As I have briefly (for me, anyway) discussed before, dental visits and procedures are a bit different for Tony than your average kiddo. Portions of the exam and visit routinely handled without anesthetics or sedation absolutely require either of those for him to accomplish them at this time…for our son, his sensory differences, anxiety, ability to comply with safety instructions, impulse control, and risk assessment necessitate their use.

In early April, Tony’s fantastic dental team decided that they would be able to perform necessary cleanings and x-rays at their office under sedation this time, as opposed to using general anesthesia in our local children’s hospital (which was determined to be safest for his previous treatments). This made scheduling a bit easier- special needs children requiring dental work in a hospital often wait months for their appointment.

By contrast, our little man’s cleaning under sedation was scheduled for June 3rd. I was overjoyed and relieved they felt comfortable doing this in-office because I knew we’d have a better chance of getting him in and out of that environment with minimal disruptions. He’s still incredibly terrified of hospitals.

Even though this was a serious upgrade in setting- from both the standpoint of prep required and overall chances of successfully getting him through with the least amount of emotional trauma- success is not as easy as simply showing up.

There was a lot of preparation and planning involved on my part, but I will also have to admit to benefiting from a certain amount of luck and/or blessings, however you want to describe it. Some of the things we succeeded at just as easily could have backfired and not worked out the way I had hoped. Thankfully, everything went amazing. I remain grateful to his dental team and I think they did an outstanding job…I want to acknowledge that first before I launch into an explanation of my preparation plan.

Reading to Tony about upcoming visits is usually the part of my strategy that looks closest to what other families might do, but I have to start much farther in advance. I was dissatisfied with the books I had purchased previously- I had picked books with characters he could relate to, but I felt most of them lacked the realism and detail sufficient to more adequately prepare an Autistic individual. And one of them was so busy and overdrawn I knew that it was visually overwhelming for him, which would get the more important content lost and overlooked. The book pictured at the front of this post, written by Joanna Brundle, was one I purchased to try for this visit’s prep, and it is my favorite for a kiddo with intellectual disability Tony’s age or younger due to the uncluttered pictures and clear descriptions.

We had leftover syringes in a cupboard from when Dickens, a.k.a. Catzilla, was still alive and requiring insulin. I broke off the needle on one of them, so that the tip was flat and entirely unpokey, and used this paired with descriptions of what would be happening as I gently touched both his upper arm (to talk about injections) and his wrist (to discuss IV medication administration). I made sure to talk about how the actual needle would come with a poke and some pain, because he does better if he is prepared for what he’s going to see and experience.

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I added this to continued desensitization with stethoscopes, scales, and dental equipment the month prior to his procedure. Emily did some of this work with me every week, and his fab ABA clinical management team (Stephanie and Cecy) also practiced brief dental exams with Tony during our team meetings using these tools. Adding other people remains important, because we need our sweet son to allow people other than Andy or I to touch his teeth. I also showed Tony some video I found on YouTube of an in-office dental sedation procedure up to the point of sedation.

The Friday before the scheduled cleaning, Emily and I took Tony by the dental office with our stethoscope. We briefly sat in the lobby, talked about the procedure, and Emily and I both took a turn listening to his chest so we could get him used to the idea of staying calm for whatever workup they planned on doing while he was still awake. We talked to Tony for several days about the fact that he would be unable to eat or drink before the procedure.

Now, I have commented before that often it feels like visiting a special circle in hell to be a parent of special needs kiddos who cannot eat or drink before anesthesia. The later in the day the procedure is scheduled, the worse the problems can be. I knew for Tony, we would need to try and do as much preemptive work as possible to prevent a morning of intensely escalated hysterics and self-harming that could undermine the success of the visit.

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This involved wearing him out the day before the procedure and keeping him up as late as possible. Our last activity of the day was to go to his favorite park and play until past his usual bedtime. This is the part that could have most easily backfired…sometimes right now, our little man is up in the middle of the night regardless of how tired he is. If he woke up in the wee hours of the morning or even at his usual time, we would have had several hours of denied requests for food that would have ratcheted up the emotions and behaviors.

As it was, he slept until about 8am. We immediately got him dressed and loaded him up into the car, where we drove around for the remaining time before we needed to report to the office. Tony really likes car drives, and I felt this would have the highest possibility of successfully keeping him from pillaging the cupboards for food or getting really angry about not receiving edibles he asked for. We received an additional piece of luck during our drive: the family scheduled before us canceled early that morning, and we were able to take Tony in just a little bit sooner. Once we arrived at the dentist, he did start requesting food with increasing frequency, and did need me to do a bit of work with him on substitute behaviors for self-harming while Andy was talking to the Anesthesiologist.

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For the cleaning, x-rays, and placement of sealants on Tony’s adult teeth, everything went better than my most daring of hopes. And, I was pleased that there were no cavities and that his dental team feels like this would be a great option for his future cleanings. Although, admittedly, I am hoping in time we can help Tony to tolerate a more traditional cleaning. I was truly grateful to have my honey there, usually it’s just me handling Tony’s medical procedure visits. Andy was able to hold Tony while he was given the sedative injection, and he worked with me at home to keep Tony safe and comfortable. The medications they used made our little man pretty unsteady on his feet for a few hours, so he needed someone by his side at all times.

The bit of time he was asleep did, however, affect his sleep schedule. He was up until 1219am that night giving his room the rowdy rockstar treatment. And it has been a bit of a tough couple of weeks for sleep disturbances, potentially related to his processing of the experience. I would like to publicly thank Emily for patiently covering a fair number of brief midday naps for me so that I could survive all of this. Outside of that, I have never seen Tony this undisturbed during waking hours following a medical procedure.

A lot of work went into preparing for this dental cleaning, and we were aided by a really lucky break in terms of Tony’s sleep the night before. However, without this much effort, there wouldn’t have been enough luck to scrape by with and acheive so positive an outcome.