Monday morning Charlie had a very successful visit to the dentist and not only because he had no cavities. I was at work teaching so Jim got Charlie got up for the 8am appointment, at which Charlie had his teeth cleaned and fluoride applied.

(I don’t have photos of Charlie’s last dentist visit as I was not there; am looking for an old one and will add it when I find it/ This photo of a yet to be paved road and the mountains in the distance reminds me of how “epic” an endeavor it has been to teach Charlie to go the dentist and to brush his teeth. This photo and the one below were taken in Meteora, in Greece, in March of 2009.)

Charlie doing well at the dentist, and at the barber--and other tasks that are fairly routine for children his age---involved years of planning, teaching, and practice. Granted, one is more likely to get haircuts more frequently than to visit the dentist, so Charlie's had a lot more chances to practice sitting in the barber chair while someone moves his head around. And while the path to Charlie sitting in the barber chair and smiling at his reflection while Antonio or Vince give him a buzz cut was a couple years in the making, the path to Charlie sitting quiet and fairly still in the dentist chair, with Jim standing by, is the stuff of an epic in miniature. (Or at least an overly long blog post.)

Charlie was four when he first visited a dentist (“dentist #1”) in St. Louis, where we were living (it’s where Charlie was born). I can’t remember how I heard of this dentist---most likely from another parent on an email list or a teacher; it was noted that some of his children are on the autism spectrum and he’s written some articles about dental care for children with disabilities. The dentist recommended that we split up the appointment over several visits. On the first visit, I took Charlie to the dental office and he walked around and sat on my lap in the dental chair. On the second visit, the dentist started trying to look in his mouth and just get Charlie used to someone else touching his mouth and lips with the metal instruments. On the third and fourth visits, the dentist tried to clean Charlie’s teeth. He didn’t get too far: Charlie stayed in the chair because I was holding onto him, but he didn’t open his mouth as requested and when he did, he didn’t keep it open. The dentist recommended an electric toothbrush to make brushing a bit easier and we talked about starting a dentist program with Charlie’s home ABA therapists.

It was a good introduction and I suspect we would have had Charlie see this dentist a few more times had we remained in St. Louis. By June of 2001 we were back in New Jersey. And that’s where this story really picks up.

Charlie was only 5, but I already knew that the days when I could hold him (wriggling and writhing) on my lap in the dentist chair were fast fading. We found dentist #2, who specialized in special needs children. He had a big office with a very nice waiting room (requisite fish tank, video games, toys) and there were several dentist chairs outfitted with video monitors. The staff was cheerful and patient. For the first two visits, an extra person helped me hold onto Charlie so he’d keep still. At the third visit, we were asked if we might start considering a “quiet room,” where there was a “papoose” to strap Charlie into. Jim and I said we’d prefer not to; that we were concerned that Charlie would find it terrifying to find his arms and legs strapped down under velcro.

The response to our concerns was polite. Before we left, the dentist himself appeared and suggested the papoose. Jim and I duly listened, and left holding onto Charlie’s hands.

All this time, we were also working on brushing Charlie’s teeth. When we’d hold the brush up to his mouth, he’d shut his lips tight and have no part of it. If I was able to get a swipe of toothpaste on his teeth, I considered my efforts a success. The thought of Charlie brushing his own teeth a very distant thought. During this time, Charlie was on the gluten-free casein-free diet and ate very few sweets, and certainly not the commercially-produced junk I remember from my childhood (no HoHo’s or Hershey bars in our house); this seemed as well. Why tempt cavities (i.e., extra dentist appointments involving novacain, drilling, fillings)?

When Charlie was six we moved to another town in New Jersey and while we could have taken him to dentist #2, Jim and I felt very under-motivated to make the trip. Charlie went without a check-up for some time and we did our best to get toothpaste near his teeth. In the meantime, Jim and I found a dentist for us whom we both liked and who, as it turned out, has an adult autistic son. Our dentist recommended a pediatric dentist not far from our house and we decided to try him.

For the first appointment with dentist #3, Charlie sat in Jim’s lap, for the first and last time. It took an assistant and me to hold his feet and hands and head and body so the dentist could try to clean Charlie’s teeth. I am quite sure that, in the struggle (which it was), Charlie’s mouth must have gotten nicked by the metal tool. After that, we decided that Charlie was too big to sit in anyone’s lap in the dentist chair, and that it was time for him to sit in it alone. One more appointment with dentist #3 followed and it was the last one, with that dentist and for two or more years: Three people holding down a child while a dentist hastily picked and scraped at his teeth was a traumatic experience for Charlie and (speaking for Jim and me) the others involved.

