Dental Solution - At Last!

I am so glad James recovered from his cold so we did not have to attempt a reschedule his big dental day. It's been a 2-year, nightmare journey to get James seen and his dental health dealt with so that he could keep his teeth.

Long story short -- hygiene and dental hygiene have been an ongoing struggle, made worse by moves, disasters, and years of life crises. The programs and family dentists we'd been using told me, once the pandemic allowed for dental appointments and he was actually in the chair again, that his teeth were so deteriorated his top adult teeth and possibly some of the bottom, would need to be extracted. 

That's 8-10 teeth minimum. He is 17 and has speech difficulties. His jaw will not be fully formed until maybe age 25. 

No. 

Some day I will go into detail about all the calls I made, and how we got sent in circles, but not today.

Enter James' aunt, who got us a referral to a dental group who deals with special needs and works with an anesthesiologist. They are about 20 minutes away. 

5 hours under general anesthesia and a lot of work and money later, all but 1 of James' teeth were cleaned, saved, and restored. They also took x-rays and gave him a fluoride treatment. When the doctor came out and gave me the good news, I kept hearing Etta James singing "At Last".

Dental Quest Nears Destination

So, dental challenges have gone hand in hand with James and autism to make teeth cleaning and appointments constantly on my radar. In fact, dental care issues are a common refrain with parents of children on the spectrum.

When he has younger, I'd have to have him lie down on the sofa, sometimes having to pin him down, to properly floss and brush. When he got older, this became harder to do. Luckily at that time, James did not like sugary things in general. For a year, we shared our house with another family, and James joined in the junior tooth brushing and flossing sessions.

Then came the stressful, distressing, constant changes ... and a new like for Starburst candies and Sour Patch candies. Enter cavities and worse. James underwent sedation dentistry and his first adult molar removal. We moved to a new dentist for older kids and families, and for a time James increasingly tolerated x-rays and cleanings. 

Then it came time for more sedation dentistry. We found a new location for this, much closer to home. Yay, no 3-hour round trip for a day of wait and sedation and wait some more.

Less than a week before his appointment, COVID-19 shut everything down. By the time I could get him in to the dental clinic again, his teeth had gotten very much worse. I am not going into details here - 2020 and the beginning of 2021 saw compressed stress and sorrow really hard life changes and loss over an 8-year period of time explode within the confines of lockdown and a pandemic (plus hormones). I did try to prevent it. I did ask for help, but there was none at that time.

Meanwhile, back at the clinic, less than 10 minutes into the sedation, I was asked in to speak with the doctor. This is never a good sign. The top teeth had deteriorated past cleaning and fillings. The only thing they could do was to pull them. All of them. I asked if some could be saved? Yeeessss, came the answer, but (1) they did not offer endodontics and (2) they either had to fix everything in one go or do nothing. My call. I told them to wake up James, we were not pulling his teeth.

Thus began a quest for middle ground to save James' teeth. 

Again, not going into detail here. Suffice to say there were a lot of regretful head shaking and "not it" responses to my search through dental offices, multi-specialty offices, endodontists, his healthcare, autism agencies, James' schools, past dentists, the Regional Center, and ABA. Lots of tears and frustration on my part, particularly when James' teeth hurt him and all I could get was recommendations for ice packs and ibuprofen. Lots of calling in circles, with agencies and dentists recommending in circles that went nowhere. 

Actually (and worse than nowhere), I made a dental appointment, after explaining special needs, severe dental care needs, and sedation dentistry needs and seeming to get a green light. We were kept waiting, then James took a lot of x-rays, more waiting, for the dentist to walk in and announce he did not treat special needs or do sedation dentistry. This was infuriating as this cost us time, money, and insurance benefits with no dental care or hope of dental care. The 3 referrals given to me went nowhere. The others offered were places I'd already called.

This all changed today. 

My sister-in-law, who has a background in health care/caregiving and has been getting to know James better, was able to talk with her dental specialist and come up with a new referral that can actually help us. Our first meeting was today. We have a dental exam under sedation set for next month, with possibly some work being done at that time. There will be more sessions. It will be costly. But James will have the treatment he needs, not what is convenient for programs or clinics.

Dental, the OR Way

So, oral hygiene and James do not get along. I am not good at getting him on track, because, well, life. Divorce, move, evacuation, deaths in the family, topped with a Really Horrible 18 months of school equals a LOT of dental work, including a back molar that James attacked after being hounded at his new school by one of its top administrators.

I know the drill by now. Talk about impending procedure with James, but not too much. Hide nothing. Remain calm. Be positive and encouraging. Don't think about the aftermath. Lalalalalalalala.

This morning I was up at 4:30. We were on the road about 5:30 and watched the sun rise over the wine country and big city commute traffic back up in the other direction. Checked in at 7:00 and got banded. Called back to pre-op about 8:10.

There we did the change to gown and four sets of review of Med History, surgery goals, and anesthesia plans while he was taped up for O2 saturation and heart monitoring. This staff is good. James downed two oral meds and opted to have the IV inserted while he was awake. It could not have gone more smoothly.

I walked him down to surgery. He was scrolling on the nurse's phone to find a YouTube video to listen to as they wheeled him into the OR room. That was at 10:10. It's 11:40. I have had breakfast, answered emails, and am settling down to wait. I figure I have another 45 minutes to go. I'll keep watching the OR board and think positive.

And: I have registration paperwork to fill out. A better school for James is coming. So thankful for that!

