Sunday, September 7, 2014

Like Pulling Teeth

A couple of weeks ago, we took Alex to his pediatric dentist who also sees adults with special needs for his regular six-month cleaning and check-up.  As I have mentioned in previous blog entries, Alex has always had good experiences at the dentist, and he eagerly looks forward to going, unlike most people. Moreover, he has been quite fortunate that he hasn’t needed any dental work other than to have two teeth filled under anesthesia last summer when he was twenty-one years old. Although we had thought this appointment would be uneventful, since his check-ups always are, we were wrong.

First of all, Alex looks forward to seeing his beloved hygienist Laura, who shows him great kindness and calls him “Sweetie” in her sultry deep voice that he likes. This time, another hygienist cleaned his teeth instead. Alex’s disappointment was obvious as he asked the new hygienist, “Where’s Laura?” I’m not certain why this change was made, as we saw Laura there that morning, but for some reason she didn’t work on Alex this time. After his teeth were cleaned, the new hygienist went over how Alex’s teeth are doing. Many times, the dentist comes and gives me a report about Alex’s teeth, but lately he seems to be unavailable for these consultations. While I appreciate the good job they have done taking care of Alex’s teeth the past several years, I don’t appreciate that he doesn’t take a few minutes to talk with me. In ways he reminds me of the character of the Wizard of Oz: “Nobody gets in to see the Wizard. Not nobody. Not no how.” Instead, the new hygienist had the task of breaking bad news, which wasn’t fair to her or me.

Since Alex has never had much problem with decay, I was stunned when she told me that his upper back molars needed to be extracted because they are “deteriorating.” I asked her if she meant his wisdom teeth or twelve-year molars, and she seemed a bit rattled by the question. Next I asked her if his wisdom teeth have erupted, which seemed to rattle her even more. She began flipping through his chart, looking for information, even though she had just examined Alex. Then she told me that it was his twelve-year molars that were deteriorating and needed to be removed and that his wisdom teeth had not erupted but were lying sideways. As if to smooth over the situation, she tried to reassure me that nothing needed to be done before we came back for his next check-up in six months. Since things didn’t seem that imminent, I asked her if those teeth could be saved by having them filled, and she flatly told me they were too far gone. Then she told me that if Alex were in a lot of pain or having trouble sleeping, we should call their office to get a referral to an oral surgeon to have them removed right away.

At that point, I was a bit overwhelmed thinking of how nasty Alex could be if he were in so much pain he couldn’t sleep. I simply thanked her, and we took Alex, who was in the waiting room with Ed and oblivious to this discussion, home. In the car, I thought of all the questions I should have asked her and felt frustrated that the dentist had not explained all the issues and had left a new staff person to go over a fairly serious matter. Once I got home and got my thoughts together, I called the office and asked to speak to her to try and address my unanswered questions. Yes, his upper twelve-year molars needed to be removed, but they most likely could wait at least six months. After she had a brief consultation with the “Great and Powerful Wizard of Oz,” the dentist, she said that if we wanted to be proactive, we could consult an oral surgeon and have the teeth removed before they caused him any pain. That sounded like a plan to me.

However, I was not comfortable taking Alex to an oral surgeon we’d never met before I knew more about what was wrong with his teeth. Consequently, I decided to take him to my dentist whom I like and trust. Fortunately, we were able to get an appointment right away, and Alex was enthusiastic about seeing a new dentist. Since Alex’s dentist never x-rays his teeth, I knew that having x-rays could be tricky because he would have to cooperate and sit still. However, the pleasant dental assistant was very good about explaining to Alex what he needed to do, and the panorama x-ray of his entire mouth went amazingly well because Alex did exactly as he was told. I think he found the rotating machine fascinating and liked that the process would take exactly sixteen—not fifteen or twenty—seconds.

