Social Stories, Emergencies and Teeth.

In ABA (Applied Behavioral Analysis), there are systems to help autistic children desensitize to situations that can trigger bad reactions.  My son’s reactions are not “melodramatic” or “over the top”.  They’re proportionate to the level of tolerability of a situation in his brain.

To one unaffected by autism, it may appear a response is exaggerated.  But because of a different way of sensory processing, to my kid, lukewarm water feels scalding, and standing in the City Dump is no different than a bed of roses. It’s all in how one processes the input to the senses.

One of the tools used to facilitate a “socially acceptable” response to a trigger is the social story.  The social story is written personally for the ASD child to address the input that leads to socially inappropriate reactions. The social story has been used successfully with my son to desensitize him to mall trips, waiting in lines, responding at school, etc.  And it has been used to try and prepare him for a trip to the dentist.

This is the "opposite" of my child...

My son is five.  He’d been to the dentist, once, when he was about three, before he was diagnosed with autism.  His baby front teeth were turning gray.  The gray color actually came from feeding him chewable vitamins with iron.  But the hellish nightmare that was the dental appointment was – well, it was bad.  Let’s just say that I regained my hearing about the same time I used to regain it after a rock concert.  My nerves were fried.  My arms were sore from holding him down.  My heart bled from the terror in his eyes.

Oh yeah, much closer to being my child...

So, social stories and cute, ABA pretend dental practice sessions aside, I did not want to re-enter the doors of hell a dental office, unless I absolutely had to.

So Thursday?  I absolutely had to.

It was the 4th day of Spring Break. We were ready to go to therapy.  I went to grab my jacket and that’s when I heard a scream.

I was alone with my son in the house.  There was five seconds between hearing the scream, knowing my son was in two rooms over from me and me actually getting to him, that felt like I was holding my breath, swimming underwater to him.  At the same time, I had that feeling of “keep it together” , “don’t freak out”.  

I came around the corner to find him on the carpet, iPad next to him, blood running out of his mouth, on his hands, tears running down his face, screaming full force til he ran out of breath. One second, two seconds, new scream.

He grabbed me and held me tight.  In between screams, he yelled for me to “CLEAN IT”!  I had to go in the other room to get wipes, to disconnect the death grip he had on my neck and get free.  There was a lot of blood.  I couldn’t really see what was going on but I convinced myself, this was sensory and not physically bad.  As far as I could tell, since he could not and cannot explain what happened, he tripped with the iPad in his hands, and instead of dropping it, to put out hands and break his fall, he fell with it and smacked his face into the iPad glass.  The glass was still intact but smeared with some fluid.

The aftermath.

I laid him on the bed and wiped away at the blood.  He kept crying.  I got him ibuprofen.  He screamed when I put the dropper in his mouth.  More holding.  More clinging.  It eventually subsided to sniffling.  At that point, I got him into the bathroom to rinse his mouth.

The blood and heavy spit poured out.  His teeth were all there. Maybe it’s just a cut inside his mouth.  More rinsing.  The water eventually cleared.  Then, he started bleeding again.  All around the base of his bottom permanent teeth was blood. Time to put that “dentist program” into reality.

Luckily, a fellow ASD mom had told me about a dentist her son saw.  I had been to a dentist for “happy visits” last fall but that office – while advertising it was for special needs – was not familiar with autism.  They were snooty, eye-rolling, unsympathetic phonies.  I called on the advice of my fellow mama and the first question that office asked after hearing  “autism” was whether my child was high functioning.  I knew she understood.

Cool wall of lit up water at the dentist.

We got there and we were taken to a private room.  Rather than a dental chair, they had a table, shaped like a surfboard.  The whole office was a beach theme, with a very cool wall of colored bubbles.

Once my son was laid down to check his mouth, the screaming began again.  They told me the room was soundproof. There were four dental assistants, the dentist, an ABA therapist, me and the dentist in the room!  Talk about helping!

There was a television on the ceiling playing Bubble Guppies.  There were earphones.  He freaked at the headphones.  They had to be taken off.  They started counting.  I had to yell for them to stop – a trigger.  They started to sing “Twinkle Twinkle” – another trigger I had to stop.

He was held down by the four women, but gently so.  They used an instrument to hold his mouth open.  It was still bleeding.  A light was shined in his eyes and his scream reached a pitch that could’ve shattered glass.  And no one flinched.  They used a portable x-ray machine and placed a film in his mouth that sent him further into the terror zone.  The x-rays had to be redone.

He was sweating.  His brow, hair and back were wet with sweat.  They got the x-ray.  He was released.  I had to hug and carry him through the office out to the front, where he calmed down again.

