*DISCLAIMER: I am not a Dentist or medical doctor. These are my stories and opinions not to be used without a professional opinion on your specific situation. The following linked article below was the most balanced for giving information on wisdom teeth procedure options, medications, tools involved and aftercare. https://askthedentist.com/wisdom-teeth-removal/ Also it covers why it is best to choose LOCAL Anesthetic if possible. After I read this article I also phoned in about what tool they were using to avoid an air embolism. I would have cancelled and rescheduled if they did not have the appropriate tool. It's tough to do sometimes but it is better to be difficult but advocate for what is best in the end.*
(Pictured; her area set up and a paper of all research summed up on do's and don'ts for myself to remember upon arrival home.)
To which I replied, "Our family has a fraught history with general anesthetic plus the risks compared to local are immense, recovery takes longer and if it's possible I would prefer to do the surgery without her going under. What are our options?"
The dentist looked shocked, "Well, most people wish to be under and most dentists prefer to perform under general because it's easier not to deal with the patient."
I am known to be a bit of a pain in medical/ health situations. I found the one Dentist in our area who would take on my daughter with normal freezing without any other drugs involved. Including the "forgetting drug" which we have also had a history with. My daughter had it when she was five for a procedure and still recalls the worst parts yet her memory can not fill in the gaps, so she had nightmares for years. The same thing happened to me in one of my procedures. Taking that drug depends on what situation it is is used for but both of us would rather remember the dental work instead of have our brains hooked on what is missing.
Two months later we walked into our normal dental office, she was frozen and three hours later she was back home. They had to freeze both sides separately which took longer, but at the time it felt fairly quick. Both my husband and I accompanied her. They wanted us out of the room as soon as the freezing kicked in but I refused for both of us to leave. My daughter was already losing it and tears began running down her cheeks. The hygienist was firm on both of us leaving, but then the Dentist arrived. "What's wrong sweetie?"
"I want my parents to stay." She answered.
To which I inserted, "I understand it is crowded in here. If you are worried about either of us passing out or causing trouble that is not going to happen. How about I go wait in the waiting room but my husband stays? I think you will have an easier time with her overall if you allow one of us here."
In my mind I knew that my husband had already established a charming relationship with this Dentist. I was fully aware she liked him over me. I also knew that men are more accepted in high intensity situations- unfortunately. Even though I was more equipped to deal with it, I felt it was worth the sacrifice. It was funny though because the hygienist had to come out four times to ask me questions because my husband did not know allergies, previous information ect. However, he did amazing at being with our daughter and that is what mattered in the end. I honestly felt more out of control waiting out when I am used to being in with my children for everything but it all worked out. It was nice to skip the bloody bits I suppose.
Before the procedure my daughter did have the beginnings of a meltdown. We had prepared her for the situation. We had equipped her with all the information on why it had to be done, what the risks were for the procedure and what the risks would be if she was put under with general anaesthetic. We warned that it would not be pleasant but she would not feel pain, only discomfort. She chose to also avoid general.
She was quite brave but at the point of her meltdown I did have to step in. I save my "harsh mommy" for dire situations. My children know when I talk in a colder detached tone that I mean business. She was beginning to panic and my response was, "Nope. You are not going to cry right now. I can promise you that you can cry as much as you want in a few days but getting stuffy when you have dental work is not going to help you. I promise we are doing what is in your best interests. If we could choose not to do this- we would. If I could have found ways around this you KNOW I would have. You know how I work. As it is, this is the best case scenario risk wise and recovery wise. I trust this dentist. I trust you. You can trust daddy and I. If you cry and melt down now they may refuse to work on you. I need you to be brave. We do not want you to get half way through and they ask for you to go under in the emergency department. Sometimes we have to do tough things. We have no choice but to get through. You know you can have years of consequences in terms of behaviour, gut health and side effects with General Anesthetic and all that goes with it. Especially being on the Autism spectrum. You are going to do this. I have faith in your strength. We will pamper you and take care of you after. Breathe. Concentrate on a favourite place like the beach and build it up in your mind. Listen to your music and you can tell them if you feel any pain. They also want you to be as comfortable as possible."
As I was saying all of this she began regulating her breathing. Each time I saw her begin to quiver I would say "Absolutely not" again. Did I want to cry too? Absolutely. Did I wish I could allow her to express her full range of emotion? Of course. But I knew a stuffy sinus cavity would make all things worse. They also gave her the option to opt out of the second one if it was too much. I turned to her and said, "Honestly, you would have to do recovery all over again if you don't do the second one now. If you absolutely feel you CAN NOT go on I will respect that but if you can make it through two I need you to make it through two. I understand what I am asking is not easy but the other option is tougher. I know what it is like as I have had a 5 1/2 hour root canal due to many issues going wrong but when I was given the option to stop I realized there would be more complications and have to re start another day so I did it. If you truly can't- you can opt out. But I need you to try even if it sucks." To which she nodded and did, even though she did not want to.
