First Visit to the Pediatric Dentist: Good Experience, Bad Results

First Visit to the Pediatric Dentist: Good Experience, Bad Results

Going to the dentist is one of my great fears. Yes, I go. No, I don’t like it. I've never liked it. My first experience as a child at a dentist office wasn’t good, and my sister’s was worse. I don’t remember my mom and dad being allowed to come back with me; I don’t remember going to a dentist that specialized in children; I don’t remember the dentist being warm and fuzzy; I don’t remember having my teeth cleaned without pain.

Based on those memories and my ongoing experiences with all things teeth and gum-related, Steve and I worked very hard to locate a dentist that would provide our kids with a better experience. Thankfully, his insurance lead us to a wonderful place here in Chicago designed specifically for children.

Yesterday, all four of us (Atia, Asher, Steve and I) trekked over to Clybourn for the kids’ first teeth cleaning. Now, before you begin writing your comments about how I should have taken Atia to the dentist well before she was 5 years old, please remember that in her very short lifetime, she’s already undergone 2+ years of DAILY chemotherapy treatment. And, although she’s been post-treatment for over a year, we’re just now getting back into the swing of it with standard immunizations and basic preventative maintenance.

Until you’ve had a child with cancer, it may be difficult to understand that it takes time to get back to “normal,” and to turn our attention to the “regular” things that “typical” parents and children do. After all, Atia just had her port removed a few weeks ago…

And sometime, you just need a break from all things medical!

In true big sister spirit, Atia opted to go first to show Asher how brave she was and that it wouldn't be a big deal, although I could see she was anxious about what this heroic gesture would warrant. She put shades on because the light was too bright; she moaned a bit from the soreness of having an open mouth for an extended period of time, and she dramatically showed us that the fluoride pastes tasted yucky by scowling and flicking her tongue outwardly. But overall, she did very well in the big blue reclining chair, even admitting that it wasn't that bad, once it was all over.

Next, it was Asher’s turn. He, too, did great. I sat in the chair with him, and after a few faint cries and moans, he closed his eyes and gave in. His cleaning seemed to go much more quickly than Atia’s.

Before we left, Atia had x-rays taken; Asher didn't (he's too young). She hesitantly sat on Steve’s lap. We  waited in the lobby for the results. Several minutes later, the dentist asked me to come back in the examination room without Atia and that’s when the pleasant experience began shifting...

It shouldn't have come as a surprise. Why would anyone think that baby’s teeth wouldn't be harmed when exposed to chemotherapy day-after-day, year-after-year? If I’d have Googled it in advance of the appointment, I would have found loads of links providing the same info:

Chemotherapy for the treatment of leukemia can cause shortening and thinning of the premolar roots and enamel abnormalities.[1,6,7] Childhood Cancer Survivor Study (CCSS) investigators identified age younger than 5 years and increased exposure to cyclophosphamide as significant risk factors for developmental dental abnormalities in long-term survivors of childhood cancer (source).

After everything she’s been through, now there was this. The x-rays showed eight cavities, and Atia would required sealant on four additional teeth. I couldn't believe what I was seeing on the film and hearing from the dentist. Her poor teeth had rampant decay as a result of the poison that fought her cancer - one of the hundreds of Late Onset Side Effects that she may experience over her lifetime.

The dentist proposed filling the cavities and adding the sealant over three session’s time. While I appreciated the gesture to reduce the overall impact by breaking up the procedures, I also knew that if the first session went bad, there was no way I was going to be able to convince Atia to come back for the second and third sessions. And if there’s one thing I’ve learned over the course of her treatment it’s that I need her partnership, her willingness. It’s critical; there’s no way I’d take her somewhere kicking and screaming, not after everything...

So, the question became what to do, and while brainstorming options, two questions manifested: (1) Was it really necessary to treat these cavities if they were on her baby teeth? My glimmer of hope was that this hadn't occurred to the dentist and therefore all of this would be a moot point. Unfortunately, that wasn't the case. The cavities are on and between those back molars which will stick around until she’s 10 to 12 years old – and (2) Did the dentist have access to an anesthesiologist? My thought was that maybe we could put Atia to sleep and do all the work at once.  Surprisingly, the dentist agreed that this was actually something we should consider.

Defeated, desperate and depressed about what Atia would be facing in the coming weeks, I somberly drove the family home.

While we succeeded in our goal to find a wonderful dentist, the universe threw us a curve ball (as it always seem to). I ended up spending all afternoon on the phone with the dentist office, Atia’s pediatric oncologist, and the anesthesiologist to come up with a plan. I am so very grateful for this amazing group of medical experts. I’m glad they’re on our team. I just wish we didn't have to consult them so very often…

We are still undecided with exactly how to move forward with this unexpected issue, but we've made some headway and begun pursuing one particular option. Tomorrow, I'll be reaching out to the insurance company to see how they can help.

About a year ago, my friend Sarah wrote a guest blog about Childhood Tooth Decay, and seems remiss not to mention it here. It's definitely worth reading.

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