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Time for a Refresher Course

Charlie at a dentist appointment that was successful in a different kind of way  We thought Friday would begin in an unremarkable way. Charlie had an early dentist appointment at the dentist he's been going to for a couple of years, and quite successfully. We've never been able to do an x-ray but Charlie usually gets through letting the dentist look in his mouth and check his teeth, the tooth-brushing, and even fluoride. Some years ago we did an ABA program which mostly involved teaching him to lie down with his mouth open and hands down. Though one of course doesn't visit the dentist too much (thankfully!), Charlie's visits for the past two years have gone well: The dentist is a compassionate man who really seems to want to see kids like Charlie. Last time, it was just him and Jim who went.

This time, we all went. Maybe from some unconscious worry about being late, I thought the appointment was at 8am when it was at 8.30am, so we had to wait in the waiting room for a half hour, while more than a few children went in and came out. Charlie did fabulous. He didn't want to sit and paced the room, repeating some phrases over and over; we knew these were self-calming measures, "others" waiters in the waiting room were not so thrilled by Charlie's presence His voice carried far and he was most comfortable standing somewhat in the middle of the room, but Jim and I knew, he could have been far less happy, in ways that no one would prefer to witness.)

Charlie went right in, us in his wake, when his name was called. He sat down in the dentist chair and starting opening his mouth. 

The hygienist asked about his medications, and she and the dentist started counting his fingers and then coaxing him to count his teeth, and Charlie twisted his head away, and the dentist was able to see that there could be something like a cavity (Charlie has yet to have one) at the back of Charlie's mouth and he took out one of his metal dental instruments and Charlie started clamming up. Jim stepped in, I tried to model Charlie opening his mouth and he did it but only for a few seconds, Charlie asked to get up-----

After five minutes of this, Jim and Charlie (not agitated, but insistent that it was Time To Get Going---that smile on his face in the photo was his expression throughout) went to the car. I ended up having a ten minute conversation with the dentist about his plans to start having an anesthesiologist in his office so kids like Charlie don't have to go to hospitals to get such dental work done, and parents don't get stuck with huge bills to pay out of pocket, and then the dentist went into how he was going to remodel two rooms by knocking down a wall and how he'd have to get a generator as a back-up source of power and he was hoping to have this done by April by there's NJ state regulations so June is looking more likely----sounds good.

Jim came in looking for me and we both heartily espoused the dentist's plans. He certainly doesn't have to do any of that---he has a steady stream of patients, many kids on the spectrum---I'm really glad he's planning to do so. I rescheduled Charlie's appointment for 8am May 4th (ok, blog friend readers, I put that down to remind myself!); Charlie asked repeatedly for "green Sprite green Sprite"; we dropped off a quite happy Charlie at school.

In the car on the way to Jersey City, Jim noted that he thinks Charlie is fine without the soda, however much he seems to be asking for it---that he's talking about it to "fill the time" to help himself transition from one thing to another. And then we had a long talk about the whole appointment as really a success (barring my memory slip). Obviously there'd been a lot of unexpected-ness for Charlie to handle, plus the atmosphere in the waiting room had been not the friendliest. The dentist and hygienist were, as all the staff at this office have consistently been, welcoming and good-hearted, but (as Jim noted), they should have just skipped all the explanations and gone right to work on Charlie's teeth---he had opened his mouth soon as he got in the chair. Time to write up a Charlie at the Dentist Guide, for ourselves.

I did talk about the dentist appointment throughout the week with Charlie, the same procedure as in the past. But something was different about Charlie this time. He is older, he for sure has more of a sense of himself and his own wants. What he learned from his old (home) ABA therapists has lasted him well for several appointments, but time to try something new. I'm not quite sure what; I do plan to talk to Charlie's teacher about doing a dental program and getting dentist tools and practicing "open mouth" and "hands down" as we once did.

It was a good reminder about we can get stuck in our own rut and need to revisit old things and try new ones.

Which brings me to the iPod Touch.

My parents got Charlie one for Christmas. After him throwing away his iPod nano, and reflecting on the times he had thrown other iPods and various other household items, I've been a little reluctant to get hin started on it. Music seems to be particularly over-stimulating for Charlie these days; he's shown no desire to use headphones (he threw away those, too). I've been waffling about getting some of the augmentative communication apps for the iPod touch like Proloquo2Go, having heard stories of friends' kids liking the iPod touch no problem, and ignoring the special apps.

