I took Logan to the Dentist last week. It was a rather odd morning, but it was full of grace and the astounding bravery of one very special little boy. Before I tell about Logan’s recent Dentist visit, I must tell some of his story. It is only with an understanding of how far Logan has come that the full extent of his little boy effort and bravery can be appreciated.
Taking Logan to the Dentist has always been an event that required great exertion, both physically and emotionally. Logan has special needs. He has Autism. For a long time, language eluded him. What was abundantly clear, even before he could verbalize his preferences, was that Logan had major issues with anything touching his face, especially around the mouth area, and that he would not bite or chew.
Logan had come to live with us at age 2, as a little lost soul. He was a prisoner of his own lonely world, captive to the disconnect that we call Autism. We went to work on connecting with Logan through love, through music, through therapy, through observing what he liked and reponded to and then using those things to reach out, through security and routine, and through prayer. Many others have come alongside our family to love and help Logan. Therapists and Teachers, Developmental Specialists, people at church, friends who cared, family, and other school and pre-school personnel have all had a part in Logan’s journey. Oh, how he has been loved!
Little Logan in a happy moment during one of our heart to heart connection sessions
When Logan was two and three and four, we had a routine. After feeding him, I spent time with him one on one. He was still strapped into his little booster seat, and my chair was facing his chair. We were face to face and heart to heart. Logan had shown us that he loved music with his little sing-song babbles, so music became our tool. I tried all of the action songs that I knew, moving Logan’s hands and arms for the motions. I sang other little songs and made up motions to go with them. Logan could not find the entrance to his little world with me right in front of him, singing to him and moving his arms. He began to make eye contact and to engage. Some of his favorites were “The Little Shoemaker”, “Deep and Wide,” “Eensy Weensy Spider,” “The Wonder Pets” theme song, and “Head, Shoulders, Knees, and Toes.” Logan liked the part where I would touch his the top of his head, his shoulders, his knees and his toes. When I got to the part about the “Eyes, Ears, Mouth and Nose” it was a different story, though. He still liked the music, but he did not want me to touch his face. He would duck his little head down as far as he could into his chest. He would turn his body sideways, squirming away from the unwelcome face contact. He finally got to the point where he would tolerate the touching of his eyes (just below or above) and ears during the song, but the nose and mouth were still off limits.
Logan’s extreme oral sensitivity not only meant that anything close to his mouth was a no-touching zone. It meant that chewing and biting were out of the question for several years (though he is now doing this some in feeding therapy, tolerating more texture in his food than ever before, and we are working on it). It also meant that brushing Logan’s teeth was an aerobic exercise for Mom and Dad. For a very long time, it took both of us and every ounce of our strength to brush his teeth. I would sit on a low bench in the little guys’ bedroom (shared by Logan and his younger twin brothers), and I would have him standing in front of me, with his back to me. I would cross my legs over his to keep his legs still and cross my arms over his chest, grasping both of his arms, to keep them still. Travis’ job was to attempt to hold his head still and brush his teeth. It was like wrestling an octopus. An arm or leg or both would wriggle free and flail wildly during the process. Added to the physical challenge of keeping him still was the fact that his jaw was clamped tightly shut, his lips were pressed together, and his head was in constant motion. We did the best we could, and one of us always held him for a while after brushing teeth until he calmed down and our heart rate got back to normal. Whew! The torture was over!
Brushing Logan’s teeth used to be a tough challenge, but it was nothing compared to the challenge of taking him to the Dentist. Travis and I used to plan to both be there and to make sure that our other children were either in school or pre-school or being cared for elsewhere. We had to devote all of our energies to Logan and to trying to assist the dental staff to make sure that a cleaning could happen. When Logan’s name was called, we would both go back with him. One time, Travis sat on the chair with Logan in his lap, holding him to keep him from jumping down and running away. I kept Logan’s legs still while Travis kept his body on the chair. At other visits, we were on either side of Logan attempting to hold him down. Usually, it took the two of us and three people from the Dentist’s office. One staffer held Logan’s arms, while another kept his head in her grasp to try to not only keep it still but also to keep it turned in the direction necessary for the work that was being done. The third staffer, the hygienist, tried to clean his teeth. Logan would be screaming, hysterical, angry, upset, crying, and snotty. But, mostly, he was a scared little boy totally out of his comfort zone, in a scary and unfamiliar place with people he didn’t know, and battling with both his Autism and the extreme oral sensitivity that caused the dental experience to be for him the equivalent of horrific torture. I must stress that the staffers at our pediatric dentist were wonderful, patient, and kind in dealing with Logan, but this is still how it was for a long time.
