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Liam and the dentist

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When I was little, my dad always used to say, “If you ignore your teeth, they’ll go away”.  I don’t know if that’s what did it, but I’ve always taken good care of my teeth.  I floss and brush carefully and religiously, and I’ve tried to instill the same respect for oral hygiene in my kids.  I know, though, that along with good home care comes the requirement for a good dentist to aid in the protection of our teeth.  I was so lucky to have a great dentist when I was a kid, who helped me create good habits and, possibly most importantly, never gave me cause to be afraid of going to the dentist.

As a mom, it’s been very important to me to make my kids’ early dental appointments as positive as possible.  I know that if they get in the habit now, they’re more likely to keep it up as they get older.  I also know that even one bad experience now can turn them into the type of adults who would rather do anything than go to the dentist.  It’s not always easy, though.  Little kids aren’t always up for letting a stranger get close to them, let alone for opening up their mouth for one, no matter how many reassurances they get.  And the process of a dental cleaning can be uncomfortable, awkward and scary, even if you aren’t a little kid.

With Benjamin, we’ve been really lucky.  First, he is just a generally cooperative kid.  He wants to do the things we ask, most of the time.  In fact, the vast majority of the time, simply asking him to do something — even something as “awful” as putting away his toys, or walking away from the ipad — is enough to get it to happen.  We did once make a visit to a pediatric dentist who explained that if the kids were difficult, they’d be strapped down … but we only stayed long enough for them to “count” Benjamin’s teeth — code for getting the kid to allow this stranger to put a mirror in their mouth and do a quick exam — and we did not go back.  Instead, we subsequently took Benjamin to our own wonderful dentist and excellent hygienist back in the US, and by the time we relocated to Vienna, he already had a positive foundation to build on.  Once he realized that the dentist here had a toy bin that he could choose from after his cleanings, just like the dentist back home, he was perfectly happy to have his teeth cleaned in Austria.

With Liam, we have not been as lucky.  When we moved to Austria, he hadn’t yet gotten any teeth, so he didn’t have any “pre-Austria” experience to draw on.  Liam is also not generally what I would call a compliant kid.  He’s not fundamentally uncooperative, either, but Liam is very unlikely to be bribed, cajoled, encouraged, pushed, led, strong-armed or threatened into doing ANYTHING that he really doesn’t want to do.  You can sometimes convince him, but you can’t coerce him.  When pushed, he pushes back.  So while lots of praise, encouragement and baby steps got us easily through Benjamin’s first dental cleanings, nothing could get us through Liam’s.  Starting when he was about 18 months old, we started having him accompany us (including Benjamin) on our cleanings, just so he could watch the goings on and get used to the idea.  This part went fine.  It took a bit of patience on the part of our dentist, but after some very kind requests, Liam did once let the dentist count his teeth without complaint.  Once.

There was nothing obviously traumatic about that visit, but after that one visit to the dentist when he was about 2, he was totally done with the idea.  We could explain to him what was going to happen, and he would simply say “no”.  We could ask if he was worried, and he’d say, “I just don’t want to”.  He would GO to the dentist without a problem — no tears, no worry, no fear — he would happily walk into the office, climb into my lap in the chair, and look at the dentist . . . he just wouldn’t open his mouth.  No promise of toys, pleading, stern insistence or threat of withholding treats made one ounce of difference.  Short of actual force, it was just not going to happen.

And so, it didn’t.  Every evening at home we’d brush and floss, and we’d brush every morning.  He didn’t love the process, and certainly complained more about it than B ever had, but we made it through, most every day, without major issue.  But when it came to the dentist, it was just not happening.

But, as time went on, as he turned 3, and then 4, the need to have his teeth actually checked and to get the process of cleaning them started became more pressing.  I would take him in every time B or myself had a cleaning, and we’d give it a try with Liam.  Each time, before we went, we’d talk about what was going to happen at the dentist’s office.  We’d practice at home during teeth brushing times.  We’d talk about how important it is, and how everyone needs to get their teeth cleaned.  B would reassure him that it had always gone fine for him.  A few times, Liam allowed the dentist to look in his mouth and count his teeth, but when it came to the idea of actually cleaning them, we had no luck.  He would clamp his mouth shut and completely refuse.  I’d try to convince him, and he’d cry.  The dentist suggested bringing him in on his own, not during someone else’s cleaning, so we tried that.  Still no.  The dentist suggested bringing him a month later, so he could find the surroundings more familiar.  Nope.