Emma at The Iron Chicken recently got an iPod touch for her son Dimitri and has been trying Voice4u and Look2Learn. She's got a video of Dimitri using Look2Learn and a great post noting the cons and pros (and really helpful comments with suggestions from parents who've used the software). Look2Learn, Emma notes, has some advantages for a child who has less than perfect fine-motor coordination. Some of these apps only have "I want" as a verb choice; as the one communication Charlie tends to do a lot of is requesting, I'm wondering if the more elaborate (in some ways) (and much more pricey) ProLoquo2Go might be of more use.

I'm more eager to read more about these apps and to consider getting them to try with Charlie. In the meantime, I found myself emboldened to try Charlie with his iPod touch again. On one of our walks (motion gets my thinking going too), I thought of how I can load photos onto it---of things Charlie likes or might request, perhaps, or of places. Also, it occurred to me that I can use the Notes function to type out schedules and lists for Charlie. Not that it's a big burden to carry around a pen and a scrap of paper but the iPod touch offers some more possibilities---I can save the notes, show them to Charlie again.

So last night, between typing on the laptop, and noting how proficient Charlie has gotten at that---he types with much more confidence, speed, accuracy than a few months ago---I took out the iPod touch (securely enclosed in a plastic case). First I opened up a note and asked Charlie to type "Barney." Even though the keyboard is so very small and it's a touch screen, he typed the word perfectly and also a few more words I dictated to him. I also showed Charlie how to press the bottom button and gently touch his finger to "unlock" the screen.. He didn't resist. I'd even say, he was curious.

A little refresher of what you thought you knew, and you realize there's a lot more possibilities than you may well have first thought were there.


Jersey Mother

We take our adult child who is also affected by autism to a specialized dentist in NJ. They only work with disabled patients, I definitely be be glad to give you the number and name if you like? They are in long branch, and are highly recommended in the disabled community.

My child bites, scratches, willl go into a full head banging mode, and attack others around them. We went through hell to get their teeth cleaned, now I as a mother don't have to worry anymore.

Kristina Chew

thank you, I would love to get this dentist's name. our current dentist serves a lot of special needs kids but it's gotten a little different now that Charlie is so much older, and taller.

Jersey Mother

My apologies, I have looked up the name and it is in holmdel not long brach, however the name is Dr. Lichtenstein. The number is 739-3337. It is at 732 N. Beers St, Holmdel 07733.

The dentist isn't always the most personality friendly, but does an amazing job, and the staff is absolutely fabulous. Let me know if you do see him, and your experience with them. Best of luck!


Dr. Hoffman, 1-732-238-4422, does a fabulous job. We like him a lot. He works with many on the spectrum.

karen d

Pete has an iPod touch (given to him by his godfather for xmas!) and he loves it. It's just music he wants.

How wonderful to see in the comments that there are at least a couple of dentists who specialize in dental treatment for people with special needs (adults even!) We've been very lucky that our dentists are good friends (before they even went to dental school -- they are a married couple) and one of their hygenists has a son on the spectrum.

And yes, your day sounds like a success to me, even though Charlie didn't get his teeth checked.


Not to be negative, but I am not a fan of office sedation. My older son (who has CP, certainly different issues) had oral surgery in the hospital. Thank g-d he was there b/c they had trouble suctioning him and he almost died. My other son with Autism has had dental work done in the hospital. Kids with Autism can be tricky b/c their arousal states might be different than others. If they start to wake up, are confused, can become very frightened and agitated. My experience has led me to believe that sedation of this sort should only be done in the hospital for special needs kids.


With Ben, the fewer words the better! I often forget that. The doctor was making too many requests, probably thinking he was keeping his mind off what was going on, but sounds like it made Charlie more nervous.

Kristina Chew

We should have asked for one hygienist---a guy---he's good with Charlie. The dentist is compassionate guy and we're looking forward to returning!


I, for one, am celebrating the possibilities you are discovering for Charlie...in so very many ways!

Susan B

When my son was younger, maybe around 6 or 7, I mentioned to his school nurse about problems we had at the dentist office. At the time he was at a private school for kids with autism in NJ. The nurse put together a great educational program for his class to help all the kids prepare for a visit to the dentist. She showed them what she looks like with a dentist mask on so they wouldn't be afraid of that, brought a giant toothbrush and model of the teeth and showed them how to brush properly, and had them practice opening their mouths, etc. Maybe you can talk to the nurse at Charlie's school and see if she can do something like that?

Kristina Chew

@Susan B,
Great idea! Will bring that up, too, with Charlie's teacher, thank you!

