daughter needs dental work-help please

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my daughter is 6.5. She meltsdown at all Dr and Dental appts. Last appt at dentist, they visually saw what they thought was decay, they had to papoose her (strap her down) to take an xray. Afterwards, she was fine although it was a very traumatic situation. She broke free from the velcro straps several times and had to basically be sat on to stop lashing and fighting. She is dx Asperger's and Developmental Dyspraxia. She is very bright and before the visits we talk about what is expected at dental visit, etc and her OT and therapist say she will do fine-then the fight or flight meltdown occurs. After the xray that was taken, dentist says she has one cavity into the dentin and 2 pre-cavities. The dentist states she won't treat my daughter unless she is under complete general anethesia. She believes no other "twilight" ot light sedation would be sufficient given my daughter's extreme aversion. Surprisingly, after the visit, she does not fixate on what occurred (but leading up to the visits she fixates on them) and she seems fine afterwards. Believe me, I didn't just let them strap her down, we have been working with this dentist for awhile trying to get my daughter to comply with oral exam. My daughter has oral fixations-she chews constantly and always has a chewy.

Have any of your children had general anethesia in a dental office? The dentist recommends capping all molars so we don't have to mess with dental visits anymore. The baby teeth will fall out soon, so no worries there but the molars she'll have until 10-12 (5 more years). Is this too extreme of a treatment plan? I'd hate to have her strapped down on a regular basis for cleanings or xrays and I fear the general anethesia. I don't know what to do!

Opinions please. Thanks.

My son is almost 8 years old and if he needs any kind of dental work he will need to have a general anasthetic. Like your daughter, he is very smart and he understands in theory why he needs to get work done, and has twice decided to go and get his front teeth extracted. He freaked out before the injections were administered and so the teeth are still there - discoloured and dead. These are his baby teeth and there are long standing problems with them, not least abscesses in his gums. He doesn't feel the pain of the abcesses, but freaks out when the dentist puts his fingers in his mouth.

I'm in Scotland and dentists here aren't allowed to administer GA any more, so if he needs any work he'll have to go to the dental hospital or local children's hospital.

The dentist has been great with him, very calm and explains what he is doing at every stage. However, I don't think the dentist really understands that my son's sensory processing "quirks" make it extremely unlikely that he will be able to tolerate dental work without sedation.

He is going to try coating his adult teeth with fissure sealant as they come through which should reduce the need for treatment in the future.

There's always a risk though with GA, and that is my worry. I wonder if hypnosis would be a viable option?

I am AS, and let me tell you, I don't think I'd have half the problems I have now if GA for pediatric dentistry had been an option. I did have a few procedures done at the local children's hospital, however, where I was put under some sort of sedation (I don't know if it was nitrous oxide or something stronger, but it wasn't full GA). My general pediatric dentist would not sedate me, however, as far as I remember (there was a point where I was actually visiting him weekly, so I think his approach was to get me used to him - it never happened). While I don't remember being restrained, my mother has told me that she did have to hold me down oftentimes when I was really little. It might be worth noting, though, that no one knew that I had AS back then (it was, after all, the 80s).

I, of course, can't speak for everyone on the spectrum, but for me, especially when I was younger, I felt cornered into a situation I couldn't control when I was at the dentist, coupled with the fact that I have oral sensory issues (if your daughter has a chewing stim, she may have some oral sensory issues as well). Visits to the dentist were (and still is to this day) a traumatic situation for me.

I wish I can help you with more information on GA, but I hope I've offered some insight as to what your daughter may be feeling. Good luck!

It sounds to me like your dentist is making a sensible and common recommendation. I know there are risks, so ask a ton of questions and make sure they are mitigated as much as possible. I don't know what else to tell you. Tough situation to be in, but you aren't the first.

I know exactly what you are speaking of , my 7yo son is AS and has sensory issues his first visit we couldnt get past having the bite wing film in his mouth more than 2 seconds . I decided not to push it as i knew if he had one traumatic experience it would be over with , I am AS and could not bear dental work as a child had to have nitrous still fought (I told the dentist this as an adult he wouldnt listen and I involuntarily bit him) . So due to yours having one traumatic experience i cant imagine it will get any better from here , though hypnosis is powerful and effective for AS people (personal experience) general anesthesia will be less damaging for all involved if only they had done that for me.

Well, people used to die from their teeth rotting and abscesses forming and stuff like that too, so there's a risk to leaving them in just as there is one for going under GA. I was put under to get some teeth pulled when I was a kid, and I was super groggy when I woke up but there were no complications.
Anyway, the dentist's plan to just cap everything off sounds pretty good. They capped me off because my teeth have some deep crevices that it's hard to reach with a brush, and I haven't had trouble since.
Just make sure (if you plan to get the same thing done when she's older..) when she gets her adult teeth that you don't wait to get those covered... a friend of mine just had to go in for a root canal because an old dentist of hers covered a cavity that hadn't been fully cleaned out!

I've had bad teeth my whole life (it's genetic, my parents do too), so it's not that I'm not afraid of going to the dentist, it's that I'm desensitized to it. It's a semi-routine thing for me. Yeah, I feel anxious on the way over, but I manage to get over myself, walk into the office, and wait for the dentist to see me.

