Dental Blessings

This is what Jersey #4 looks like following dental work. The left side of her mouth was quite numb.

(My sister jokes that Slurpees must have healing powers for our family....because that is what the kids are often pictured with after medical and dental procedures. It is funny that they all seem to ask for a Slurpee after a procedure where they have had to have empty stomachs. They drink them down quickly, rehydrating, and settling their tummies too.)

Taking Jersey #4 to the dentist this morning was a huge deal.

Huge.

I was very worried about her cooperation.....or, really, her lack of cooperation.

We have a fantastic pediatric dentist. This is a good thing too, because we also have terrible teeth genetics. So, we spend a lot more time with our pediatric dentist than most folks experience. Our pediatric dentist really wants the kids to learn healthy teeth care, in a positive environment. His office is kid-friendly in its design and decor. There are prizes, gifts, and goodies a plenty there. The hygienists are the most patient people I have ever met. They take great care to show the kids all the tools and instruments and sounds before they experience them in the big chair. The hygienists are also very organized. They have every single tool ready to go, so that the dentist can work as efficiently as possible. The level of teamwork among that staff is incredible.

When a very young child needs dental work, our dentist will do the work at a day surgery clinic, with the child under general anesthesia. This is what we have been through with both Jersey #2 and Jersey #3, for different reasons. The benefit is that the child does not remember the procedure, and does not develop a fear of the dentist. For older kids, who can be more cooperative, there are levels of conscious sedation medication to help them relax and be drowsy for procedures.

Jersey #4 was 3 years old when her dental needs were discovered. She had a fairly large cavity that needed attention, as well as a smaller cavity on a different tooth. The good news was that she only had the two problems to deal with, not a whole bunch like her siblings. The bad news was that she was still too nervous to sit in that big chair, even after visiting twice for cleanings.

The dentist recommended attempting to treat her in the office, instead of the surgical option. It is better to avoid general anesthesia if we can help it. Her age and ability to cooperate was there, but her willingness to cooperate was the concern. The dentist hoped that giving her sedation medication prior to the procedure might help with her cooperation. I agreed, because we want the least invasive methods possible.

The problem is what to do if she refuses to cooperate in the midst of the procedure. If the dentist was already started into the work on her teeth, she would need to be restrained so that he could complete the work. This was something I had to understand and agree to before choosing the in-office procedure.

Restrained. That is the big topic that comes up in any conversation about pediatric dentists. There are a few in town who are known for having parents authorize restraints, even for lack of cooperation for cleanings. The idea of restraining a child to a dentist chair brings up images of torture, as well as a lasting fear and hatred of going to the dentist. I have always advised my Mommy friends to avoid any dentist who does not let you go back with the child for cleanings and procedures. And to avoid any who require you sign a restraint agreement from the beginning of a routine cleaning visit. I have never thought restraining a child at the dentist was a good idea...

...Until I was put in this position of restraint versus general anesthesia, for minimal dental work. Wow. Just when I thought I knew it all, I am always thrown for a loop.

Ultimately, I agreed to attempt the in-office procedure. I agreed to the sedation medication in advance of the procedure. And I agreed to allow Jersey #4 to be restrained, if she refused to cooperate in the midst of the procedure.

I rationalized the decision with the fact that our family has been going to this same pediatric dentist for over 6 years. This is the first restraint recommendation he has ever mentioned to me. I know his goals of the least invasive, least traumatic procedures possible. Trust is already established there. I inquired about the method of restraint, and learned they would use a blanket to wrap Jersey #4 like a papoose, so that her arms could not flail. The hygienist was also quick to point out that they would work very hard to re-earn Jersey #4's trust, so that she did not despise going to the dentist. I was glad they had a plan to help her overcome the trauma of such an experience. Unfortunately for Jersey #4, this decision was being made a month prior to Jersey #2's open-heart surgery, so being swaddled like a papoose in a dentist chair, just did not have as much traumatic weight.

Knowing that Jersey #4 is not a very forgiving child, my biggest fear was that she would develop a hatred for going to the dentist. I did not want that for her. That was the most troubling side effect of the entire decision.

I tried to prepare Jersey #4 in advance. As I went over her teeth...brushing them myself, after she brushes them first....I talked to her about going to the dentist and sitting in the big chair. Three days before her appointment, I started explaining to her that the dentist needed to fix her tooth. I started to prep her for what to expect. I prayed for cooperation from her.

When I woke her up this morning, I told her it was time to get dressed and go to the dentist. I assured her she was a big girl and she was going to do great sitting in that big chair and opening her mouth. She replied, "No, not today."

We are doomed!

As we drove over there, I debated with myself as to how to approach this boundary with her. Do I go the positive, cheerleader, encouraging route? Or do I go the firm, this-is-the-limit-and-you-must-obey route? Jersey #4 is a VERY strong-willed child, so I had to pick my battle carefully and prepare for war. She would pounce on any wishy-washy response from me.

I chose the cheering path. I approached the entire experience from the perspective that I believed she was a big girl and she could handle this. It is the same approach I take with Jersey #2, for all of her medical experiences. It can be hard, because I am sensitive to their fears, and I want to cry for them. But, any catering to their fears gives them the false impression that they can get out of the procedure, so that makes the battle worse. So, I stood firm in my position that Jersey #4 could handle this. I praised her and encouraged her every step of the way.

I took a step back and let Jersey #4 interact with the hygienists first, so that I could gauge her level of cooperation. Much to my surprise, she was a trooper. She answered their questions, and followed their instructions during all the vital signs readings. I praised her for being such a big girl. She picked out a movie to watch, took her medicine (looking at me to make sure she really had to drink all of it), and settled right in. The medicine worked great on her, and she became quite loopy about 10 minutes before they called her back for her procedure.

With her new-found boldness at the dentist, I let her follow the hygienist down the hall, and I walked behind them. I did not direct Jersey #4 at all. She was listening to the hygienist and following all the instructions. She climbed up into that big chair, no problem. I praised her and covered her with her blanket, and handed her the stuffed animal we brought. I scooted my chair close by her side, and patted her leg and told her I would be right beside her the entire time. She relaxed and cooperated just fine.

The hygienist asked me if Jersey #4 was always so polite and cooperative. I nearly fell out of my chair laughing at that description. Um, no, quite the opposite. I shared that this was the first time Jersey #4 had ever even sat in the big chair, so I had been preparing for her to be restrained. The hygienist was as surprised by my answer as I was by her question. Are we even discussing the same child?

Jersey #4 was cooperative for the dentist too. He was very efficient in his work, so it did not take long. All of my worries about restraining her were unnecessary. She didn't even so much as cry or complain, so restraining her was not even considered. There was only one time when she did not respond to the dentist's request. He reached over and turned down her level of laughing gas. She was not responding to him, because she was falling asleep. When the procedure was over, they continued to give her pure oxygen to help wake her up. She took a nap in the chair instead. She even snored. She was quite relaxed. When she woke up more, she picked out a couple prizes. She was still fairly loopy as we were leaving, so I had to hold her hand as we walked out to the van. She has not taken many medications in her 3 years of life, since she is a pretty healthy kid, so those meds had a strong effect on her.

I praised her heavily for how good she did at the dentist. The dentist and all of the hygienists praised her too. She left with a big smile on her face. It was obvious she was mighty proud of herself. I am so proud of her too.