Open W I D E

Does an Apple a Day Keeps the Dentist Away?

Some say YES, others say NO.

Apples contain properties that can kill up to 80% of bacteria that form in the mouth. But dentists suggest that apples can be as bad as candy due to the high sugar content.

For my daughter Melissa, the answer doesn’t matter … because she won’t eat apples.

Over the past decade there have been significant advances in dentistry for special needs children. Now some dentists focus their practice on Special Needs Dentistry. Just do a Google Search and you will find many of them.

But this wasn’t the case twenty years ago when my daughter Melissa was growing up.

Over the past 20 years we have endured many dental challenges.

BRUSHING. As I have previously written, Melissa has an oral aversion resulting from her Propionic Acidemia metabolic disorder and as has been tube-fed for most of her life. It is well-documented that people who are tube fed develop dental issues.

The big offender is plaque. We know that plaque is that sticky mix of bacteria that builds on the surface of our teeth. And the bacteria in tooth plaque releases acid that damages tooth enamel, creating holes that we know as cavities.

But what I didn’t realize is that you don’t have to eat to develop plaque.

I always thought that it was the food that we eat that creates the plaque. But I have discovered that plaque buildup can be worse for those who don’t eat because chewing our food, in part, helps to dislodge some of the plaque before it hardens into tartar.

As every dentist or hygienist will tell you, brushing and flossing is the way to rid your mouth of plaque. But what happens if you can’t stand to put a toothbrush in your mouth? Or when the taste and texture of toothpaste makes you gag? The answer of course is that you FIGHT.

This was the situation with Melissa. Since she was a child, we had to fight daily to get her to brush her teeth. And that fight continues to this very day!

SWOLLEN GUMS. Tooth eruption (breaking through the gums) can be delayed in young children with growth disturbances. When she was little, you could barely see Melissa’s baby teeth in part because gums were swollen—a common side effect from phenobarbital. We gave her phenobarb for a couple of years, following a series of seizures she had during a hospital stay when she was about two. And even when we stopped the medicine, the gums remained enlarged. As her permanent teeth were ready to appear, her baby teeth were still stuck in her gums. To correct the problem she had out-patient surgery where they extracted the baby teeth allowing her permanent teeth to come in.

CROWDING and MISALIGNMENT. Many of us have had crooked teeth and braces to correct them. And if you have had braces, you know that keeping them clean is challenging. Now what if you have difficulty brushing because of an oral aversion? Should you forgo braces or struggle to keep them clean? That was the question that we faced with Melissa. In the end, we decided to try braces. She had four teeth removed to make space and then had braces installed. We fought with brushing for a year. During that time the teeth moved and while they are not perfect, they look straight. She now wears a retainer to bed every night. We found that the end result was worth the struggle.

Interestingly, Melissa has done some “modeling”for the company where my wife Kathy works. The company UCare is an HMO and Melissa has been featured in a variety of their marketing materials. Most recently UCare has sponsored a “mobile dental clinic”. They decorated the side of the bus with a variety of pictures … including Melissa’s. If you look closely you can see that her gums are slightly red and inflamed which is her “normal”dental state. We find it so ironic that her picture would be used for anything “dental” related!

Melissa is third from the left

Our dental challenges continue. We have just scheduled our next dental adventure … removal of her wisdom teeth. We are confident that she will do fine and are keeping our fingers crossed that she does not develop any complications.

Some of the things that we found helpful during our dental journey include:

Make Visits Routine. Melissa goes for a cleaning every six weeks. While this is costly, it is now a routine and she no longer fights these visits. It also helps to keep her mouth in better condition due to her less-than-effective daily brushing.

Offer Distractions. The noise and smell of the dentist office makes many people apprehensive from the moment they walk through the door. We have asked our dentist to use a clear shield (not a mask) because Melissa is frightened by masks. And she brings her own music player with her so she can control the sounds she hears.

Physical Restraints. In the past it was not uncommon for dentists to suggest using physical restraints for children who would fight during procedures. I’m not aware of the current practices but after several very challenging visits, we reluctantly agreed to the use of a “papoose board” as a way of restraining Melissa during dental procedures. While it was successful in holding her still … but it was also unsuccessful because it made her even more frightened to go for the next visit. In retrospect, I think it was a mistake.

I hope that some of our experiences might help you with your parenting dental challenges.


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