nauseous boy home and put him to bed. After a few hours sleep he woke up, glared at me and said, “I was conscious and I remember everything.” He then proceeded to give me a blow-by-blow account of the entire episode. His recitation ended with the heart wrenching words, “You are my Mom, you are supposed to protect me!” He was conscious and he did remember everything. I wished I had a video of that conversation to show to the doctor. I want to tell him that he should really listen to the concerns of parents with special needs kids. We know our kids better than anyone else and we work very hard to try to ensure a successful outcome. I’m quite certain that from the doctor’s point of view it was a successful surgery.  I‘m sure within a few days he will have forgotten the incident. However, I doubt my son will ever forget it!