We tried again a month after that.  This time — success!  He allowed the hygenist to clean 3 of his teeth.  Yay!  Wonderful!  Lots of praise.  I was certain we were on our way!

We came back again about a month later.  No progress.  He was still only up for getting about 3 teeth cleaned (and I was a bit frustrated that the hygenist started over with the same 3 teeth — I’d been thinking that at least we could maybe get through his mouth 3 teeth at a time . . . but no).

I try, as best I can, to balance being empathetic with my kids against the fact that certain things really DO need to happen.  I get that they’re scared of the dark, but I’m not up for them sleeping with the lights on.  I know that going to school can be tiring and sometimes scary when you’re little, but it’s important to go and learn.  I know that vaccines hurt, but they’re essential.  In this case, I couldn’t tell whether I was being overly empathetic, and basically feeding into his fears by letting him say when he’d had enough, or if my forcing the issue of him getting his teeth cleaned was making a bad situation worse.  I wasn’t going to flat-out force him, and I wasn’t getting a lot of support or direction from the dental staff — I still don’t know if they thought I was going too easy on him or making too big a deal of it (and though I might not have been swayed by their opinion, I wish I had known what they thought, since they have much more experience with this than I do).

When we flew home for Christmas, I decided to try what had worked so well for Benjamin when he was little — we went to our dentist at home, had Liam watch Benjamin and I get our cleanings, and then it would be his turn.  Benjamin did great.  Liam got his teeth counted, but no more.  At the sight of the cleaning tools, he was done.  (Again.)

I was totally frustrated.  I was worried about Liam’s teeth.  I was tired of going to the dentist once a month.  I was embarassed that though I could clean his teeth at home, I couldn’t convince him to let the dentist clean his teeth (I’m fairly certain our dental hygenist here in Austria doesn’t believe me that I was brushing and flossing his teeth every day).  I was afraid of creating a lifelong phobia or setting him up for serious dentral trouble down the road.  I had no idea what else to do or try.

In January, after things had calmed down from the holidays, we went back again to our dentist here in Vienna.  I talked with Liam beforehand.  We’d talked about what I wanted the dentist to do and why.  I explained that he’d be safe.  I promised that I’d hold him.  I assured him that it wouldn’t be much different from what we did at home every night.  He said the dentist could count his teeth, and that the hygenist could clean a few of them.  I agreed that’s what we’d do.

And, for some reason, this time was completely differnt.

He was still nervous.  He still wanted to go slowly and only do a few teeth at a time.  But he ultimately let her clean all of his teeth.  We went from 3 teeth at a time to all of his teeth at once, and he was fine.  He wasn’t traumatized.  He didn’t cry.  He didn’t object at all.  I have no idea why.  I don’t know what changed.  He was so proud at the end.  I was so proud of him, and so relieved that we’d made that progress.  I was so grateful that we’d FINALLY gotten that first cleaning done, and that it was a positive experience.

Next month, we go back to try for a second time.  I’m hoping that he’ll remember that positive experience, and remember that it wasn’t as scary as he’d feared.

Broken tooth

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Ask any American expat to name the experiences they most dread having abroad, and I think “dealing with urgent dental problems” would make almost every list.  For starters, dental care in the US is absolutely fantastic.  Americans take good care of their teeth, in general, and our cultural emphasis on perfection in appearance means that we want our teeth to look great, which means they need to function well and last a long time.  Dentists tend to be very good at what they do, and very well trained.  Secondly, there’s always something vaguely intimidating about the dentist, and that’s even when you both speak the same language.  Plus, while most of us will accept that we’ll need some kind of routine medical and dental care while living abroad (everyone gets sick sometimes, plus we need annual flu shots, locally specific vaccines, and yearly check ups) I think most of us hope we can put off or postpone anything more significant until we return home to our regular, well known, English speaking doctors and dentists.

But, it doesn’t always go that way.