Jim and I were starting to talk about having Charlie sedated in order to have his dental work done. Charlie was now eight and we had started a home ABA program for him again with the Lovaas agency. Going over programs with our new consultant, we eagerly said “yes” to a teeth-brushing program. A picture schedule of the various steps was made and a bin with a lid procured for Charlie to keep his teeth-brushing materials in. Rather than holding the toothbrush with our-hand-over-Charlie’s-hand, the therapists brought toothbrushes of their own and had Charlie imitate them putting on toothpaste, putting the brush up to their mouths, putting it in their mouths, brushing, drinking some water and spitting it out, rinsing out the toothbrush. (At school, Charlie’s teacher also started a toothbrushing program, with a picture schedule but without her or the aides modeling what Charlie was to do.)

I turned to the Internet and found the names of some dentists nearby, surmising that we’d rather not have to travel too far for Charlie to see the dentist (i.e., to revisit dentist #3). I found a practice that said it specialized in special needs children and the Lovaas consultant and I went to look at it. Within a  minute of looking around, she and I looked at each other with expressions of “why didn’t they make dentist offices like this when we were kids”:  The office had balloons, prize machines, video monitors, small private rooms, lots of light and windows, a little movie theater where kids could watch a video about going to the dentist (and, yes, fish in a tank in a waiting room). Plus, it was in a big open, airy space. We talked to the dentist and took a lot of photos, which we made into a little book to show and talk through with Charlie before his appointment.

The consultant and I also talked about what Charlie needed to do to have a successful dental check-up. Thinking it over, I realized that---aside from not screaming and moving around---Charlie needed to keep his hands down (so he didn’t push away the dentist as he worked on Charlie’s teeth) and to keep his mouth open. And so those two things---hands down, mouth open---were practiced again and again with Charlie lying on his bed, with his home ABA therapists. I bought a set of dental tools at Walgreen’s and part of Charlie’s ABA sessions involved “seeing the dentist.” The therapists practiced putting the mirror and a toothbrush in Charlie’s mouth as he lay on his bed and counted off the seconds, often with him grinning.

A therapist came for our first appointment with dentist #4. She was a bit late; Charlie was sitting in the chair and his face lit up when he saw her. She held his hands when he started to push at the dentist’s hands and (albeit with a certain look of “what the!! is going on” on his face) got through a cleaning of all of his teeth. Six months later, with a different therapist, he did just as well; six months later, Jim and I went with him alone; six months after that, Jim and I went with Charlie and Jim left early to catch a train, and Charlie got his first fluoride treatment. And then six more months passed and it was this past Monday, the 31st of August, and Jim and Charlie went together.

Teeth-brushing at home continues. About a year ago, Charlie was getting everything out of the bin by himself and brushing up and down and left and right for several seconds and starting to use a floss stick. Last year, along with its other woes, saw a loss of teeth-brushing skills, with Charlie flat refusing to brush his teeth, or putting on toothpaste, washing it down the drain, and then barely passing the toothbrush over his teeth. Jim and I figured, let it go, we can start up again. Slowly, since July, Charlie has been brushing more and on his own. I stand by and model brushing up and down and left and right and front top and bottom with a finger and, while Charlie only makes a few passes with the toothbrush on each part of mouth, he again had no cavities at his most recent appointment. Charlie has yet to have an x-ray taken and I'm thinking of calling the dentist office to ask more about the equipment, and think of ways to practice.

So that’s our minor epic tale of something like (!) success at the dentist. His getting older and maturing has played at least a small part in his being able to handle the check-ups. We’d like to see Charlie brush his teeth more thoroughly and I need to dig out the floss sticks. So far it seems that he’s one of those lucky people who (like my dad) isn’t prone to cavities. His teeth are coming in at various angles and he could use braces but whether or not he would (1) be able to have them put on and (2) tolerate wearing them (our dentist has told us about how one autistic boy pulled off his braces). We’ll wait and see on this one.

But then, we did wait and see and work our way over many a rocky obstacle, a couple of dentists, and several steps to teach Charlie both to brush his teeth and to handle a dentist visit. As I tried to show in this post, it took time for Charlie to get used to the sensory onslaught of a dental check-up. Practice doesn’t always make perfect, but it can make things you thought would never happen more possible.

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