Dental Trauma and "Adjustment Disorder"

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.

Oh Dawn, this must have been so absolutely horrific for you, I don't know what to write but wanted to still write something even if it cannot express adequately.

Are implants possible? My husband had two and says they were worth the money. I only had one extraction and the gap is bearable, but I can see how six might not be even once they have healed over.

Hi, all I can say is to be really careful in what you are doing. I’m in my 50’s and from a result of treatment as a child, have had PTSD ever since, with flashbacks everyday. I had a meltdown when I sat in the dentists chair, I was to have 6 teeth removed, I bit one of the dentists and tried to climb out of a window. Four adults held me down and forcibly administered gas anaesthetic. I ended up in hospital for a week with severe dehydration from a severe shutdown. Obviously you have your sons welfare at heart, my personal thoughts are that he will never trust you again, from not knowing it was going to happen, if it was me,  I would spend everyday wondering if it was going to happen in that day again. He will have a mouth full of stitches, the sensory issues from that alone can be hell. Apologies if I sound blunt.

You are not permitted to advertise your company here....although you are probably a God damn bot anyway!

Are you quite certain this procedure is essential? If it is, then is he not able to understand that having the teeth removed will improve things for him in the long run? [removed by mod]

NAS83709 said:

Anyone with experience of recovery from dental extractions

Yes.....me.....and I have a MAJOR problem with dentistry.  I am 50+ years old and am generally considered to be a capable, calm and logical being - albeit a "little odd."  I am not prone to meltdowns because I have developed strategies to soothe and contain my turmoil at times of stress.  I am not an aggressive type.

I have been agonising over this response to you.

I can clearly see and understand your dilemma with your son's dental treatment.  I do appreciate that it is a very hard judgement call that you have made.  Accordingly, I do not proffer my thoughts below lightly or flippantly.  You are in an impossible situation, but for what its worth, I think you should consider pivoting your strategy here - and tell him what is going to happen - AND WHY!

I say this based of my own experiences and feelings surrounding dentophobia.  I have had 3 of my wisdom teeth out plus a handful of other extractions and a couple of root canals in my adulthood.  As you might expect, I have planned and prepared for each of these events, including "special measures" to help me cope with it the experiences.

Despite being relatively in control of myself, I have totally 'lost my sheet' on two occasions AFTER dental work.  Despite the lead-up to these events being horror inducing and the event itself being unimaginably awful (despite the variety of drugs employed).......it wasn't until AFTER that my meltdowns occurred - and they were proper "red mist", animated aggressive posturing, and I think I actually created indoor lightening and thunder on one occasion !  I scared everyone to death - including myself.  It took me weeks and weeks to come back to a point of balance and poise.

I think it is the sequence that I would ask you to consider.  There is a BEFORE, DURING and AFTER.  I think there can be little doubt that your current intended approach is best for handling the BEFORE and DURING parts........but I fear it may induce a catastrophically destructive effect in the AFTER phase.

I fully accept that my dentophobia is illogical and causes me unnecessary and mind-bending pain at times and for prolonged periods.  I also fully accept that my nearest-and-dearest cannot possibly appreciate how visceral my fear is and I appreciate that they would consider it a "kindness" to override my indefensible "dignity of choice" arguments if they could - but I won't let them.

If I woke up one morning to find no pain, a full mouth of pristine white teeth - but knew that it had been done without my knowledge, I would be furious and my trust in them would be critically endangered.

If I woke up one morning to find a lot of pain, more missing teeth from my mouth, oodles of swelling and bruising on my face, a couple of weeks of needing to be VERY careful with the weird "jelly" blood clots in my mouth (that feel like sea anemones), I fear that I might be prone to a full psychotic break.  And that is not hyperbole.

I do not think you should change the plans you have made for your son (and congratulations on organising the logistics) but I really do feel that you should tell him; a) what is going to happen b) why it must happen c) what he must expect afterwards.

Naturally, this is just my opinion and I wish you and your son the very best of fortunes, no matter how it unfolds for you all.

Oh dear God, poor you. Your poor son. You have my prayers.

It was such a procedure that finally led to my autism diagnosis. I was expecting one extraction. They took six. I took off with suicidal intention afterward, was spun into a melt down/ shut down cycle complete with self harm, which went on and on. I'd never self harmed before. I was mute for weeks. I could never let my husband kiss me again. It causes eating problems and I've lost too much weight. I am still not coping.

Four years on the dentist is still trying to put plates in my mouth and I am dry wretching immediately. The desensitization isn't working. I want it to. I want those plates. I want my mouth to feel normal again. But it doesn't and I can't cope.

MH never believed me, misdiagnosed me. I worked out it was a sensory problem due to autism for myself in the end. Worst is my tooth condition is degenerative, and WILL get worse.

I wish I could be more cheery, offer more hope, but I can't find an answer for myself yet. Your son is likely to be thrown into the most severe of sensory and psychological shocks, especially if they take him by surprise like that. Is that really wise to ambush him? I'm surprised they are allowing an approach like this. Autistic people cannot handle surprise, especially not surprise by their worst nightmare. The trauma will be beyond tolerance.

I really don't know what to suggest. I so wish I did,  except to say you and he are not alone with this. I'm so sorry, this won't be what you want to hear. I'm so sorry I don't have a better truth to give. I'm so sorry this must be so scary.

Please keep us updated. I hope you find an answer. I'd like an answer. Please keep shouting at professionals to help you. Short term medical care afterward won't do. He will be severely traumatised. They may not have ready answers, but don't let them stop trying.

My heart really does go out to you.

That sounds like it will be a horrific trauma for him and he might never trust you again!

Recovering from extractions is not a simple matter as the holes are quite vulnerable for some time, days, even weeks. If the blood clot comes off it can cause dry socket I think it's called, which is very bad. All 4 wisdom teeth means he will not be able to chew on either side during this time so will need soft or liquidised food. He might have sensory issues with this. Also it can take a while to get used to the new layout inside the mouth and when he is allowed to chew again it takes time to get used to the difference here as well and he might bite his tongue more for a while.

Are you quite certain this procedure is essential? If it is, then is he not able to understand that having the teeth removed will improve things for him in the long run? 

50 hours of "desensitisation" sounds quite traumatic in itself, I am surprised it was not realised sooner that it was not working, and might even have made things worse. Sensory issues cannot be cured by exposure, in fact are made worse by it.