Last spring, I got a sudden stabbing pain in my mouth when I bit down on something (I think it was a pumpkin seed).  It hurt a lot, but went away immediately and didn’t come back, so I didn’t think much about it.  But then, about a week later it happened again.  And then again.  Every so often, it would happen — I’d bite down on something in just the wrong way and have some brief, but undeniable, pain.  My teeth are generally well behaved, so I knew something was wrong.  By the time I decided I needed to have it looked at, I was about 2 weeks out from my bi-annual dental cleaning and checkup, so I talked to my dentist here about it.  (I also emailed my dentist at home, to get a remote second opinion.)

Both agreed — I probably had a cracked tooth.  I was horrified.  A lot of people who know me know that I take particularly good care of my teeth.  I’m fastidious about oral hygiene, and I look after my teeth really carefully.  I was pretty upset that something might be wrong with one of them — especially something that might necessitate something as drastic as a crown, or worse.  My dentist here suggested a wait-and-see strategy, while my dentist at home advised that I treat it immediately, before it could get worse.  I waffled.  I didn’t want to do anything drastic, but I didn’t want to be chicken about it and cause myself more trouble down the road.

I decided that I’d wait until Christmas, when I’d be home in the US.  I’d go see my dentist from home, and get his actual, in person opinion, and then decide how to proceed.

Which was a fine plan, except that last Wednesday, my tooth broke.  A piece (I’m sure it was small, but it felt huge) broke off of one of my molars.  It was kind of traumatic.  (I’m very attached to my teeth.)  It didn’t hurt at all, but it forced me to stop procrastinating and get it fixed.  It turns out, too, that the pain wasn’t coming from the tooth that I thought it was, either (so in that way, I suppose it was good that I didn’t do anything drastic to a different, healthy tooth).

I couldn’t get in to see my dentist until yesterday.  I spent much of the weekend quietly agonizing about the trauma that I imagined awaited me in terms of getting it fixed.  As it turns out, it really was a small piece, and he just covered up the spot with the same stuff as for a dental filling, to prevent decay.  It took less than 20 minutes and didn’t hurt at all.  All my worry was for nothing.  And, best of all, the intermittent pain from last spring and summer seems to be entirely gone, which is wonderful.

So, much as I never would have volunteered to have something go wrong with my teeth EVER, much less while living abroad, it was no problem at all.  (And though I don’t know what the same procedure would have cost in the US, I imagine it would have been more than the €130 I paid here — and that’s before insurance reimburses us for most of it.)

Liam goes to the dentist

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Today was Liam’s first ever dentist visit.  He was too young to have gone before we moved here to Austria, and I was kind of waiting until we had a visit home to visit our (much loved) dentist in Virginia.  But, a few weeks ago, I noticed a spot on one of his front teeth, and I’ve been freaked out ever since.  The pediatrician and I agreed that it needed to be seen by a dentist, and probably shouldn’t wait until our next visit home to the US (scheduled for December).

I’ve been worrying about it since.  I’ve been worried that it’s something dire, I’ve been worried he’ll be uncooperative at the appointment, or traumatized by it.  I’ve been worried that there was something that I’ve done (or didn’t do) to cause him some kind of horrible dental damage.  We had an appointment scheduled for 2 weeks ago, but he was sick with some kind of flu-like illness, and it just didn’t seem like a fair time to subject him to a first dental visit, so we put it off until today (and since then I’ve been worried about some awful consequence resulting from the delay).

I’ve been anxious about the visit for days.  I woke up early this morning and laid in bed, stressing about it.  How was it going to go?  This isn’t a children’s dentist — would they know how to handle a 2 year old?  What was the dentist going to say?  What would happen next?  Would I feel comfortable with any problem being solved here, or would I feel the need to have it taken care of at home?  How urgent would it be?  Would I have to make an extra trip home with Liam to get it taken care of?  (This is how I spent an hour of my early morning today.)

So, just before 9:00 this morning, I dragged an uncooperative Liam out of the house (not literally, but almost — he didn’t even have his shoes on).  The elevator was broken and he wouldn’t walk, so our trip began with me carrying him down the stairs from the 6th floor.  We’d been talking about this visit for weeks, and telling him what to expect.  We told him the dentist was going to look in his mouth and count his teeth.  We told him it would be ok, and that it would be quick and easy (Benjamin added his reassurances).  But apparently, he did not want to go.  I did not feel encouraged.

