First Dentist Visit

Today, I took Patrick to the dentist for the very first time. His pediatrician has been telling me for months that I need to and, well, routine dental care is actually a requirement for kids on a transplant list. But I’ve been nervous. Dental care is one of those things that can set bacteria loose in the bloodstream and I didn’t want to risk another infection with just a dental cleaning.

A few months ago, I resolved that I’d take Patrick to the dentist after I’d had a chance to pick the brains of the docs in Seattle about how to do it safely. Today was the day.

Patrick's favorite feature of the dentist's office was a magnet wall.

Patrick’s favorite feature of the dentist’s office was a magnet wall.

I did a TON of research in picking a dentist. I had a few requirements. 1)The dentist had to have experience with special needs kids. I know what it’s like to try to get treatment from a doctor who doesn’t know anything about TPN or central lines. I wasn’t going to risk that in a dentist. 2) He had to know how to handle Patrick’s sensory needs and do the work in a way that wouldn’t add to risks of oral aversion. 3) The dentist’s office had to be funner than Patrick’s average doctor’s office. After all, with all the hours he’s logged in boring hospital clinics, I figure he’s earned a really cool dentist.

This dentist's office had a playhouse

This dentist’s office had a playhouse

Finally, after hours of searching online, I came across a blog about this great dentist in South Jordan. Little People’s Dental.

They met all my requirements. Dr. Stewart did his pediatric dental residency at Primary Children’s and still works there in addition to his regular practice. His website had various videos of him teaching about children’s dental care on a local TV show and he seemed to know his stuff. The mom writing the blog raved about how well he did handling the sensory needs of the little boy. The admission paperwork (which I downloaded from their website) even had an optional page where I could tell the dentist about Patrick’s communication and sensory needs. And the office? Well, it had both a playhouse AND a slide.

Climbing up to the slide

Climbing up to the slide

The appointment went really well. Patrick was in love with the magnet wall inside the playhouse, though he soon thought the magnets should stick to all the walls in the office. He ran along the stepping stones, climbed up and down the stairs, and slid down the slide which he called an “AAiii!” Oh, and of course he flirted with the friendly office staff

Finally, it was time for the appointment. They showed us to the room and immediately pulled out a puzzle for Patrick to play with. This is why I have only one good picture from the room. Patrick saw the cabinet where the toys were kept.. it even had a hole in it that he could look into to see the other toys.. and so his attention went there for most of the visit. Besides, we hardly waited in the room at all.

Dr. Stewart came in and while Patrick played with the dental assistant, the toys, and the nifty button that made the dentist’s chair go up and down, Dr. Stewart asked me questions about Patrick’s medical needs: his liver, his TPN, his diet.

The toy cabinet in the exam room

The toy cabinet in the exam room

Then, he gave me a crash course in children’s dental health. Here are a few things I learned.

1) The primary caregiver’s dental history can affect the child. This has nothing to do with genetics. I guess it’s the bacteria that live in your mouth. Therefore, because I have had few cavities in my life, meaning my bacteria is good, there is a greater chance that the bacteria in Patrick’s mouth will be good, too.

2) However, the screwed up bacterial balance in a child with short gut can offset this, so we’ll still treat Patrick as being high risk for tooth decay.

3) It’s a good idea to let kids go at least 2 hours between eating to discourage tooth decay. That means that, at most, his “small frequent meals” would be about 6 times a day. This doesn’t count g-tube feeding. Right now that’s easy, but after transplant when frequent small snacks are a must, I may need to adapt to protect Patrick’s teeth.

4) Teeth that touch and deep pits and grooves are places most likely to get cavities, so they are important places to clean.

5) Patrick’s adult teeth are forming now. Who knows how his health will affect their development, but if there are problems (say from his liver) there are options to correct them.

It made me smile as the dentist warned about the dangers of candy, carbohydrates, juice and pop. (All on Patrick’s forever forbidden list.. But the message of keeping teeth clean was heard.) And I was surprised that he didn’t give me a lecture about using a pacifier. In fact, he said that it looked like I was following the exact right schedule for slowly weaning him away from it. He looked at Patrick’s teeth and answered my questions about safe non-food chewable options to meet Patrick’s need to chew.

I knew from the website that the dental exam wouldn’t be done in the dentist’s chair. Instead, he had Patrick sit on my lap, then he put his knees up to mine and had Patrick lay his head back on his lap. I restrained and comforted Patrick while Dr. Stewart counted his teeth. (Just cutting his 2-year-old molars, and he’ll have all his baby teeth.) He scraped the plaque off and that’s when Patrick started to get nervous.

Flossing was new and that made Patrick cry, but it was done quickly and we got to move on to funner things like toothbrushing and putting on fluoride. Dr. Stewart showed me the right way to do these, including where to put my fingers to help keep his mouth open without getting bitten and told me that the more we brush and floss at home, the less scary the dentist’s office will be.

Because he throws up easily, Patrick has permission to start using fluoride toothpaste now to make his teeth strong.. He’ll swallow it, but as long as I don’t give more than the size of a piece of rice each day, that should be ok.

Playing on the stepping stones

Playing on the stepping stones

And then, we were done. They gave Patrick a stack of “prizes,” mostly coupons for goodies, some of which Patrick can have, and some not. And then he said to brush and floss the way he’d shown me… including having Patrick lay back in my lap.. and to come back in 6 months.

It was everything I could have hoped for in a dentist visit. I’m glad I did my research because I don’t think we could have hoped for a better first trip to the dentist.

If you’re looking for a pediatric dentist, especial one who can handle special needs, I’d highly recommend Dr. Stewart.

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