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Dental Trauma and "Adjustment Disorder"

NAS83709

Anyone with experience of recovery from dental extractions and general anaesthetic in adults??

We have a 31yr old severely autistic son who has refused dental treatment for years despite 50 hours+ of "desensitisation" from our local psychologist team and multiple attempts to cajole/persuade him to enter the hospital supported by our "multi-disciplinary team" over the past 7 years.

We finally (after presenting him as an emergency 12 months ago) have a date booked for "the procedure".

"The procedure" involves pre-med in the home environment supervised by an anaesthetist, car trip to hospital, at least 6 tooth extractions including 4 wisdom teeth, a trip to the recovery ward and a blue-light ambulance trip home followed by some form of short-term monitoring/nursing care.

All of this has to be done without giving "the patient" any advance warning and so is being "bought off" by the Court of Protection.

We are , of course, expecting severe recovery problems, his reaction is likely to be extreme but he desperately needs the treatment.

Does anyone out there have experience of handling a case like this? What strategies should we use? What help should we expect from NHS and Social services? etc ?

Thanks for any helpful suggestions.

PT and AT

Parents

  • As an autistic man the most traumatic part of dental treatment was the aftermath where I realised the geography of my mouth was permanently changed and the textures of my filings etc were extremely distracting / unsettling. For me it was fear of the results of dentistry not the process that was the issue and the solution has been better planing with my dentist about exactly what kind of interventions are used. I'll share those observations but I'm not sure if they're relevant to your situation.

    1. Of all the filling materials I've tried (which includes composite and glass ionomer) ironically mercury amalgam is the least distracting from a sensory point of view. However only after it's been polished to a shiny silver surface which requires a second visit after the filling has fully set.
    2. Composite filling is just about tolerable for centre of tooth fillings but will need a lot of post set polishing to get it to a shiny smooth surface that matches the level of the surrounding tooth. If you don't do this it actually feels really rough and abrasive.
    3. Porcelain crowns (and I assume implants) are quite tolerable except they can be quite rough where the glaze is ground off to get a good fit / bite. Encourage the dentist to avoid grinding a crown for fit as much as posable. (dentists tend to over estimate size because porcelain shrinks unpredictably in production, easier to grind down than order a new one, but for autistic people I'd say no don't do that)
    4. As much as posable encourage the dentist to be carful not to leave any sharp enamel edges around drill sites even if they are not likely to cause cuts, from a sensory point of view they're very distracting.
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  • As an autistic man the most traumatic part of dental treatment was the aftermath where I realised the geography of my mouth was permanently changed and the textures of my filings etc were extremely distracting / unsettling. For me it was fear of the results of dentistry not the process that was the issue and the solution has been better planing with my dentist about exactly what kind of interventions are used. I'll share those observations but I'm not sure if they're relevant to your situation.

    1. Of all the filling materials I've tried (which includes composite and glass ionomer) ironically mercury amalgam is the least distracting from a sensory point of view. However only after it's been polished to a shiny silver surface which requires a second visit after the filling has fully set.
    2. Composite filling is just about tolerable for centre of tooth fillings but will need a lot of post set polishing to get it to a shiny smooth surface that matches the level of the surrounding tooth. If you don't do this it actually feels really rough and abrasive.
    3. Porcelain crowns (and I assume implants) are quite tolerable except they can be quite rough where the glaze is ground off to get a good fit / bite. Encourage the dentist to avoid grinding a crown for fit as much as posable. (dentists tend to over estimate size because porcelain shrinks unpredictably in production, easier to grind down than order a new one, but for autistic people I'd say no don't do that)
    4. As much as posable encourage the dentist to be carful not to leave any sharp enamel edges around drill sites even if they are not likely to cause cuts, from a sensory point of view they're very distracting.
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