Logan feeding himself in 2010
Logan has had a lot of therapy over the years to address many developmental needs. During speech and occupational therapy, the oral sensitivity issues were addressed to some degree, gradually overcoming some of his fear and increasing his tolerance for things touching his face and mouth. It has been a slow process, but progress has been made. This Fall, we have been able to begin working with a therapist who is helping Logan to overcome his fear and sensitivity issues related to eating. We have already seen some progress, but this process is going to take a while. Travis and I have been gradually increasing the texture in Logan’s food for several years. It becomes clear very quickly when we need to back off and have pushed him too far. At that point, he stops eating altogether. We are careful to continue pushing him but not too far so that he can maintain a healthy diet and continue to grow. At age 8, Logan is tolerating quite a bit of texture now, but he still does not bite or chew his food. He just swallows. He learned to drink from a straw about a month ago. His oral sensitivity always prevented him from wanting a straw anywhere near his mouth, but years of therapy and the addition of the feeding therapy have finally allowed him to overcome this hurdle. He took a couple of bites of a cracker a few weeks ago in therapy, but it freaked him out so much that his therapist has had to back off on trying to get him to bite for a while and focus on changing up some other things instead. We are more than hopeful that Logan will be biting and chewing sometime during this year. We are counting on it! After all, we have seen progress in several areas. Logan now lets us brush his teeth and does his best to cooperate. It is still hard for him. It’s hard for him to open his mouth wide enough for us to brush, hard to keep it open, really hard to tolerate the brush going past the teeth in front to the deeper parts of his mouth, and difficult for him to remember to keep his tongue out of the way. However, he is not fighting it or screaming. He is trying, and that effort is happening in spite of the fact that he still hates it.
At the Dentist’s office, there have been improvements in Logan’s tolerance as well. The last couple of times Logan had an appointment, I’ve been able to take him by myself. It has not been necessary for my husband to be there as well. Instead of 3 staffers helping in order to get his teeth cleaned, we have been able to have only one other than the hygienist (to hold Logan’s head and turn it the right way). I’ve still had to hold Logan’s hands and keep him on the chair, but he has not been as wild and crazy as he used to be. One of the times when he had his teeth cleaned, he had a message for the hygienist after she was finished. He pointed at her and said, “You bad!” Other times, he would just be screaming by the end of the cleaning. Once, the Dentist came to check his teeth after the cleaning was finished and gave him a talking to about the screaming. That seemed to make an impression on him. Having the dentist talk to Logan like a big boy + all of the therapy he’s had + the patience of the dental staffers during multiple visits over the last few years + Logan’s ability to communicate more effectively that he used to + a little more maturity and life experience + perhaps a gradual recognition on Logan’s part that a visit to the Dentist was survivable = a real breakthrough!
So, last Thursday morning, I took Logan to the dentist. I signed him in and sat down in the waiting room. A few minutes later, I was called to the appointment desk and asked what Logan was supposed to have done. My husband had actually made this appoinment, so I said that I assumed it was for a cleaning. The office staff told me they could not find an appointment for him on the schedule, so I said that perhaps it was because Logan’s permanent teeth had come in behind his baby teeth on the bottom and the Dentist may have wanted to re-evaluate the two rows of teeth. Meanwhile, two ladies were searching and scanning all of the appointments on their computers and still not finding anything. One of them said that they could go ahead and get the Dentist to look at Logan’s teeth again since we were there and that they would work him in. I sat down in the waiting room, confused about the whole thing. I knew that my husband would not have a non-existant appointment on his calendar, so the whole thing did not make sense. I decided to try to make the most of the fact that I’d taken Logan out of school for this phantom appointment, so I went back to the desk and asked whether there was any way that Logan could be worked in to the schedule for a cleaning since we were there. Again, two ladies scanned and checked their computers; and I was told that Logan would be able to get his teeth cleaned. Victory! Then, the office staff told me that Logan’s cleaning appointment was really supposed to be in February, with two of his brothers. We usually try to schedule all 5 of our younger boys within a week (our oldest son goes to a different Dentist), so I asked about the other two boys and then found out that the office still did not have all 5 of our boys listed together as belonging to the same family. Three of them were in one group, and our twins were in another. This computer problem was fixed, and appointments for the twins were added to the February date. About this time, Logan’s name was called, so I accompanied him back to the area where cleanings are done, still wondering why his appointment for that day was not showing up on the office computers.