Extreme Dental Visit

James has been seeing a pediatric dentist regularly since he was 3.  For several years, his teeth would get cleaned and checked. While James does not like sugary foods or sodas, he also won't brush or floss properly without an assist. We don't always make sure he does a thorough job, as we are usually exhausted by day's end.

This caught up with James last year: a cavity was discovered. Because it is difficult to get James to sit still for a cleaning and impossible to get him to sit still for x-rays, his dentist recommended sedation dentistry. Because he screams and freaks out over needles and whirring noises by his ears, she recommended general anesthesia (GA) - quote for which was $800, which we don't have.

Turns out there is a special program for kids with issues like James'. We could get it from his health care HMO. Catch: they only offer this in a service area that is over an hour away.

So I did phone consults and health histories. The day before his procedure his Dad took him to the pre-op physical at a facility an hour+ away. I spoke with four different people about GA and James. The week of the procedure, I worked 10-hour days so I could take a day to accompany him to the almost 2-hour away hospital without losing pay. He started fasting 12 hours before his procedure.

We got there early and signed in. James got his wrist bracelet and a number code, so I could track his progress on the Outpatient Surgery Board. We've been here before. What was different this time was that James' number showed no status - not even that of "waiting room," which some others showed. I was concerned about this because (1) James has a history of wandering and (2) I wanted to make sure they knew he was here so they didn't give his slot away as a no-show. It took a few minutes, but I was able to talk with someone who could not find him in the system, even though he'd checked in. Yikes!

Within 5 minutes we were called back to the prep area. I noticed that James' number now showed a proper status and I was assured we were not only on time, we were an hour early. The nurses, staff, and surgeon were all super nice. We had James changed into a hospital gown and up in a gurney in no time. He had his blankets and found Nick Jr., which kept him busy for most of our 2-hour wait.

I had a final GA consult and got some expert help from a nurse to get James to take the initial oral sedation. I checked all the procedures he was going to get with the nurses: tooth cleaning, first dental x-rays. at least one cavity filled and dental sealants. They would also take blood for several lab tests that had been postponed due to James' fear of needles. I gave James an overview of the procedures and told him I would be there with him until he went to sleep and when he woke up.

It was a long afternoon. I had some lunch, read a book, and took some walks up and down the hospital corridors. At last it showed he was being taken to recovery. It took a while, but he started waking up. And he wasn't happy. While the type of GA used made him less contentious, he  REALLY hated the sore feeling from having the breathing tube in his nose and throat. Despite  warnings to his team, James ripped the IV out of his foot. He really hates needles too.

An hour later, a helpful orderly helped wheel James outside. Fortunately I had been able to park so close to the hospital that could see James the whole time I picked up the car and drove back to pick him up. Then we had a 2 hour ride home with James moaning (and occasionally roaring) in the back seat. It took him a while to realize that a tooth was missing (a loose baby tooth). He didn't like that either. Turns out he had 4 cavities. Luckily none of them were serious, but we do need to step up the oral hygiene. I don't think either of us wants another extreme trip to the dentist any time soon.

Different At the Dentist

I didn't tell James that he had a dental check-up this afternoon. That's because lately every time we've driven by the office on our way to the grocery store, he's become distressed and repeated "We're not going to the dentist!!!"

I am not sure where this came from. He started off with semi-calm visits, and then last summer he got freaked out.

It could be the noise from the drills and suction devices, except that we've been watching a Mr. Bean episode with a visit to the dentist and he's laughed at them then.

I blame the seat. He did get very anxious when he was lowered back and down last time. He was very unhappy about that bright light in his face too, despite the technician putting a cartoon on the ceiling screen (the things these kids get at the dentist these days; so not what I had, let me tell you).

The dentist, as usual, was awesome, talking soothingly with him and getting him to climb up finally on the dreaded seat. She then proceeded to do his checkup with a minimum of invasive  tools. I believe she used his new toothbrush, a mirror on a handle, and the room's regular lighting. I held James' hand while she gently scraped away a small area of plaque from his lower front teeth.

The good news is that his teeth look fine and he has no cavities!

I could feel him relaxing, and at the end I thought James would go for some fluoride treatment if I put some on my finger and then applied it to his teeth. This worked so well that the dentist then applied the foam fluoride treatment to his teeth with a toothbrush. Wow! This is great news and another big first -- James has never sat still and let us apply a fluoride treatment before.

This whole visit is a great example of why I love our dentist. James' loud noises and distress did not vex her. She was very calm and positive as she kept moving him forward through his visit. She was willing to try a different way to get him his checkup. And bonus: because so many clients are special needs children, I got the scoop on second grade teachers for next year!


Savouring a melon-y fresh victory in dental hygiene and maturity!

A Day at the Dentists: First Cleaning

Due to changes in dental coverage, we had to split the kids' appointments and arranged for James to come by himself for his first cleaning. He did really well, sitting on the chair and staying on it while it was first raised, then tilted backward.



He gamely sat and had his teeth brushed, and 5.5 teeth flossed. Then he was "Aaaaall done!" I sat by him, holding his hands and trying to keep his wriggling body and thrashing head in place on the chair. The hygienist got in a bit more flossing before calling in the dentist. Result: James has good teeth and no cavities so far -- yay!

The dentist also got in some fluoride treatment before James had truly had enough. I am so glad we can keep seeing her. The entire office has experience with special needs kids and tons of patience. It's also only a mile from our house.

Our secret at home to getting James to brush and floss? We let big sister "help" him. She does it, he wants it too!