Christos’ dental journey

I recently got a message from Christos’ dentist, Ioanna, to tell me about his most recent visit and the progress he has made. I also wrote about one of his visits in 2015 – Back to the Dentist. I asked Ioanna if she would be willing to contribute to this blog and here is the result.

My first encounter with autism was 15 years ago when Christos was referred to me by his family dentist. He was the first child on the autism spectrum I had in my private practice as a young pediatric dentist. I knew nothing – as I realised later – about autism, but Christos inspired me to get involved and learn as much as I could.

And that’s how I was introduced to the world of autism. I am so lucky to have had the best guides! Unique Christos and his special family!

He was only 4 1/2 years old when I met him. His dental problems, the behavioral restrictions due to his young age and the difficulties due to autism made it easy to choose a full dental treatment under general anesthesia. The first goal was achieved. Our next goals – and most difficult ones! – were helping Christos brush and have good oral health as well as gaining his trust and cooperation for the frequent dental visits over the upcoming years.

Dental treatment doesn’t differentiate between people on the autism spectrum and other patients. Rather we have to be aware of behaviour management and accommodate the needs of the patient. This is a real challenge! Sensory disorders make it even more difficult. What I’ve learned, in the last 15 years, is that I have to be armed with patience, understanding, persistence, flexibility, creativity and love when I work with people on the autism spectrum…and with people in general!

In the beginning, I used to see Christos every 2-3 months. This was to help him become familiar with the dental office and, of course, with myself. I could see how hard it was for him to adjust and take in all those new things; smells, lights, doors, drawers!!!!  I must admit, it was hard for me too. I had to interpret his behaviour and the only reason I managed to do it was because of the great help of his parents. I felt them to be some kind of translation between me and my patient!

It took Christos 3 visits to finally sit on the dental chair and open his mouth. I tried to teach him and his parents how to brush. His mum and dad were so brave to fight that battle at home! (I think Dora described it once in one of her articles – Thinking about the things you don’t think about: b) Attack of the Toothbrush). You can see why brushing can be a real struggle for people on the autism spectrum! After that we managed to put some fluoride varnish – that’s one with the strange taste! – on his teeth! 2 1/2 years later we managed to do the fissure sealants on his newly erupted first permanent teeth! That meant that he would have to sit for a significantly longer period of time with his mouth open, tasting too many strange things with odd tastes and feeling all the weird textures. But we made it!

A moment I won’t forget is when I got a phone call from Christos’ dad one weekend. He was so happy and proud that Christos said my name while showing his moving tooth!!! This was Christos’ way of explaining that something was going on with his tooth and it was his dentist’s job to take care of it. It was another milestone in his personal progress and I was so excited and happy for him!

Another memory I have is of how anxious I was when we decided to extract two teeth to make space for the new ones. We needed to make sure the teeth settled and were arranged well as it wouldn’t be possible for Christos to have braces. I had to give him local anesthesia with an injection. However, once again Christos surprised me. He acted like it wasn’t a big deal at all! His parents and I were so relieved and so proud of him!

Step by step, Christos knew he had to accept and follow my rules; but I also had to follow his! I couldn’t break some of his routines. I had to accept and try to understand many strange (to me) behaviors and obsessiveness, especially at the start. For example, he wanted to drink water immediately after the fluoride application and throw the plastic cup in the dustbin. During every appointment I would try to convince him not to do that and …guess what? We made it last time!!! After 15 years!!! What did Christos teach me? Never give up on my goals! Keep trying!

His last visit also came with some very interesting parts. Christos took on the role of a role model for another special boy! The boy who had the appointment before Christos came back into the room when he saw him entering my office. I asked for Christos’ permission first but he didn’t look bothered by this other new person in the room. From Christos, this is a permission! If he didn’t want someone there, he would make it very clear! At the end of our appointment, I asked Christos’ mum if we could take a photo to send it to his sister with his progress. To my surprise, she had already done it!!! Not only that, but after the appointment I also got a warm sms from Christos’ dad! The people around him are so sharing, so loving and so alert.

A couple of years ago, I was part of an internet conversation with colleagues from other parts of the world to share useful experiences and knowledge about autism and dental treatment. I got a message from one of them saying “You don’t want autistic patients!” His words shocked me. I thought about my long journey and realised how valuable it was for my career, my personality, my view about people and life to meet Christos.