Now, as a kid, it fluctuated. I didn't mind doing check-ups, and had baby teeth pulled enough times to see as not that big of a deal. I was afraid of doing it myself, and refused to let my parents do it, so they took me to the dentist for that, and I preferred it that way. The shot of novocaine and the dental pliers made it less painful than pulling it myself. However, one thing I was terrified of is the dental drill. As soon as I found out that I was going to have my teeth drilled, I'd start crying or when I got older, look panicked. If not, the dentist had to spend time convincing me that he/she was not going to drill, and I wouldn't believe him/her until he/she moved the drill assembly away from me. In the end, I got pens or small trinkets for "being a good patient". I'm sure the clinic got them from prescription drug companies, but who cares, they were still pretty good.

Now, your daughter might benefit from this chart here: http://dentisign.com/getit/. It shows different hand gestures people can use to communicate with their dentist. I myself use hand gestures during dental treatments, and I'm 26. It will empower her in some way by allowing her to use meaningful communication methods when she's unable to talk. After all, dental appointments are very disempowering, probably more so than other types of medical treatments, which is why so many people have dentist anxiety. With this chart, your daughter can communicate clearly and know she'll be understood (the dentist gets a copy of the chart too). While it's not going to completely eliminate anxiety for your daughter, it'll reduce it a more manageable level.

My kids have always gone to a pediatric dentist and my AS son always has laughing gas for any procedure. Even xrays are tough for him(sensory issues).
When he went to have 4 teeth pulled before getting braces, the oral surgeon prescribed a 10 mg valium! Which I was surprised but thankful for because I could not have dragged him in there, he's 16 and strong!
Sedation has to be the least traumatic way to go. But it's not covered on my plan, but I do it anyway. I don't know about caps but he's had sealant on all his teeth and even with lousy brushing he's had no cavities yet.

My dentist refuses to do anything beyond a regular checkup with me because I get absolutely terrified at anything beyond that. I was sent to the hospital for a tooth x-ray once as I wouldn't stop fighting the way they tried to do it at the dentist because it scared me and he won't offer me cleanings or whatever he does for the rest of my family.

I have weak teeth, and when I need a filling or, more recently, a tooth out, I get put on a waiting list for a clinic where I am sedated for the procedure. I always get the same dentist. He's very nice. I'm scared of needles too, but he uses what he calls a "baby needle" - so it's a tiny prick, the kind they use on young kids, and it doesn't really hurt. I hate having teeth taken out - I learned you can feel it being taken out even under anasthesia, which almost resulted in him being unable to remove it - but fillings aren't so bad under anasthesia, though you get groggy.

My son is 11 now and had to have a general for root canal work and cappings on several teeth. He was fine, mind you he has now had about 9 generals for different things. My son J was 8 at the time of the dental work. Your dentist sounds smart, knock her out and fix as much as they can= less trauma in the long run.

Just a suggestion - have you considered sealants? They are not anywhere nearly as traumatic as capping the teeth. They paint on a mild acid, which etches the tops of the teeth, then paint on something similar to what's on the space shuttle and expose it to UV light. I had all my daughter's teeth (the ones that could be done) sealed as a young child, and then again later when her adult teeth came in. She's now in her 20s and has never had a cavity in one of them.

The dentist won't make as much money on them, though.

It's a tough call and scary. Our son is 16 and the only way we could have a dentist work on his teeth was under GA. It's very scary for a parent and it was for him too. It will be next time too, but it is the only way his teeth can be cared for. All his baby teeth left at that time were capped, two were pulled. I am not crazy about the metal caps, still worry about possible mercury. He was not a happy guy when he was waking up but better than his teeth rotting. Just make sure that when it is time for the baby teeth to come out, the capped teeth do so and don't get stuck in the process.

I know there are dentists who specialize in Autism but they are few and far between. I am in California and we have something like an HMO that does not cover much. I did some research though and found that if you have the diagnosis of Autism or Asperger's you can have Nitros Oxide and our insurance will cover it. I also cant stand the dentist, I dont like people touching any part of my face and certainly not my mouth. You can stick needles in me anywhere else....I actually used to be a Phlebotomist....but not in my mouth. Neither my Autie (nearly 5 year old daughter) or my aspie (7 year old son) have been to the dentist yet. My daughters teeth look good even though there are many days that she will not allow me to brush her teeth (they are doing it at school so that helps). My son is already loosing baby teeth, his teeth look good but are crooked like my husbands. I personally would not be against giving some Valium and would not be against the "gas" but I agree that General Anesthesia should not be taken lightly. Both of my kids have had to have surgery when they were babies and did fine under GA so If it had to be done Id accept it but if your child has never been put under or you have any problems with it in your family then I would look for another dentist who is more understanding.

My daughter chipped a tooth when she was very young. We went to a pediatric dentist. Their offices insisted that parent not go in the back room with the kids. They felt that parents got in the way. After under a minute, I heard my daughter screaming her head off. The nurses tried to hold her down to look in her mouth. We left that dentist and decided not to go back.

I asked around town to my friends and family what dentists they saw. We found a very nice dentist, who is okay with me being in the room. She never pushes my daughter past her comfort zone. She always uses that pre-numbing stuff before they give her novacaine. She also descirbes what she is doing and what it will feel like before she does anything. My daughter still has some anxiety in a dentist's office, but nothing like it was year ago. So my advice is, see if you can find a different dentist. P.S. Our dentist also has T.V.s in the patient rooms; that is a nice distractor from the dental work.