A recent photo of Logan
From the beginning of that day, even though I had office mix-ups to handle, Logan was a little gentleman. That morning, he was excited about going to the Dentist! Wonder of wonders! We used to avoid telling him. Then, as soon as we pulled into the parking lot at the Dentist’s office, he would start saying, “No! No!”; but on this morning, he went willingly and happily. He played while while we were waiting and shared with a younger child who was there. When his name was called, I didn’t have to carry him or drag him to the chair. He walked back on his own, climbed up in the chair by himself, and did everything he was told to do (scoot up on the chair, wear sunglasses provided by the office to block the glare from the light, lean forward to have the cord for the ‘bib’ fastened around his neck, etc.). The hygienist who worked with him and cleaned his teeth is so wonderful. I would even go so far as to say that it is impossible that anyone could have done a better job with him than she did that morning. She talked to him so sweetly, and he really responded well. He was communicating with her, answering her questions (“Do you want some water?”, “Can you turn your head for me?”), and he was even telling her when he was not ready or was uncomfortable. Having help from another staffer was not even necessary. It was just the hygienist, Logan, and me. I did hold Logan’s hands to keep him from reaching up to grab for a tool or the hygienist’s hands if something bothered him, but I did not have to hold him down on the chair for most of the cleaning. He was actually relaxed and trusting. It was like witnessing a miracle. The oral sensitivity issues were not gone by any means, but he was choosing to conquer them by willing himself to be still and to cooperate. He was such a brave little man! When he was not quite ready for something, he would say, “No, thank you.” in a very civil tone of voice. He would reach his tolerance level for opening wide and saying “Ah”, and then he would have a suggestion for the hygienist. “Say ‘eee'”, he would tell her. (That’s what we have him say when we are trying to brush his front teeth.) She would comply and work on the front teeth for a little while and then get him to open wide once more. He was so incredibly good through the entire cleaning. He even tolerated and allowed the flossing with no protest. He did look panicky when the hygienist held up the long string of floss; but after she explained that she was using it to clean in between his teeth, Logan allowed the flossing even though it was clearly very uncomfortable for him. Finally, the hygienist was ready for the polishing paste on the rotating rubber cup that serves as the tooth polisher. That freaked Logan out. The combination of an unfamiliar taste and too much stuff in his mouth was gagging him, and I did have to hold his torso down for a few minutes to keep him from trying to sit up or get out of the chair. He was not screaming, but he was making some noises of discomfort (ugh, ahrg, ah). The rinsing and the clearing by “Mr. Thirsty” (the vacuum tube, which Logan was able to use properly when I told him to ‘kiss’ it and got a proper pucker) did help some, and the whole procedure was finally finished. Logan was quite ready to get down, but I did get him to say, “Thank you.” This was the best he had ever done for a Dentist appointment! However, our dental experience was not yet complete.
Just as Logan was getting out of the chair, another staffer from the Dentist’s office came to tell me that they had finally located Logan’s appointment and that what he had been supposed to have was an extraction. I was totally shocked at this news. At Logan’s last visit, the Dentist had decided to wait on extracting any of the teeth in Logan’s two bottom rows (where the permanent teeth were coming in behind the baby ones). She was hopeful that the baby teeth would come out on their own and an extraction would not be needed. However, she did say that she wanted to see him again and would extract teeth later if necessary. I think that what happened was that a follow-up visit to re-evaluate the extra row of teeth was scheduled; and the Dentist later may have requested that her staff schedule extra time for an extraction on that day, just in case she decided to remove any teeth during the appointment. We were never told that an extraction time had been set up. Hence, the mix-up about not knowing what type of appointment to have the office staff locate on their schedule. At this point, I was not sure that Logan was going to tolerate any more oral intrusion after what he’d just been through with the gagging and discomfort during the application of the polishing paste; but the Dentist was ready to re-evaluate his teeth and perhaps do an extraction. However, first she wanted an X-ray.
Off we went to an X-ray room. Logan was kind of quiet, but he walked into the room and willingly climbed up into the chair. He didn’t protest when the lead apron was placed over him. Then, the X-ray technician was ready for him to place the camera into his mouth. The camera housing was a pill-box sized brown plastic rectangle, about 3/4 inch thick, with a long cord dangling from it. Without knowing Logan’s oral sensitivity issues or about the fact that he didn’t bite or chew and has a strong aversion to the cookies and crackers that people have always tried to get him to eat, the X-ray Technician said something that I just knew would have Logan running for the hills. She said, “You just have to bite down on it like you are biting a cookie.” The young woman had no idea that she was saying this to a little boy who never bit and chewed on toys or teethers, never chewed his food, and who was in special feeding therapy to overcome this very issue. She had no way of knowing that only a month before, Logan had a 10 minute long meltdown at his therapy just because his therapist had brought a cracker into the room. She wasn’t aware that Logan had successfully taken a tiny bite at two therapy sessions in a row, only to then become so freaked out about biting that his therapist had been forced to back off on trying to repeat it (still his current status). I waited for Logan to cry or jump out of the chair, but he just sat there. I didn’t say anything to the X-ray Tech at that point because it takes too long to explain and because I wanted to give Logan a chance to be my big, brave boy once more. He did not disappoint. Bless his little heart. The Technician told him to open wide, and he did. She told him to bite down on the plastic camera housing, and he did. However, he was unable to hold the thing in his mouth long enough; and she missed her opportunity for an X-ray on the first try. At that point, I said, “He has extreme oral sensitivity and normally doesn’t bite or chew. We can try again, but it’s going to have to be quick.” She got her cord in hand with the go button and repeated the insertion of the camera housing. Once again, Logan was a trooper. He opened wide and bit down. She was quick and got the X-ray on attempt #2. I didn’t even leave the room or have protective radiation blocking. Sometimes a Mom just has to do what a Mom has to do. If Logan was going to do this incredibly brave thing…twice!…I was going to be right there with him. The X-ray Tech checked to make sure that the picture was a keeper, and then we were ushered off to another room to await the Dentist.
