Autism and Dental Surgery Part 3 - What to Expect the Day of Surgery

This is the third post in a four part series about dental surgery and autism. For children with autism, the dentist can be really difficult and many issues require sedation and surgery. When my son Christopher, who has severe autism and is nonverbal, needed to have dental surgery, I was overwhelmed at all of the information that I had to learn very quickly. I’m hoping that sharing our experience helps others going through the same thing. If you haven’t already, be sure to read Part 1 – Autism and Dental Surgery and Part 2 – Anesthesia and Medication. Once again, I am sharing what I decided was right for my son. This should in no way be taken as medical advice or replace the advice of your doctor/dentist.

In this post, I want to talk about the actual day of surgery. If you are lucky, the surgery is scheduled for first thing in the morning. Though it is difficult to get everything together, including your child, at 5AM, it is much more difficult to keep your child away from food or drink while you wait for the actual surgery. Most procedures requiring anesthesia mean that no food or drink is allowed after midnight. The first time Christopher had dental surgery, it was scheduled for 7AM. I kept him up a little late so he was sleepy in the car and pretty compliant. The second time he had surgery, we were unable to get an AM appointment. I kept him in his room as long as possible, until it was almost time to leave. Even though I tried to explain to him that he wasn’t allowed to have anything to drink (even though I can’t be certain how much he can fully understand, I always assume intelligence – I think he knows a lot more than people give him credit for), all he could think about was how thirsty he was and that I wasn’t letting him have anything. He screamed the whole ride and I had a difficult time calming him down in the waiting room.

What to Bring

It’s best to pack a bag the night before. That way you can just throw your sleepy kid in the car and get going. Here are some suggestions for what to bring:

Something comfortable for your child to wear after the procedure.
Diapers, underwear, or pull-ups. Christopher was potty-trained when he had his second surgery, but I put him in a pull-up for the procedure. Even if your child is fully potty-trained, it is a good idea to bring extra underwear just in case (you never know what will happen under anesthesia and it’s better to be safe than sorry).
A cup and something to drink: Christopher was extremely thirsty after waking up (especially after the second procedure, when he was screaming for a drink all morning). I packed his sippy cup (a cup without a lid or straw is ideal after dental surgery to prevent dry sockets, but not all children can drink from a regular cup) and a few liters of coconut water. Coconut water is a great drink because it effectively replaces electrolytes and doesn’t usually have added sugars or other crappy ingredients.
A favorite toy, books, or iPad: You might have a long wait before the actual surgical procedure and you will want to make sure that your child is comfortable and occupied. If you are in a hospital, you will probably be waiting in a triage area on a bed and there might be a television. Surgical centers will probably have a waiting room area with toys and games. But, those aren’t guaranteed and you will want something that you know your child likes.
Pain management medication. I chose to use homeopathic remedies before and following the surgery, which I will discuss in further detail below.
Copies of your paperwork. Be sure to bring all of the paperwork you’ve done leading up to the surgery, as well as a list of all the medications and dental materials you’ve agreed on. Even though you will have already discussed this with the anesthesiologist and dentist, you will want to review it the day of the surgery. It is better to have it written down because you might not remember everything and you will likely be exhausted from getting up so early and frazzled from the whole experience (especially if your child is anxious).
Your insurance cards. Even if you’ve already provided insurance information, you will most likely need to provide your child’s insurance for the hospital or facility to make copies of.
Identification. This is probably a no-brainer, but don’t forget your ID to prove that you are the parent or guardian and holder of the insurance.
Books, magazines, and your phone. Sometimes dental surgeries take hours. You are usually required to stay on the premises. So, make sure you have something to do other than sit and worry.
Snacks for you. Same as above. If you are at a hospital, you can probably grab something at the overpriced snack shop, but many surgical facilities won’t have anything and, as mentioned above, you will need to stay there for the duration of the surgery.

When You Arrive

When you get to the facility, you check in, complete paperwork, and provide your insurance card/s and identification. Make sure to keep all of the paperwork you are given that day – you might need it later for insurance or other purposes. When we had the dental procedure in the hospital, we were taken back to the hospital bed right away and waited there with the nurses for the dentist and the anesthesiologist. At the surgical facility where we had Christopher’s second surgery, we were in the waiting room for a half hour or so and then were taken back. At that time, I tried to explain to him that the doctors were going to make his mouth feel better and that he was going to go to sleep so that they could help his teeth. I told him not to be scared and that I would be right outside, and that I would be there when he woke up. Then I waited. The first surgery was pretty extensive and took about 5 hours. The second one was only one large cavity (the dentist ended up extracting the tooth) and a small in-between cavity, so it was much quicker – probably under 2 hours.

After the Procedure

When the procedure was finished, the nurse brought me back to be with Christopher until he woke up. This is the time to ask any questions about how the procedure went. He woke up pretty quickly, and was very grumpy because of the IV in his arm. At the surgical center, they quickly removed it. At the hospital, the nurse told me that she couldn’t remove the IV until he calmed down (which he didn’t, because he was upset about the IV). Finally, a kindly nurse realized this and removed it and he instantly calmed down. He then drank (gulped!) over a liter of coconut water.

Pain Management

As I mentioned above, I decided to manage Christopher’s pain (both before and after surgery) with homeopathic remedies. Homeopathic pellets are made with milk sugar. For most children with autism, the amount is so minute that it does not affect them. However, if you want to avoid this, most remedies are also available in lactose-free liquids. Most liquid formulations have alcohol in them. For my son, alcohol is more problematic than a miniscule amount of lactose. Please be sure to consult with your doctor or medical provider regarding your choice of pain management, homeopathic or otherwise. The specific remedies that we used were:

Belladonna 30C – given before surgery for tooth pain. This was especially helpful to us before the second surgery, when Christopher was in a lot of pain while we were waiting to schedule the procedure.
Aconite 12c – given before the procedure, for anxiety and fear.
Arnica 30C – given before and after surgery to help prevent bruising and to alleviate pain and soreness.
Ruta 30c – given before and after surgery, for quicker healing and reduced pain (I alternated this with Arnica).
Hypericum 30C – given after surgery for nerve pain and to help nerve regeneration.
Calendula 30c – given after surgery for pain (I alternated this with Hypericum).
Phosphorus 30C – given after surgery, to alleviate nausea.
Nux Vomica 30c – given after surgery, for irritability and to detox from anesthesia (I alternated this with Phosphorus).

The Rest of the Day

I had honestly thought that after the surgery, Christopher would be wiped out the rest of the day. I had planned for him to lay on the couch watching movies. He did do this for a few hours, but then he wanted to play. He recovered amazingly well and seemed to be doing fine. This does not happen for every child, and some react more strongly to anesthesia than others. I was really surprised at how quickly he was back to his old self. So, prep for an easy relaxing day but also prep for a normal day just in case.

You will want to give soft foods, per the instructions of the dentist. We did a lot of peppermint tea with honey, chicken broth, and applesauce. By the next day, he was back to his normal foods – but this too many vary depending on the exact procedure that was done.

Below are some of the references that I used before our surgeries and when writing this. Please check out next week’s post, the final post in the Autism and Dental Surgery series – Follow-up Prevention and Care.