But, we made it.  I carried him the whole way to the strassenbahn, and the whole way to the office, but we made it (and only a few minutes late).  As we made our way to the office, he calmed down and regained some of his enthusiasm.  I reminded him that the dentist was going to look at his teeth (which he said was “ok”).  But as soon as we got into the reception area, he stopped looking at anyone, stopped talking, curled up against my chest and hid.

The dentist was great, though.  They told me I could fill out the paperwork afterwards, so he wouldn’t have to wait, and we went straight in.  I sat in the “big” chair, with Liam on my lap, and the dentist and I just talked for several minutes, about Liam, about his history, and about my concerns.  After a few minutes, Liam started peeking out for quick glances, and then started listening without hiding.  I told him the dentist wanted to count his teeth, and he tentatively opened his mouth a tiny bit.  The dentist gently checked out his teeth, and even got a mirror in to see the backs of them.  Liam did GREAT (although he did not speak a single word the entire time — it may be the quietest 10 waking minutes Liam has had since he started to talk).

003It turns out that the discoloration on his tooth is an early form of decay (pre-cavity) and that there’s nothing actionable about it for the moment.  We just need to keep an eye on it and be fastidious with our oral care for him.  (Which, apparently, we already are — the dentist was pretty impressed that we’re already flossing.)  Evidently the dentist’s son had the same thing, and it didn’t get worse or better, or need particular attention.  So, nothing catastrophic there.  (He suspected that pain medicine/fever reducer was to blame in his son’s case — it showed up shortly after they’d been using it a lot, and it’s one of those things that we routinely give after teeth brushing . . . and it contains a lot of sugar.  I’m guessing it might be the same thing here.)  The dentist was impressed with how well Liam behaved and how willing he was to have his teeth looked at by a stranger.  (I’m feeling pretty proud right now.)  And then, after the exam, Liam got to pick out a toy (a blue race car) and his smile and chatter came right back.

So, all that worry was pretty much for nothing.  I’m glad I got it looked at, but I’m even more glad that all is well for the moment.  I’m glad he doesn’t need any urgent dental care right now.  And I’m really proud of my brave little guy who trusted me so much today.

Delaying the dentist

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I’m kind of an oral hygiene nut.  Actually, I’m not as bad as I used to be — in college, my friends used to make fun of (and also, I think, kind of marvel at) my level of fastidiousness about my teeth.  I really like to take care of my teeth.  I’m religious about brushing and flossing, and I don’t even mind my biannual dental cleanings.  I’m weird like that.

007I’ve tried to be careful with my kids’ teeth, too, but since I’m admittedly a bit overly enthusiastic, I’ve tried to temper my concern with age appropriate expectations.  It’s only been moderately successful — I still remember the time I woke up in a cold sweat worrying about Benjamin’s teeth and how he hadn’t yet been to the dentist.  (He was 18 months old at the time.)  Ever since my kids have had teeth, we’ve made sure they brushed regularly (maybe not EVERY day, but very nearly).  We even floss their teeth (although that’s been less consistent).  When B was little and we were in the US, we were sure to use the non-flouride toothpaste, and when he was old enough, we took him to the dentist in the US.  We had a fairly disastrous first experience with a pediatric dentist, and then we started taking him to our friendly, gentle and kind regular dentist, which went MUCH better.  After that first experience, I was worried B would be traumatized, but with the help of our great dentist, he gradually got over his trepidation and would accompany both Dan and I to our cleanings and have his teeth “counted” when we were done.  And all was well.

Living abroad has complicated matters somewhat.  First of all, the water here is not fluoridated.  Some doctors recommend supplements, some advise against (reasoning that if you use a fluoridated toothpaste, which is pretty much the only thing you can find here, the kids will get enough incidentally).  We went without for the first 6-8 months we were here, and then I decided to go for it (I’m still not 100% sure of that decision, since over-fluoridating can cause problems, too).  Also dental care here is not, on average, up to American standards.  After some trying, we found a dentist that we’re reasonably happy with, but it’s not like it is at home.  There’s less focus on comfort with more focus on efficiency, less focus on aesthetics and more on finances.  I’m happy to go there for a cleaning, but we weren’t confident that the kids would have good experiences.  I took B along with me for the first time last fall, and he got his teeth “counted” again (all looked well) — but he’s used to the procedure now.  I wasn’t sure how Liam would take it, since he had no positive experiences to build on, so we haven’t taken him.  I’d just recently been thinking that I would probably try to make him an appointment when we next visited the States, most likely this winter.

