I’ve written before about how even the simplest of things can become a trial if you have a child with autism. I should say that not everything is difficult and sometimes even those things that you’ve had trouble with before will go perfectly smoothly. Autism goes hand in hand with a certain level of erraticism and irritability, which is why many autistic children are prescribed antipsychotic medications. So good things can become bad, bad things can become good… it’s difficult to know which will be which until the moment is upon you.
Today Nemo has to go to the dentist, something that has been difficult from an earliest age. He has never experienced pain at the dentist or even a thorough cleaning with all the scraping and picking and whatnot. His dental trips have all been as gentle as they can be, with the dentist basically just looking at the condition of his teeth and gums and then giving us thoughts about how to better care for his mouth.
I think the problem arises from the fact that Nemo does not like any foreign object in his mouth. He hates it. Teeth brushing every night is a struggle, first to get him to submit to the process in the first place and then to get him to comply with the various things necessary to get the cleaning done: head up, mouth open (not too wide!) and body still. My wife and I both know he needs more thorough brushing than he gets, but it’s a case of getting part of something or all of nothing.
The actual dental visit is simply a magnification of everything that goes wrong during the nightly brushing. His anxiety spikes as soon as he’s in the chair and it moves to tilt him back, then he grows very concerned when the mirror has to go in with the pick so the doctor can check his teeth. At the best of times there is flinching and crying out and some physical struggle with his hands. At the worst of times there is full-fledged screaming, attempts to escape the chair and tears. One horrible visit required me to put my full weight on top of Nemo’s body to pin him to the chair just so they could get into his mouth and the dentist had to use a kind of metal and rubber prop to keep his jaws open. It was traumatic for everyone involved.
On those occasions when Nemo has required more thorough dental care than he can stand in an office setting, we have had to take him to a hospital where he is put under general anesthetic and worked on by a surgical dentist. If it turns out he has a cavity this time, it’s to the hospital we must go in order for him to get his filling because there is no way he will sit still for shots in his gums, plus the drill. It’s expensive and stressful and when we had to do it before Nemo was terrified, but he leaves us no choice.
What concerns me even more than the trials we have now is what will happen to him when he’s an adult and no longer on our health insurance. Thanks to the Affordable Care Act he can stay on our family’s plan until he’s 26, but afterward, should he be unable to hold down a job, he will have to go onto Medicaid, and Medicaid is notoriously tight-fisted about the things he’ll need. He could end up losing his teeth or, if an infection gets particularly bad, his life. It’s not something I like thinking about.
It may turn out that today is a good day and the dentist visit passes without incident. I’m sure the dentist will admonish us for not brushing thoroughly enough and he’ll probably get another prescription for special toothpaste, but if we can avoid cavities then we’re ahead of the game. But that’s thinking ahead. Right now I have to keep my eye on just keeping him in the chair and calm.