Tuesday, 22 April 2014

A Surprise at the Dentist

The dentist is probably the worst place you can imagine to have to take a child with autism.  The same is true with many typical kids and even some adults.
If you talk to older people about their childhood experience at the dentist, before high speed drills and the like, it was more like torture.  Times have changed, it is not just better equipment, but (some) attitudes have changed.
For someone with autism, going to the dentist should not have to be a terrifying experience; people with autism actually have a high pain threshold.  True they have lots of sensory issues, but it seems to be the fact that they do not understand what is going on, that is the real problem.

A better way
There exist some very child-friendly dentists who are more than a match for a child with autism.  They can achieve what seems impossible, a calm and cooperative dental patient, who will sit back and let the dentist do his work.
One such dentist has even made a training program for other dentists to show how to achieve this.  In effect, it is a very practical ABA lesson for dentists.  The dentist is called Dr Tesini and his program is called D-Termined and he is indeed determined to succeed.
Here is clip from Youtube.

 Dr Tesini even teamed up with an autism charity to make a DVD of his method.  It used to be free but now costs $13.
Here is a link to the foundation that funded the program.
I acquired the DVD 6 years ago, but could not find any local dentist interested to apply the method.
The method is great because once the child has got used to the nice friendly Dr Tesini and gone through all the steps, he is apparently then able to “tolerate” the less friendly regular dentists, for future dental visits.
In some special schools they have a dental chair for the kids to practice on, which as another great idea.

Monty at the Dentist Five years ago

We have a nice friendly dentist, but I think he felt from the start that working on a child with ASD was going to be too much.  We made a few very brief visits when Monty was four and five years old and even brought along the Dr Tesini D-Termined DVD,  but this really just showed how difficult a task lay ahead if any actual drilling and filling was required.
It was never really clear whether Monty had toothache or not, since he could not verbalize the problem.  So sometimes if he was behaving aggressively, we might think that he had tooth problems.  Later things would calm down and we would forget about teeth and dentists.
In the end I had to find a practical solution.  Were we live there seemed to be no good solutions;  generally people with ASD just have rotten teeth.  A State hospital clinic did in theory offer dentistry under full anesthetic, but it looks like the hospital block of a gulag and there was a three month wait anyway.  Private dentists are not allowed to give sedation or full anesthetic, for safety reasons, just local anesthetic.
Eventually I found a solution in a neighboring country where you could have dental work under general anesthetic, in surroundings that did not look like a prisoner of war camp. Aged five, Monty had his four fillings and one extraction under full anesthetic with a German dentist and a Hungarian anesthetist.  The first part involves an injection into a vein in the arm, even this little step involved a great deal of kicking and screaming (Monty and his Mum).
So as not to repeat this unpleasant, and very expensive, experience too often, I stopped Monty drinking so much fruit juice and came up with a special tooth brushing regime.
One of Monty’s first words, aged about 40 months was “juice” and so pleased were people to hear him use any word, that juice is what he got.  In fact when he said “juice” he really just meant he was thirsty, water would have been just fine.  The acidity of fruit juice rots milk teeth.  Also, at the start of an ABA program, or even PECS program, there are a lot of edible reinforcers (candies) involved; great for speech, but not your teeth.
The teeth brushing regime involved brushing first with a manual brush and then again with an electric tooth brush.  This way there is more chance of not missing anything.

Monty at the Dentist Five Years On

Having not had any dental work for five years and still not having found a dentist who wanted to learn how to treat a child with autism, I was faced again with the undesirable option of full anesthetic.  I hoped that in the subsequent five years there might be some options closer to home.
While it seems that only hospitals can give full anesthetic, one of the small private medical clinics that also do minor surgery, has started to offer dentistry.  So I thought that if they have an anesthetist available for the minor surgery, why can’t the dentist use him?
A few phone calls later, it did indeed seem to be possible.  It clearly was not something they usually did, but the dentist did not think it was a crazy idea.
So last week Monty, myself and his assistant, who teaches him at home in the afternoon, turned up at the clinic.  Expecting to see an older male dentist with a serious face, I was very surprised to see a small slim female dentist and her smiling assistant.  It was as if we had stepped in to Dr Tesini’s training video.
All happy, smiling and fun, the dentist let Monty play with all the buttons and bits of equipment.  She made balloons out of surgical gloves and generally made friends with her new patient.
Her attitude was “why would I need anesthetic to treat such a nice boy”.  She gave him an examination, with Monty being surprisingly compliant.  She concluded that his toothache was caused by his four rear permanent that have yet to emerge.  One of the five year old fillings in his milk teeth looks a bit poor, but the X-ray showed that it is far from the pulp of the tooth.  The tooth should fall out before the filling fails.
In fact the only intervention is protective fissure sealant on four permanent teeth and ultrasonic de-scaling his front teeth.
I say “only”, but this still needs him to keep still with a drill inside his mouth and not bite the dentist or her to cut his tongue.

So far so good
After six visits, three teeth have their fissure sealant and one more visit remains.
Monty is friends with the dentist and is dancing to the music in the waiting room as he leaves for home.
Who could have imagined such a surprise at the dentist?


  1. It's really inspiring to see that technology has adapted to people with special needs. I agree that it was a nightmare to bring a kid with autism to the dentist before. The good thing is that nowadays, dentists, especially those trained to service kids, also cater to children with special needs; thus, making the whole experience easier for both the child and the parents. :D

    Stephen Malfair @ Dentist Kelowna

  2. Nice story here! I remember my first ever visit to our family dentist! I will not forget that lovely moment.


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