Did I freak out inside when I signed the waiver of all that could go wrong? Yes. My husband knew from my raised eyebrow that I was freaking out inside but she had no idea. Afterwards the Dentist said, "She did better than many adults. We were so impressed. She really has control over herself. Thanks to her attitude and relaxing techniques we were able to proceed much quicker than usual once the freezing set in."
We were so grateful for the Dentists abilities, confidence, and talent. I brought Valentines chocolates to reward the Dentist too as I knew that it would have been easier for her for our child to be drugged. Luckily, she was from Eastern Europe where the mentality on pain, sheltering children and necessary protocol is slightly different. She was brisk and to the point but these attributes worked in our favour for this procedure.
Both the Hygienist and the Dentist wanted to prescribe Toradol (click) for pain. Again I refused. I understand there is a time and place for different treatments, pain killers ect. I have been on Toradol. I know the side effects and how it works. I will not risk a stroke for medium pain. I am well versed on most meds due to my fraught history under aged 25 with the medical system. At that time I took anything and did anything I was asked. Skip forward ten years of therapy later, armed with information, experience, natural methods and knowing my own body and this time I asked for another option. I'm used to being the pain in the ass. I try to be kind about it and very grateful when professionals work with me.
They prescribed T3's. When I went to the Pharmacist, he told me to start her on extra strength Tylenol instead and work up to T3's only if needed. At the Dentist I was told the opposite. I chose to trust my Pharmacist when it comes to medications and the Dentist when it came to aftercare. I bought the T3's in case but we never used them. ( Read this article for why I chose this method.)
Let me be clear. If my daughter was in immense pain I would have had no issues giving her stronger pain meds. I also gave her the choice. I explained the difference between T3s and Tylenol. The side effects and my experiences of massive stomach issues and hallucinations. I told her she may not experience any of that. Or that if she does she may prefer it over pain and that it had to be her choice. She asked to have the T3's available but tried extra strength Tylenol first. She did not want to risk more nauseous on top of what she was already feeling.
Aftercare included one of us being with her for the first 24 hours constantly. We put on an icepack tied with a scarf every 15 minutes religiously until bedtime and then immediately upon waking. She lived off of broth for 48 hours then worked up to smooth yogurt and hummus. She had regular Tylenol for the first 30 hours but then she asked to only have it at bed time. I also lightly applied aloe vera mixed with vitamin C and moisturizer on her jawline and mouth twice a day to promote healing and combat dryness.
I had read about "Dry Socket." Perhaps I was overly protective but I would not let her do anything except be elevated on the couch or go to the bathroom. She was not allowed to have her head below her heart for three days. The literature on rinsing with salt water is mixed but I chose to go with the cautionary tales of not allowing her to swish and rinse until the 6th day. Instead, since she was on broth and yogurt for three days she was allowed to gently brush her front teeth on the evening of the second day. I would not allow her to swish and she had to let the water dribble out. We also put barely any toothpaste so she could swallow it if she needed to. (Again, read THIS article for everything you need to know about NOT using straws, sucking on popsicles or swishing for at least three days.)
We are on the fourth day. Yesterday my daughter said to me, "Mom for the first few days I just wanted to cry but I remembered what you said about being stuffy. I felt a bit sorry for myself but now that I can talk and tell my story, I realize that it was as traumatizing as I originally thought but I did it and it wasn't worse. In fact, I am quite proud of myself. I can't believe I did that. I now realize I can do other things in life. Maybe it helped me understand recovery for if I have babies a little bit better although I know that is different. Also, now I know what to do with my kids. At first I was mad at you but I think sometimes you make me a bit mad on purpose so I am not sad."
I laughed, "Yes, my sweet, smart girl. Inside I sometimes feel like I am breaking but I need to do what is best for you. I'd rather take your anger then see you lose it and miss an opportunity for easier healing."
Honestly? I did almost break down myself later when she was ok. My husband had to hold me as I was so proud of her that I felt overwhelm. Years of therapy for both her and I paid off in that moment. To which my thankfulness was tenfold. I am DREADING my boys turn as I know it would be worse with four teeth out (my daughter didn't need the other two out.) I had horrid experiences with my surgery. It took me six weeks to recover. I bled internally, reacted to the meds, and it took 8 days for the general Anesthetic to clear my system and stop affecting me. Unusual responses are my typical. The running theory is due to autoimmune disease and leaky Autistic gut but it was terrible. My nose bled constantly and I bruised so badly it was two months before my jawline looked normal. Which is why I did everything in my power to make sure my daughter's experience was the best it could be.
Notes on Autism and The Dentist:
* In general Autistics spend more time at the Dentist. They also have unusual reactions or Atypical. For instance, I take triple the time to actually freeze but once frozen, it takes me triple as long to clear the freezing from my system. Thus the Dentist has begun to use 1/4 of the amount for freezing and asks me to come in half an hour earlier to begin the process. He says I have extra nerve paths and crossed wires. He has to freeze at different points to get the paths he wants which is baffling to him but we've worked out a system after years of treatment.
