Office of _______ Pediatric Dentistry
In order to improve the chances of your child having a positive experience in our office, we are selective in our use of words. We try to avoid words that scare the child due to previous experiences. Please support us by NOT USING negative words that are often used for dental care. These include:
DON’T USE: needle or shot; INSTEAD: sleepy juice
DON’T USE: drill; INSTEAD: whistle
DON’T USE: drill on tooth; INSTEAD: clean a tooth
DON’T USE: pull or yank tooth; INSTEAD: wiggle a tooth out
DON’T USE: decay, cavity; INSTEAD: sugar bug
DON’T USE: examination; INSTEAD: count teeth
DON’T USE: tooth cleaning; INSTEAD: tickle teeth
DON’T USE: explorer; INSTEAD: toothpick
DON’T USE: rubber dam; INSTEAD: raincoat
DON’T USE: gas; INSTEAD: magic air
This will help you understand your child’s description of the filling experience. Our intention is not to “fool” the child – it is to create an experience that is positive. We appreciate your cooperation in helping us build a good attidude for your child!
Today I have been through something almost bigger than words. It was like having my world briefly torn in half and now I’m working on mending. To many, it might not seem like much. To me, the struggle I have now is in trying to write it all out concisely and accurately although there is no chance, really, of me forgetting it.
The above “Practice Terminology” was given to me almost three years ago when I first stared taking my children to a recommended pediatric dentist. The handout gave me pause – big time. But hey, I’m no dentist. After all, this was a highly-regarded pediatric practice (employing several people I personally know) absolutely posh compared to my childhood tooth doctor. The first appointments flew by and the kids were happy. Over the years I had no reason to reconsider our practitioners, even if I was a bit confused at the de rigueur application of nitrous oxide – whoops, “magic air” – and the times I’d pass a room and see adults looming over children and holding them firmly and speaking in STERN-VOICE. Fine, whatever; I hung out with my kids during the procedures – cleanings, x-rays, and fillings – and everything seemed fine and friendly and none of stern voice that unpleasantness was involved.
But today I got to see first-hand how the staff treats a child who wants to direct an aspect of their own care.
After cheerful and hilarious teeth-cleanings during which my children happily participated, Nels told me he understood he needed fillings – sorry, there isn’t a “whimsy word” for those – but that he didn’t want to have the rubber dam (“raincoat”) installed. He never wavered on this (I realize now) and the possibility of proceeding without one was never discussed by the staff.
Over the next forty minutes or so as we proceeded with this attempt of a filling I watched as an increasingly unpleasant and confusing (to me) negotiation took place. Mostly this was done by grownups coming in the exam room and talking quickly, or at times sternly, or bargaining, all the while dialing up, and up, and up, the applied mask full of nitrous oxide (apparently there are no side effects to this?). The assistant began to speak faster and faster and crank the dial up and bribe him with extra quarter-vending toys (Seriously. What the hell? Maybe that works for some kids?) and plead a Trustworthiness my son obviously found unearned. In response to his questions about the “raincoat”, she’d tell him they weren’t talking about that now, just to lean back and open his mouth. Nels said, “I think you’re trying to trick me.” Then he pointed to the “raincoat” and said – “I can see it!”
It really would have been comical if it weren’t that, over time, he became more convinced that what I’ve told him all this time – “Remember Nels, it’s your body” – would not, in fact, be respected; that he would instead be forced to undergo something he found terrifying.
After a while Nels began to cry. He asked me to go home. He said, “I love you!” and held my neck. Even then I truly thought he’d change his mind (as he had when he voluntarily received vaccinations half a year ago – although then it was a far briefer episode of trepidation and he was not drugged during this event). Eventually I was asked out of the room by the dentist (asked nicely). In the hallway he assured me children did better without their parents (I’ll bet). He told me they wouldn’t physically hold down my child. Okay. Well, instead of retiring to the waiting room as they suggested (out of earshot) I stated my intention to sit right there outside.
And I sat down.
The dentist re-entered the exam room and for a long while I heard nothing. I called my husband on the phone and said some stuff. I hung up. Tears welled in my eyes as I looked out the window. A hygienist passed by, did a double-take, and asked, “Are you okay?” I shook my head and said No. She asked if she could get me something; I shook my head and said No. She silently handed me a box of tissues and I said Thank You.
Ten minutes later to my surprise the door opened and the members of the practice emerged. They were sort of laughing, but rather grimly. “That is a strong-willed little boy you have there,” the dentist said. He had conceded defeat but he wasn’t happy about it (like most practices they run a very tight schedule and, after all, he’d just had his time “wasted”). My son emerged and – even entirely looped-out on Novocain and nitrous – he was still himself. He was calm and sure.
See, he did not want a “raincoat”.
I realized the adults were entirely surprised at his resistance given the massive doses of gas administered and the two- (or three?)on-one adult treatment they’d done in that little room.