After the x-ray was developed, my dentist carefully examined Alex’s teeth on the image and in his mouth. He also showed me in the dental mirror the decay on the back of Alex’s twelve-year molars that was cause for concern. He was quite understanding as he explained that keeping the back of his back molars clean was difficult and that by removing those teeth, we could take better care of the rest of his teeth. For that reason, he thought removing the bottom two back molars might be a good idea, as well. Additionally, he recommended removing Alex’s impacted wisdom teeth at the same time before they cause him any pain or problems. He explained that when his twelve-year molars are removed, that will allow easier access to the wisdom teeth to remove them, as well. He recommended all eight back teeth be removed under IV anesthesia for Alex’s comfort and felt that doing it all at once would be easier on him in the long run.

After addressing that concern, he checked all of the rest of Alex’s teeth and said that they are in good shape. He asked me if Alex brushed his own teeth, and I explained that his fine motor skill weakness makes it difficult for him to do his own oral hygiene. Therefore, I do most of the brushing of his teeth. He then told me that I “deserve a pat on the back” for the good job I’ve done in keeping his teeth clean and healthy. This was a nice recognition no dentist had given me before and made me feel better about the decay in Alex’s back teeth, which he reassured me was difficult to avoid. Although we aren’t thrilled that Alex needs to have eight teeth removed, we appreciated that we now understood why this would be best in the long run, thanks to my dentist’s gentle and compassionate explanation of how this will help Alex.

Also, he agreed with us that we shouldn’t wait until the teeth cause him problems and should proceed with getting them removed instead of waiting six months, as we had been told we could. He then gave us a referral to a local oral surgeon along with Alex’s x-rays and a written explanation of which teeth need extraction. When we got home, I scheduled an appointment with the recommended oral surgeon for a consultation, and we will wait to see what he says then. Since Alex did well last summer when he had teeth filled under anesthesia, we are hopeful that he will do well with having these teeth removed under anesthesia, but we are concerned about how he’ll react to the discomfort afterwards. Alex, on the other hand, has no worries and is looking forward to the process, seeing it as yet another adventure. I suspect he thinks he has a big payoff coming from the Tooth Fairy in the future. If that makes things easier for him, I’m sure she can fulfill his wish.

“Putting confidence in an unreliable person in times of trouble is like chewing with a broken tooth or walking on a lame foot.” Proverbs 25:19


K. C. Wells said...

Wow. That's definitely news you didn't expect! Sending good thoughts for extraction day and the days that follow.

Pam Byrne said...

Hi K.C.,
As you know from your own experience, life often sends us curve balls! Although I wish Alex didn't have to go through this, he has always been such a trouper when it comes to medical procedures, and I'm sure he'll come through the oral surgery fine, too. Hope you all are doing well.

Byron Kennedy said...

Looks like Alex is really warming up to dentists! I'd have to say that the dentists you dealt took care of Alex pretty well. "Testing out the waters" was a good step to determine how he’d react. He’s off to a great start, and it’s likely things will only get better in the future!

Byron Kennedy @ A+ Family Dentistry

Pam Byrne said...

Dear Dr. Kennedy,
Thank you for your nice comment. It's nice to have a third opinion from a professional! Alex goes for his consultation appointment with the oral surgeon this week, so we'll see what he thinks is best. :)
Take care,

Kathy Dibling said...

My son is having at least 5 wisdom teeth and 4 molars removed this Saturday I'm so worrid about after pain :(

Pam Byrne said...

Dear Kathy,
How did your son get along yesterday with having his teeth removed? You have been in my thoughts and prayers this week, and I hope that he doesn't have a lot of pain and can deal with it calmly. Alex is having his wisdom teeth and 12-year molars removed under general anesthesia on November 5th, and I'm hoping that he deals with everything well. He's usually a trouper about medical procedures, but I just don't want him to suffer.
Take care,

Weston Wadlington said...

You did the right thing there. Better arrest the problem now before letting it stay for too long and let it affect the well-being of your child. It's good that the visit went well and I'm hoping that things will get better for Alex more. I commend you for your alertness and commitment to always help your son put the best foot forward. All the best to you!

Weston Wadlington @ Peak Family Dentistry

Pam Byrne said...

Dear Weston,
Thank you for your kind comments and good wishes. Alex's oral surgery went even better than expected, and he is healing nicely. :)