*My Autistic son had dental work done 22 times in a period of 16 months when he was age 4/5. This gave us both a lot of experience. He did meltdown 2 out of the 22 times. However, the Dentist, Hygienist and myself were a great team. It is important to get a team who either understand Autism or are willing to be educated on it.
*Being firm, kind and communicative are crucial. Autistics often understand higher amounts of medical information. But they get confused when it comes to reactions, interactions with other people and emotions. I trust my children with higher amounts of explanations. Even at aged 4, I would tell them WHY they had to do something. I read them articles even if it went over their head. I assumed competence. However, I also made sure that there were strategies in place to catch them in moments they needed support. I understood that with capability there are also disabilities. I knew this from my own experiences.
*Rewards are important. Not as bribes (although sometimes necessary) but as true gratitude for their bravery. I told my children not to expect anything but if they did their best I would try to buy them something appropriate for the situation. Verbal words of affirmation were always piled on them afterwards. I would re iterate how brave they were, how kind they were to their caregivers, how amazing they did with the situation and how lucky they were to have health care and a team that cares about them. In tougher instances I made sure they knew of the reward beforehand and talked about it during the tougher parts (My youngest has had several tooth extractions. He has only had one of his baby teeth out on it's own. His teeth just don't fall out. It's a smaller version of a wisdom tooth removal. It is easier but they do put a chemical in to loosen the tooth before really pulling to get it out.)
*I also made sure my children were part of giving their caregiving team gifts later. They would help pick out the plant or card for the Dentist or Hygienist. I wanted them to reframe some of their experiences in the lens of gratitude. To see a different perspective that someone who may have caused slight distress in a medical situation was also fixing something for them. It's a tricky lesson because I did not want my children to celebrate pain or get confused about what pain means. On the flip side I wanted them to learn resilience and that they could do hard things.
*Sensory issues are 3/4 of the problem in medical situations for Autistic people. When my children were little I made sure they had a stuffy (and the Dentists usually gave them one until they were older and could pick tiny treats instead) to hold. They also had comfortable PJS or clothes they picked. I wanted as much in their control as could be. They were allowed to pick the movie on TV or if it was already on I brought music as an alternative if they did not like it. I made sure to put firm pressure on their legs to let them know I was with them the entire time. If I felt them squirm or begin to lose regulation control I would talk in a soothing sing song voice. The Hygienist also followed suite. I also found explaining every single facet of the situation made it better. In my daughter it was the opposite so my strategy was to distract her with silly stories or imaginative games.
*Different Autistics need different sensory solutions. Find what works for your children. I brought their own sunglasses to wear when they were little. My daughter found that a heavy book on her legs during wisdom teeth surgery reminded her that she was grounded and not in some weird head space. I brought a large hardcover volume just in case and she said it made such a difference for her. Some children wear weighted vests ect. For myself, I ask the hygienist to keep me dry. I can not stand drool on my face, so they constantly are wiping me and applying lip gloss during procedures. I also ask them to regularly use the suction in my mouth as I also hate swallowing during a procedure.
*If you have close friends or family inform them of what is happening. I would not allow visitors the first 48 hours but I updated with pics. My daughter benefited from flowers, gifts and money due to people being kept up with her story and wishing to make things better for her. It sometimes is beneficial to have the community involved ( the ones who know the children at the deepest heart level) to show their appreciation of the bravery a child has conquered in a tough situation.
What are your tips at the Dentist?
Post Note: We were also particularly proud because this all happened shortly after she was officially diagnosed with my same condition of Polycystic Ovarian Syndrome ( PCOS.) They do not like to diagnose teens but I insisted she be checked. When her Testosterone came back high they said it could be a lab mistake and wanted to re test. I made sure it was on the 19th day of her bleed again (even though some doctors say it does not matter.) It came back almost TRIPLE for what a child her age should have for Testosterone which explains a lot. It took all my prowess to get us out of that Drs. appointment without agreeing to birth control ( to which I have loads of research about and against. In some circumstances it is appropriate and it does have a band aid affect for a few years but later on this is akin to putting a band aid on a deep organ wound.) As it was I had to take a prescription just in case to get out of there. We are seeing my naturopath for her this month as I am on a natural Androgen blocker that is slowly making a difference. PCOS explains a lot. It's nice to finally have the answers I have pushing for since puberty began with a 55 pound weight gain. She was tiny (to the point I could carry her on my hip still at nine) and she rapidly gained and she got her period at eleven and it spiralled from there. PCOS is often most genetically given from the third generation's exposure to chemicals (even small amounts of Bleach, Mr. Clean, PBA, Foods ect) and drugs ect. My grandmother was on strong steroids for Colitis and her bowel removed which affected me. My mother did not know much about the cleaners she used ect. I do not blame the previous generations for the times they lived in or the lack of awareness in choices. At first it was devastating to me that many of my life choices (that came with some sacrifice) would not fully affect my daughter and give her benefits but I have hope for the next generation that maybe they will suffer a little less and each one will get better if they make informed choices. I highly recommend the book below for anyone wondering about this condition.
Song Choice: The Next Right Thing (She chose this song for obvious reasons.)
