Cleaning, Filling, and Straightening the Teeth of Autism

Going to the dentist can be very stressful for people with autism. The noises and smells, the poking and prodding, the bright lights that shine in your face, while you are tipped back in a chair that changes heights, can all be over stimulating for sure. We went this week and Tate got his teeth cleaned. He is finally tolerating it all very well and I can give most of the credit to the magnificent dental hygienist who cleans his teeth and a team of dentists who are so patient and kind.

Tate’s siblings went for a “happy visit” to our dentist when they were about five and the dentist just sat them in the chair and counted their teeth. After that, we would start going regularly for cleanings. Tate’s first visit did not go well. He was uneasy in the chair and panicked when it laid back. He would not hold his mouth open and gagged anytime the dentist tried to put anything in his mouth. I was not surprised. I wondered if he’d ever be able to see a dentist and what we would do in the event of a cavity. For that matter, how would I know if there was a cavity? Tate did not tell me when he was hurting. He did not have the ability to communicate to me when he hurt. He often had terrible ear infections as a toddler but I never knew until there was a fever. It was always a guessing game for me. Sometimes I took him to the doctor suspecting an ear infection, and there was nothing wrong and sometimes the doctor would say, “OUCH, he must be in so much pain!” And, Tate never said a word or indicated to me that he was in pain. But I was talking about teeth…

I was able to brush Tate’s teeth at home but usually had to get him in a headlock to do a very good job. I did not accomplish the headlock and the good job every day. If I handed Tate the toothbrush he would rub it on a couple of front teeth, spit, toss the toothbrush toward the sink, and call it done. He actually does not do much better than that now, at age 12. I cannot still get him in a headlock and I have to stand on a stepstool if I am going to help him these days. He is so tall!

That first time in the dentist chair at age five, was a disaster, but all was not lost because of an amazing dentist with some great ideas. The dentist sent us home with a little mirror on a stick and told me to “play” dentist with Tate. He told me to get a sturdy chair and practice reclining him in it and putting the mirror in his mouth until he could tolerate it without gagging. I did that several times over the next few months and Tate became tolerant of it. The next trip we made to the dentist went very well.

HOWEVER, the first time Tate had a cavity we were back to square one. I believe he was seven years old. The visit to try and fill the cavity was disastrous. So, we rescheduled and arranged for an anesthesiologist to put Tate under so the dentist could fill two cavities and get x-rays. It was expensive but it did not look like there would be any other way.

Getting that filling was quite an experience. He had no idea what was going to happen and not enough receptive language for me to really explain it to him. When we got to the dental office I told Tate he would be taking a nap in the dental chair and I pulled out a new DVD and his little DVD player. Tate was elated. He climbed right up into the chair and started his movie. They gave him a shot almost right away. It must have hurt ‘cause he hollered, but he did relax right away. He did not even flinch for the IV. They wrapped him tightly in a blanket and taped his eyes shut and then it was time for me to leave. I hated walking out of that room. I was banking on him not remembering anything but later that day he told me several times that he had bad dreams while he took his nap at the dentist and “they moved his teeth all around.” It probably felt like they had. They filled two cavities, removed two baby teeth, put sealants on his molars, took xrays, and plaster impressions for an orthodontist. They did it all in 90 minutes. Coming out of the anesthetic was rough. He kept bursting into tears and saying, “I’m so sad.” He insisted I kiss him so I kissed his cheek. He said, “No! Kiss my mouth.” His breath about knocked me down but duty called. HA

The plaster impressions they took that day were sent to an orthodontist. Tate’s teeth were actually so crowded that some were coming in behind others, but I thought any notion of Tate being able to handle braces in his mouth was absolutely ridiculous. I did go to a consultation with an orthodontist who assured me that he could put braces in Tate's mouth, move his teeth, and do it without overwhelming Tate (or his mother). We found that the orthodontist was just as incredible as our dentist. Tate was amazing. He did very little complaining and handled much more than I ever dreamed he would be able to. We went slow and did a minimal amount of work on the teeth but it made all the difference. The braces were worn for about a year, while Tate was in second and third grade. His under-bite was fixed and his teeth do not overlap like they once did. We found that wearing a retainer is out of the question though. Tate can’t even hold it in his mouth without choking and gagging. We hope to go back in the future for more work on straightening everything up further. 

2010               and                2011

Tate had a cavity filled in the dental office without anesthesia a couple of years after that first cavity was filled. He did quite well and I thought we would be fine from there on out. However, we tried to get a cavity filled in the Spring of this year and the drilling was just too much for him. Tate tried so hard to cooperate but he could not. He kept closing his mouth and putting his tongue in the way. He asked for a drink over and over and gagged a lot. The dentist tried everything he could but it was not going to happen that day. So, we rescheduled and called in the good old anesthesiologist again. The experience was very similar to the first time except he only had to be under for about 20 minutes. This time, upon awakening he did not cry. He just said, “I love you, Mom” about fifty times which has become something he does when he is stressed lately. I don't hear it often enough and I do love hearing it but wish it was not usually under duress. 

The other day when we went for the cleaning? They suggested we begin using a Sonic toothbrush. I haven't worked up the nerve yet to suggest we push something noisy and wiggly in Tate's mouth. School starting back up was stress enough for one week. I guess I had better practice my ninja moves and my headlock holds and break out the electric toothbrush soon though.

I recently blogged about our last trip to see a medical doctor. You can read that here: Immunizations 

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