Kristina Chew

We've definitely thought about taking Charlie to the hospital for dental work. One concern was that insurance might not/would not cover this---not an insurmountable problem for us, but one to consider. I have looked into some other dentists in NJ that use office sedation and had some concerns about them----will have to see what develops with our dentist. Thanks for noting about arousal states and sedation in autistic kids---much to research.

@karen d, envying your dentist!

funny thing is, in the Bay Area, we know a dentist or two and my uncle is a dentist in Sacramento.......


I am fortunate that my boys have done pretty well with the dentist. Xrays have been tried but not accomplished for Andy. (He thinks the xray will hurt him?)

We have seen the same pediatric dentist for 9 years now. The staff is wondeful but we seem to get a new person every visit or 2. Then we have to explain all over again about the boys.

There are so many fun apps for the iPod Touch. Did you show Charlie that he can get YouTube? (As long as there is wifi.)


John loves loves loves his itouch. We did get him proloquo2go when it first came out -- and while I think it's a phenomenal app, John so far shows no interest in it (which I attribute more to his age). He is quite adept at finding videos on youtube and there are so many interesting game apps, educational ones too, it's very motivating for him. Good luck with it! Maybe one of your friends could let you play around w/the proloquo2go before you purchase it.


I highly recommend P2Go - be it on an iPhone; iPod ... or iPad (which I need to work on first before ultimately confirming). I would set aside, also, any kind of set structued way of teaching it or imposing or enforcing its use at first in any way that does not stress the creative and the exploratory above all.

I know some great schools encouraging use of P2Go in their environments; very much supporting it in the manner the student desires to use it. As well as the SLPs at those schools actively working with any of their students who bring in their iPhones/iPods to assist them in their use of P2Go.

Jersey Mother

Yes our dentist does sedation, but usually most of the time it is just laughing gas, or numbing cream to help some of the fear. His staff is fully trained and has extra weighted lead aprons, blankets, special glasses and soft music in the rooms.

What I love the best about our dentist is that during the whole process, they monitor the heart rate of the child and are prepared for anything.

I hope the best for your son, please let us know how it goes!


I went with a client to a great dentist here, who is apparently used by a large number of my clients, and one of the private autism schools, when they do work to teach kids to go to the dentist, will use this place. It was apparently several trips before the dentist even looked in this child's mouth on the occasion when I went with her. Prior to when I went, they suggested some things to help get her ready for the dentist coming in to look at her teeth, and when I was there, they suggested something to start doing in order to help get her ready to do x-rays. If I am correct about where I believe you live, I don't think it's as far as CHOP, however, I believe they don't do sedation there. I'll have to ask another kid's mom in a bit, because I believe he has gone there, but they've sent him to CHOP for sedation.


I can heartily recommend the previously mentioned Dr. Hoffman. He and his daughter practice together and my kids, who are not on the spectrum - just regular kids - go to him. He's patient and he explains what's going on. He's a major reason why my three have no fear of the dentist (and none of them has ever had a single cavity!)
Charlie probably has no idea why he has to open his mouth and keep it open why a guy or gal pokes around in it with pointy tools.
I noticed what looks like a bump on Charlie's head in the photo. Is that from head banging? Poor guy. He's a handsome boy. Hopefully the bump will subside in time.


You've said that Charlie used to be cool at the dentist, right? Is it possible the wait was just...too..long this time, or has this always been kind of on the edge? In any event being up close and personal, I'm sure that you and Jim can gauge what you need and want to do, and change of plan and a progressive practice program could be helpful.
This is just a personal note, but has Charlie gone through sedation before, and come through it well? If so, cool. If not, you might want to talk to your dentist about how his other patients have handled it. My daughter is relatively gentle and cooperative and she turned into the equivalent of a combative drunk when coming out of sedation (that may be unique to us, but I was warned that was a possibility); for that reason I was kind of glad that we chose the hospital for the first time. But like anything else, it probably depends on the individual and what is used - people have posed other options.
We've been working on this for awhile, and have a great friendly bear of a dentist with a great staff, so our daughter actually looks forward to going and we've been able each time to make progress towards having procedures done without anything more than would be done with any other kid, and I've tried to scoot myself out of the picture (foot by foot (smile)). Very recently she had to go through a lot of poking around in her mouth to have a fixed appliance installed; I was kind of doubtful, but it went well with no fallout, so I hope we are out of the woods on the dentist (crossing fingers and knock on wood).

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