A little preparation can go a long way toward helping your small child have a more positive dental experience.

Weeks prior:  Read books, play dentist, have child brush adult’s teeth, doll’s teeth, stuffed animal’s teeth.  If your child will be having gas sedation and you have access to a CPAP (sleep apnea) machine or another similar device, you may want to give your child a chance to play around with the mask.

Morning of:  Tell child that you’re going to the dentist, that the dentist will count her teeth.  Depending on whether the child is aware of the problem that will be fixed, you can explain in simple language:  “[Dentist name] is going to help your teeth so that they won’t hurt anymore.” 

Pack your toolkit, including:

• Comfort objects (stuffed animal, blanket, pacifier, etc.)
• Lavender or any favorite calming essential oil on a small cloth in a baggie
• Rescue Remedy, administered prior to appointment
• Portable DVD player (or favorite DVD if the office has a DVD player)
• Any positive distractions you can think of – favorite toys, stickers, silly mask for you to wear!
• Chamomile tea to drink before and after the appointment (warm if possible)

Most importantly, try to stay calm, positive, and reinforce the message that you are there with her, and that you’ll all get through it together.

Surviving a Dental Procedure with Your Toddler or Child

When my daughter was a few days shy of 21 months, we took her to a dentist at our local Children’s Hospital to have decay removed from both sides of her top four front teeth.  The method used was Atraumatic Restorative Therapy (ART). 

Here’s what I wrote the night after the procedure:

Unfortunately, the experience was not atraumatic – at least for mama.  On the advice of our dentist regarding the standard of care for a child her age and with her level of decay, we chose to do the procedure without sedation.  We opted to use the papoose (baby straight jacket on a board) rather than the knee-to-knee posture (her body in my lap with her head on the dentist's lap).  If I had it to do over again (and hope I never do!), I think I would still choose the papoose, but it was incredibly hard to see her writhing around trying to get free.  I didn't like the design of this papoose -- there was a very small (perhaps 4-inch wide) board under her head, so it kept flopping around when the dentist wasn't holding it.  Then there was the bright light shining in her face and the clamp they put in her mouth to keep it open, which made her gums bleed by the end.  None of the distractions we brought (including the new portable DVD, stickers, etc.) were any match for this setup.  I wiggled my hand into the papoose and touched her leg during the procedure and kept speaking to her, saying, "Mommy and Abba [our word for Daddy] are here with you, we're here together, and it will be over soon."  At one point, I had my husband fish out a cloth with lavender on it and I put it up on her chest.  Prior to the procedure I gave her chamomile tea and Rescue Remedy.  I felt pretty calm during the whole thing but I felt myself disassociating (feeling "out-of-body") because it was so difficult for me to witness (I have memories of having my teeth brushed). 

Most importantly, she seemed to be fine – if a little dazed – after the procedure and was back to herself within a few minutes.  The dentist said that he got all of the decay, with the exception of a little bit that was left behind on the tooth that was in the worst condition.  He explained that he had to err on the side of caution and avoid exposing the root, which he said would have been painful to her and potentially made it necessary to extract her tooth.  Going forward, as long as we are able to keep the decay under control with brushing, diet, xylitol, etc., he said we will definitely not need extractions. Whew!  The glass ionomer material that he used contains flouride that will be released into the cavity and help remineralize the teeth. 

The whole thing felt a little too hasty to me -- I think it would have been easier if he could have gone more slowly at the beginning to get her more comfortable with the dentist doing stuff in her mouth.  The major piece of advice I have for anyone else thinking about this is to try and block off extra time with the dentist if it is important to you to not feel rushed (obviously, best to discuss this with the dentist in advance since their openness to doing this is probably indicative of their overall style).  In our case, I think the timing was a function of being in a clinic setting at Children's Hospital rather than a private office.  Our dentist seemed much more rushed than he had seemed in our previous appointment.  I do think he did an impressive job of filling her teeth while she was thrashing around.  Though he said that the glass ionomer/ART fillings weren't meant to be especially nice looking,

I am just glad that the decay is out of there and that we have a second chance.  We're absolutely going to continue with night nursing, but really try to ramp up wiping her teeth with xylitol gel after each time and putting xylitol on the nipples.  The only limitation will be my own fatigue level causing me to fall asleep before she's done nursing; I have to start getting to bed earlier!!  It just occurred to me that one upside of her waking every 3-4 hours is that if I wipe her teeth each time, then there is no difference between night and day, and in fact, with only breastmilk in her mouth, nighttime should be even less hospitable to the bacteria that cause tooth decay.  (I don't know why I didn't think of this before.)

Tonight in the bath she said something that I couldn't quite make out about the dentist, and I said, "Yeah, we saw Dr. G and he did something special to take care of your teeth.  It was hard, but you did a really good job."  She cried out in her sleep tonight and it sounded like the way she cried during the procedure.  So although she seems fine externally, I would not be surprised if this experience has entered her unconscious mind and will play itself out in dreams, etc.  I do have hope that the secure bonding I have tried to create with attachment/unconditional parenting will guide her through this experience without too much baggage.

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