One of the interesting parts of my job – and it’s one of them that I love! – is that I can follow the changes in the life of my young patients and their families. It’s amazing! I had the chance to see Christos growing, starting to talk, improving his communication skills, being happy after his trips to meet his sister, being a teenager with a big change in his behaviour and becoming an adult. His family shared some of their worries, some of their endless efforts to give support to their hero, some of their philosophy about life with me.

Christos gave me the first piece of the autism puzzle and it is a precious one! I want to really thank him for it!

Thank you Ioanna for your words. But mostly, thank you for your patience, kindness and love over the time my family has known you. I can only say that I hope you are a role model to your colleagues in the same way that you are an inspiration to those around you.

PS: The green thing Christo is holding in the photo is a mirror so he can watch exactly what Ioanna is doing. Did someone say control-freak? 


Thinking about the things you don’t think about: b) Attack of the Toothbrush

So, I can write a lot about this because I went through it myself. You see, my dad (sorry daddy, I love you) has a real thing about brushing teeth. He sits there and stares at you while you brush, and if you don’t do it right he makes you do it again until you do it right. Who knew there was a right and wrong way? My dad does; not gonna lie, there were tears involved. He times you and asks you 3+ times a day if you’ve brushed your teeth. Even without Autism in our house, this would still be a daily thing. He just wants us to be at our healthiest all the time, but man it was a mission.

I had ‘okay’ teeth when I was little, personally I blame my nan for having a cake shop and the heaps of icing, sugar just low enough for me to reach. What was I supposed to do? Not cover myself in sugar and chocolate? Insanity. Anyway, I got my ‘adult teeth’ and they were pretty good, and then came the dentists. Dear Lord the dentists, they still give me nightmares. My dad can never come in with us at the dentist; he starts crying and it’s a whole ordeal. But everyone’s happy after it’s done… except me.

The reason I’m writing this is for you to imagine this PLUS Autism.

I mean it’s pretty rough having your teeth fall out when you have the ability to understand why; imagine not knowing. You wake up in the middle of the night because one of them fell out and you call your mum; imagine if you can’t. Your dad takes five minutes brushing your teeth and you don’t understand why. When he was younger and we had to do it for him it was a battle. There were tears, there were tantrums, there were fights, toothpaste everywhere. He hated it, we’d have to hold his head, have him sit on our laps, chase him around the house with the toothbrush. Unfortunately, he had really bad teeth as a result of his complete refusal to brush more than a few seconds. He had to have extensive repairs and even surgery. Again, tears, tantrums, he would not, under any circumstances let the dentist touch him. He would not sit still for any of it. I mean how could he with that light shining in his face, someone’s fingers in his mouth, the taste of gloves, the sound of the suction, the tools, the pain and us holding him down; again, this PLUS sensory sensitivity. It was unbearable to know he is in such pain, but it was for his own good, we insisted and persisted and now he doesn’t mind it as much. He had his operation and it was dreadful, we all fainted, we all cried, it was the kind of aftermath you would expect from a family like ours.

Once he started speech therapy and we started incorporating pictures and words in it things got better (Making routine flexible.) It was part of his routine now to brush his teeth, and he understood that he had to photodo it; he didn’t like it though. He had this cheekiness about the whole thing, he would try and wash off all the toothpaste off the toothbrush, he would pretend it was too hurtful, he would pretend to cry while he brushed, or try to kiss you or wipe the toothpaste on you. Like all things, he needed a time limit – my dad sitting there staring was incentive enough for me, but it wasn’t enough for Chris; so we started counting. It was 10 seconds on each side, up down, front teeth and tongue. I giggle when I remember saying to Chris when he got older “Time to brush your teeth” the sheer horror in his eyes, like it was “Come on time to torture you”. It’s so funny to remember the bathroom fights we used to have because he would do it too fast, or my dad would count Mississippily slow to get that extra second in, so Chris would get frustrated. When he learned how to count he would do it himself, no man on earth could count as fast as him while brushing his teeth. All the numbers mashed up into one. As you may have guessed, we had to have him start over again, and again, and again.

But, like in most cases, our persistence paid off. Brushing teeth has now become something he reminds us of. He doesn’t go to bed at night without brushing his teeth, by himself, for a whole minute. He even uses an electric toothbrush now – took some getting used to.

This, of course, takes a load off my dad because he now doesn’t have to sit there and stare or count; he just listens through the door and gives us a look when we do it wrong. It was all for a worthy cause though, we both have a healthy straight set of gnashers and didn’t need braces; all thanks to that wonderful man sitting there, staring at us while we brush.