Again, Logan walked willingly and got up into the chair willingly. We didn’t have to wait long for the Dentist. In the meantime, Logan was distracted for a few minutes by the wall-mounted television in the room, playing part of the “Bug’s Life” movie, which is one of his favorites. However, when the Dentist came in to look at his teeth, Logan had reached his limit. He would not cooperate with her at all as far as turning his head the way she needed and opening his mouth. A staffer had to help, and I was on duty holding Logan’s arms again. The Dentist turned to me and explained that she was going to extract two of his baby teeth, which would allow the permanent teeth to begin moving forward and then hopefully crowd out the remaining baby teeth. However, because Logan had reached his limit and was not cooperative, she would not be doing the extraction on that day. She was going to need to have him anesthetized, with both medication and laughing gas. We would have to come back on another day, and he would have to be out of school for the whole day. The extractions would be really quick, but the effects of the anesthesia would take up to 7 hours to wear off. We will go back next week for this procedure. Once again, both Dad and Mom will be there. Hopefully, we can get this done without too much trauma.
As I drove Logan to school after his appointment, I reflected on the way that events had transpired and marvelled at the progress that Logan has made and at his extraordinary effort and bravery on that day. I am thankful that the computer issues happened that morning. We were able to get Logan’s cleaning out of the way, and he was able to have the most positive dental experience that he has ever had. Hopefully, he will remember the good and not be able to remember the extraction. If he had gone directly in to see the Dentist in the cooperative mood he exhiblited for so long on that day, the Dentist might have tried the extraction without anesthesia (with nitrous oxide and numbing injections only); and the procedure could have been very traumatic for him. I was so glad that the appointment turned out as it did and that after the extraction, Logan will not have to go back to the Dentist for a while since his cleaning is already done. Again, I marveled at Logan’s good humor and his bravery. He tried so hard to be good and to be brave, to do what was asked of him, and to conquer his fears and discomfort for a very long time that morning. I didn’t think I would have done as well under those circumstances.
I drove a happy little Logan to school. He was ready to resume his routine, and the Aide from his Moderate Autism 3rd grade class greeted him with a joyful hug. I explained that he’d just come from the Dentist and had not yet had his lunch. Our appointment had stretched to almost two hours, and Logan had missed having lunch with his peers. We send Logan’s lunch to school in his backpack since he has a special diet. I was glad that I had included a cold pack in Logan’s big food baggie that morning since the appointment had been longer than expected. The Aide assured me that he could eat in the classroom and that all would be well. How thankful I am for people like her and for the wonderful Hygienist who was so good and patient. How thankful I am for unexplainable circumstances and graces like phantom appointments and for the precious gift of a very brave little boy!
Update: Logan’s tooth extraction is over, and he is doing just fine! My husband, Travis, and I were both there for the procedure, and it took both of us helping (with Travis holding Logan’s legs and me holding the arms) plus the Dentist and 2 assistants to get everything done. One of the assistants was handing things to the Dentist, and the other one had to use a special tool to keep Logan’s mouth open. Logan did have anesthesia and laughing gas. He did very well keeping the mask on his face, but he did not like the numbing of his gums, the process of having sealants put on his back molars, or the extraction. We did have to work together to hold him still and get it done, but hopefully the anesthesia will prevent him from remembering it very well. Logan couldn’t stand up after the procedure, so I was glad that Travis was there to carry him to the car and into the house. One of the hardest things that day was not being able to let Logan eat breakfast, but he was pretty good about it. He got his oatmeal with yogurt (his usual breakfast) after he’d been home for a while and was awake enough to eat. He rested on the couch and watched TV for a couple of hours, and he was fully alert by the time his brothers got home from school. After that, you wouldn’t have known anything took place. He’s been a happy camper ever since. 🙂
Update on Logan’s feeding therapy, June, 2013:
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Travis L. Boyd / WorshipSounds Music
Family Song 