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  • Posted on May 15, 2010 at 10:00 PM

Executive Summary:  Alex dislikes dental work.  I believe in empowering patients to make choices regarding their own dental care.  Yet, I do not allow Alex to refuse dental care.  The difference is that care is being sought for my child’s benefit, and not my convenience.

The waiting room was okay.  Alex bounded from spot to spot, reading as many words as he could find.  Then, the dental assistant came.  We talked for a few moments.  When it was time to go into the back I called Alex to me, but he didn’t come.  I took him by the hand.  He walked with me and stopped a few paces in front of the door.  I tugged gently on his hand, an act that was more communication then force.  He looked at me, and took just enough steps forward so he was inside the door.  The door closed behind him.  Step by step, we moved forward—him resisting, me encouraging.

I said, “I will carry you if I have to.”

Alex chose to walk.

The dentist’s office is a difficult place for Alex to be.  He generally resists anything that involves others touching his mouth.  He resists brushing his teeth, flossing, and all forms of dental care.  He resists us looking at his teeth or checking for wiggly, loose ones.  He resists the removal of wiggly, loose teeth or the removal of any miscellaneous particles he decides to chew on.

I expect resistance, which is why I travel two hours to take him to this clinic.  The staff is prepared for his resistance and the facility is equipped to make dental care as safe and as comfortable as possible.

This particular appointment was a “quickie.”  The task was to fill a chip on his front tooth.  Easy access.  No drilling.  No paste.  If Alex had cooperated the whole thing would have taken 5 to 10 minutes.

Of course, Alex did not cooperate.  Or, to be more accurate, Alex cooperated as much as he was able to do with his current level of oversensitivity and anxiety.  He squirmed most of the time.  He cried quite a bit of the time.  He got out some good words, through a pry-thing that forced his teeth apart, saying, “I don’t want.  Don’t want.  I don’t want.”

We acknowledge his words.  We told him we understood.  We explained as best we could that we had to fix his tooth so the big-boy tooth didn’t rot and break the way his baby tooth had done.  He understood.  He took a few ragged breaths and was relatively calm (but still squirming) for a few precious moments, which gave the dentist the opportunity she needed.

The dentist was quick as she could be.  She talked to Alex with respect while she worked within his limited range of cooperation.  She chided him when necessary and complimented him whenever possible.  In the beginning of the session, she joined in as I sang Alex’s special song to him to help him control his anxiety.

Alexander, Alexander.  I love you.  Yes I do.

Really special boy-oy.  Really special boy-oy.

I love you.  Yes I do-o-o-o-o.

Despite not liking the work she does, Alex likes his dentist quite a lot.  He made excellent eye contact with her, which is rare.  When it was all done, he even smiled for her.  But for all that he likes he, that doesn’t mean he’s able to cooperate while he’s in that chair.

The experience is hard on all of us.  He doesn’t want to do this.  I empathize, because I find the dental experience to be a miserable one myself.  I also don’t want Alex’s teeth to deteriorate the way mine have after a childhood (and much of my adulthood) of not receiving proper dental care.  I know, in the long-run, the misery of receiving dental care today is much, much better than the misery of decayed teeth with its tooth aches, drilling, pulling, and fake teeth.

One might think that all of this is beyond his understanding, but Alex gets it.  As much as he dislikes this he does get that we’re not trying to hurt him or ignore his wishes.  He gets that this needs to be done, and he gets that we try to make it as good for him as we can.  There was a precious moment after the filling was put on and set when Alex was calm.  He stopped squirming and crying.  He took a few ragged breaths.  He looked at the dentist’s face and he waited.  It was like he was saying, “Okay, what happens now.  I’m ready.”

The only thing that was left at the point was the x-ray.  Last time it took an extra person and four tries.  This time it only took two tries and no extra assistance.

We’re making progress.  Alex did really well.  The dentist and I praised Alex profusely.  Alex left with a smile, but he also left as quickly as he could.

Still, I look back and think about that precious moment of stillness.  As a mom, one of my biggest challenges is doing things to my kids that I know they don’t want, but need anyway.  Things like dental care, shots, and surgery.  These unwanted needs make me wonder how deeply my respect for my children really goes.  I strongly advocate the patient’s right to choose the type of care received or to forego care entirely.  I advocate these rights for patients who society deems incompetent to make these decisions.  Yet I make decisions like this for my children.

There are times I feel like a hypocrite.

Then, I think about that moment of stillness.  I think about the smile Alex gave to the doctor.  I think about the way he cuddled close to me after all of it was over, and how he relaxed after I told him he did a good job and that I was proud of him.

I think about how there are times, even as an adult, when I don’t want, but still need medical care.  I think about how anxiety-laden my own dental appointments are.  I think about how much it hurt to regain the mobility of my wrist.  I think about how, after the surgery on my wrist, I kept apologizing for needing a heftier dose of pain medication.  When I got home I apologized for needing my husband and my mother’s help.

And I let go of the guilt and the doubt.  I’m not a hypocrite.  As a parent, I have to make some tough decisions.  I have to decide what medical care has sufficient value to force that care on my children.  Sometimes this means dosing the child with antibiotics.  Other times it means restraining my child so a dentist can fix his teeth.  Sometimes it means talking the child through the anxiety of getting blood drawn or getting a shot.  But at no time do I do these things for me.  At no time do I put my convenience over my child’s care.  At no time do I treat my child as if his will doesn’t matter.  I talk, I explain, and I comfort.  I give my children choices whenever I can.  I refrain from making choices based on my needs or my convenience, but base my decisions on the long-term best interests of my child.  And my children recognize the difference.  That difference is going to empower my children to make their own decisions in the future.