And I realized – at that moment –
I realized I’d sold him out.
But he’d prevailed anyway.
He is six years old.
While Nels wandered out into the waiting room the doctor talked words at me. I could hear him but I was also non-responsive, feeling the entire body-blow, the fact I’d betrayed my son and humiliated myself by failing my own strength. After a few minutes the roar of blood in my ears died down enough I could hear the doctor telling me that although my son said he would return later to get his fillings, it was a concern the same episode might happen again. The doctor told me about a medicine, an even stronger one, he could give my child. The dentist was smiling when he told me it was “kind of like giving a child a six-pack of beer”. Occasionally the medicine had the effect of making the patient angry. Of course parents couldn’t be in the room during the procedure. The staff needed to “focus” on the child. “There wasn’t enough room.”
My brain started working again as I paid attention to what the man was saying. At that point an assistant busied up to us. “Two Versed procedures, right?” she briskly asked the dentist, pushing blue forms at me to sign for the next visit. I signed them, knowing it was the easiest way for now. I thanked them for their time and acknowledged the missed opportunity they had. As my pen finished on the form the assistant just mentioned, is all, that children under sedation would get happy “floating” hands so they’d use these light straps to control the hands. And she pushed the blue forms at me. I have them here now. It makes me ill to read. “No food eight (8) hours prior to sedation…… we suggest bringing a change of clothes, since it is common for children to lose bladder control during a sedation… Keep your child’s head upright and slightly flexed backward…. papoose safety wrap may be determined necessary.”
That fucking “wrap” is going to be used most every time because the child will be flailing in a nightmarish, horrible, drugged and fear-laden state and that’s why there is no way they’d let a parent see the procedure.
It was when the doctor spoke of the “kindness” of the medicine as having an “amnesiac” effect that I recognized the whiff of the horrific “Twilight Sleep” (and let me tell you what a total goddamned travesty it is how few articles delve into exactly what this really was; the pictures in this one give me the chills). And I was right, because when I got home – after Nels sweetly asked for cuddling and fell asleep, and while our other child warmed up from our outdoor exertions – I looked up the medicine, and was horrified to read of experiences (verified by both user experience and the U.S. National Library of Medicine and lots of other places). At first I felt shocked a practitioner would so lightly ‘splain this medicine and gloss over the experience of patients. But later I felt only sadness: this man has performed such procedures on many, many children. It must be a part of his job he dislikes immensely – unless by now he is deadened to it all.
Almost tangentially – in what otherwise would have been the preoccupying subject of my day – they also recommended a tooth extraction and lower lingual arch for our other child, who agreed to this. We’ve been discussing the treatment. After Nels’ experience I barely had room for this except to feel deeply grateful for both my children and both their abilities at self-validated choices. As far as Phoenix’s prognosis goes, we don’t know anything about extractions or devices worn by children, so I guess we need to do some research.
In the car I felt safe enough to sit quietly. Nels hummed to himself and sat on my lap. He asked me what they wanted to do next. I said, “They want to give you lots of drugs and tie you down.” Flatly, but almost in wonderment. Raw emotion passed over Nels’ face at this… then he said, “I never want to go there again.”
More power to those who take their children to this practice and are pleased with the results. I completely acknowledge the doctors’ intentions are good and many of their skillsets are impressive. Sheet of Lies aside, until today I’d had nothing but positive experiences.
My body memory now reminds me of a brutal hazing I saw in a movie once: pulling sheets over a slumbering person and beating them with socks full of oranges.
After our dentist visit I was due almost immediately for a rendezvous with our friends Steve and Kit – first we ate at Ace BBQ (unassuming website, delicious and inexpensive fare) and then a rather long nature walk at Tumwater Falls Park. In a short period of time I gained a semblance of “normal” and genuinely enjoyed the company of my friends, my children – and the lovely, wild falls – while my mind did me the kind service of dissociating from earlier events of the day, to later live them out.
And when I got home Ralph asked me for the full story of what had happened, when I was finally able to break down and cry.
Because you know, don’t you, what it was that scared me so much? It wasn’t that Nels was hurt and frightened. It was that I almost hurt and frightened him so much more before I came to my senses.
My husband respected me enough to confirm I’d let our children down today. I appreciate his honesty more than I can say. But then he told me something I hadn’t thought about. He told me I had created conditions that allowed them both to stand up today. Phoenix had autonomously agreed to treatment today – knowing what the treatment would be – and on the drive home crossly expressed annoyance at the Sheet of Lies(TM) – which made me smile. And then Ralph said, “Nels stood up to a a roomful of highly trained and educated medical professionals who’d drugged him and tried to force him to do something he didn’t want to do.”
Or as Steve said only a few hours before, in appreciation as we climbed alongside the roaring falls: “Nels, that is pretty punk rock!”