It was heart-wrenching but his teeth were not fractured or broken.  Three were loose on the bottom but the dentist told me he would heal in a few weeks.  If my son was not autistic, he would have put wire in there to stabilize the teeth.  That was not happening.

Social stories are great for casual outings. Not for emergency dental visits.

So as we got in the car to leave, he said to me, “Give mommy the teeth.” He was reaching to wiggle them out.  “No!  No!  You have to leave those alone.  Do not pull out those teeth.”

“Mommy to take the teeth and get you new ones!” he responded.

“No.  Those teeth did grow back when you lost your baby teeth.  These are permanent teeth.  You don’t get any more if you lose these!”

He looked shocked.  Good.  He understands.  Sometimes, a mom just has to improvise her own social stories.  On an emergency basis.


About solodialogue

I'm a lawyer and the mom of a 6 year old boy with autism. I work part time and spend the rest driving here and there and everywhere for my son's various therapies. Instead of trying cases, I now play Pac-man and watch SpongeBob. I wear old sweaters and jeans and always, always flat shoes to run after my son. Yeah, it's different but I wouldn't change it for anything. The love of my child is the most powerful, beautiful and rewarding aspect of my life.
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10 Responses to Social Stories, Emergencies and Teeth.

  1. Lizbeth says:

    You know in an emergency I’ve found very little works other than good old fashioned hugs and real support that only you know how to give. When Alex was about three or four he fell down some steps, bit through his bottom lip and had to have emergency surgery. He was terrified. After anesthesia he chewed through his stitches in under 20 minutes and had to go back in for more work. Sigh. I’m glad that’s over but I suspect if we ever enter an OR suite again he will flip out.

    I’m so glad T is OK. Now go get yourself a margarita and join me on the back deck. Sounds like you could use a little R & R after that. God knows, I need on just from reading. There is nothing worse than that sinking feeling after you hear that SMACK sound.

  2. utkallie says:

    The dentist ranks right up there as one of Cameron’s worst medical experiences. I don’t know anything that will make it better, especially in an emergency. Do social stories start working better as they get older? I’ve not had much luck with them on Cam.

    On a side note, my 4yo got hit in the mouth by her brother and the same thing happened where the blood started collecting around the teeth and I had to take her into the dentist (which she loves). Her two front teeth eventually fell out but they were baby teeth.

  3. Kelly Hafer says:

    Holy Sweet Mary…my heart is pounding just reading that. You did such a good job, Karen. It’s amazing what a mom can do when push comes to shove. Poor Tootles. I hope you have both recovered.

    PS: the dentist you found? Worth the office’s weight in GOLD. So very jealous.

  4. Mom2MissK says:

    Wow… T is very lucky. I flipped over the handlebars on my bike at age 8, knocked out my front permanent tooth, and broke my jaw in the process. It was not a pleasant experience… and I’m neurotypical. I can only imagine the terror poor T felt — and the terror you felt too… HUGS MAMA!

    I wish I had been able to go to a dentist office like the one you took T too — it sounds like a great place. What you have found there is truly gold.

  5. O, your poor baby, how terrible for him to have to go through. Sounds like you did a great job helping him through such a rough situation.

  6. Wow! Engaging story. So sorry you had to go through all of that. You are such a strong person! What a huge blessing you are to your son. I’m thankful you found a kind dentist. Hope the teeth heal super fast and stay in place. My gut was twisting, as I could imagine just what you were going through. My son with ASD had to have three teeth pulled. It was awful, once he got home and started to feel the pain. You are helping so many people by sharing your stories. They are very well written, easy to understand, and I love how you separate the words with photos. Makes it easy on my aspie eyes. Hugs! Sending you a Mommy Warrior Award. ~ Sam

  7. Oh my goodness! Poor you, poor boy. That dentist looks incredible though. It will be nice to go there in a non-emergency so he can get a feel for the place. I was terrified of dentists as a child, I can really relate. We would go to an understanding dentist in Florida while living in Northern Virginia, but I haven’t found anyone here yet. This prompts me to keep looking before we have an emergency to deal with too.

  8. C... says:

    It’s amazing that sometimes the blunt un-sugarcoated truth has to be what you say to get through to them but I find with my son I have to do that. My son told me this morning after I explained something too much, “That awkward moment when someone over explains something.” He pretty much has made it clear that the point from A to B should be a straight unflowery line. Just the facts ma’am (mom). 🙂

  9. Lisa says:

    I felt my anxiety rise as I read this account. An injury AND the dentist office?! Poor Tootles. Poor YOU! You were amazing, I must say…you were so calm under pressure! And your improvised story sounds like it did the trick!

    BTW, your dentist sounds spectacular!

  10. eof737 says:

    Could they have given him something to help or put him out to do the procedure? I don’t know… 😦

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