And then, about 3 weeks ago, we noticed a spot on one of Liam’s front teeth (not the very front ones, the ones just next to those).  And, of course, being the dentally obsessed person that I am, I freaked out.  Does he have a cavity?  Did he damage his tooth?  Have I been over-fluoriding him?  Is it going to get worse?  Is it going to hurt him?  Will he lose his tooth?  Will this happen to his other teeth?  Will it happen to his permanent teeth?  (That was all in the first 2 minutes of discovering that it wasn’t a small piece of food and I couldn’t scrape it off with my fingernail.)

After calming down, and realizing he didn’t seem to be in any pain, I consulted with our pediatrician.  She wasn’t sure what it was, either, but recommended I have a dentist look at it.  She (also an American, and a parent) suggested that if we were visiting home anytime in the next two months that we just wait until we go home.  But we’re not, so I can’t.  But, I’m with her — I’d rather have it looked at in the US, too.

But, that’s not an option.  So, we made him an appointment with our dentist here.  I’m encouraged by the fact that they didn’t seem alarmed, concerned or overly urgent (nor did they refuse to see a 2 year old, so I’m desperately hoping that they do this all the time and will be shockingly impressive at comforting and reassuring him).  That appointment was supposed to be today.  But, since Liam is still recovering from his recent illness, including being so congested that he can’t breathe through his nose, I decided to postpone it another two weeks.  I just can’t imagine things going well if he’s sick on top of having a new (potentially scary) experience, and I want to set him up for success.  So, in two weeks, we’ll go in and get his tooth looked at.  It hasn’t gotten worse in the past 3 weeks, so here’s hoping it doesn’t get worse between now and then.  I’m worried about my guy.  And I’m really missing the excellent quality of dental care in the US.

Der Zahnarzt

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I haven’t been to the dentist since January.  I’m a bit of a nut about oral hygene, and my teeth were starting to feel icky, so I just couldn’t leave it any longer — it was starting to get to me.  So I found a dentist, and today, I went.

This is another one of those experiences you just won’t have as just a tourist or a visitor to another country — even going somewhere as a foreign exchange student, for an entire school year, you could probably manage to do routine dental (and any other) visits during school vacations, or to go just before you left and then wait to go again until you get back.  Visiting the dentist is one of those things you only do in a foreign country if you live there (or have some kind of dental emergency).

Visiting any type of doctor here is a little weird.  At home, I’m used to a dentist (or any kind of doctor) having their office in an office park or some kind of medical center.  Here, the doctor’s and dentist’s offices are mixed right in to residential buildings.  Not, as you might see in the States, on the ground floor of a residential building, but in just any building, on any random floor, next door to regular apartments.  As such, you have to get buzzed in to the building, and then again to the office unit . . . and you ride up in the elevator along with the building’s residents.  This afternoon, on the way to the dentist, for example, I rode up in an elevator full of young women, laden with beer, having a party, I presume.  There was just something odd about getting off on the same floor, and going in to the neighboring apartment . . . to have my teeth cleaned.  (I should be used to this by now, really, since there is a doctor who has her office downstairs from our apartment, and she appears to ALSO live there, which I also find strange.)

Going in to it, you don’t know what to expect.  Do they do things the same way here?  Will my teeth be taken care of?  Do these people know what they’re doing?  Will I be able to communicate with them?  Have I rotted my teeth out on coffee and pastries over the past 6 months?!?  For all the strangeness of the office location, and the nervousness and anticipation, the actual experience of getting my teeth cleaned was pretty much the same.  The dentist was nice, the hygienist was nice.  The dentist is originally from California, so there’s no language barrier there (although living in Vienna for 10+ years gives him a very strange accent) and the hygienist, who is Austrian, spoke English very well, and got assistance from the receptionist when she got stuck (she told me she was going to “shower” my teeth, but knew that wasn’t right . . . the receptionist looked it up for her, laughing — the word she was looking for was “rinse”).

It was a fine experience, and my teeth are clean.  I admit I miss my dentist and hygienist from home, though.  But this is definitely one of those things that I kind of took for granted at home that I’m not sure I will again.  And it’s another one of those moments that reminds me that I’m not just visiting.