Well, Katherine is now down to one set of bottom incisors.  Her adult teeth were coming in behind her baby teeth instead of replacing them.  In December one of Katherine’s home therapy implementors discovered that an adult tooth had come in behind her baby teeth and an x-ray confirmed that Katherine was well on her way to having a second row lower incisors. With full roots still in place, the baby teeth would not come out on their own.

See photos.  The “before” shot is pretty blurry because Katherine and a cell phone camera are not a good mix.

Katherine’s substantially delayed communication skills are completely inadequate to assure cooperation for four extractions so we opted for full intravenous sedation.  So with medical paperwork submitted, a copy of her last check-up, and an on-the-spot check of vitals and weight, Katherine was cleared for sedation.

All-in-all things went very well.  With her last bit of sustenance 16 hours behind her, Katherine arrived at the dentist office with a chip on her shoulder.  She waited, mostly patiently, for 45 minutes while the anaesthesia team finished with the child ahead of her, thanks to a novel waiting room and a couple of games on my Ipod Touch.  We only had two short rounds of high-pitched shrieking and mild self-injurious behavior.  The first when she didn’t want to cooperate with the nurse taking vital signs and the second when Katherine lost patience with my attempts to take “before” shots of her lower jaw.

When we went back to the procedure room, they started with a shot of ketamine in the tush while I distracted Katherine with the game she had been playing.  Needless to say, she was on to them after that! They tried to follow the shot by taping some gauze over the injection sight and Katherine was having none of it.  There was no way she was going to trust them anywhere near her buns a second time!

A few seconds later she returned her attention to the Ipod game, a very cute little app called Cookie Doodle where you roll out, cut, bake and then decorate a cookie.  She was in the sprinkles phase of the game and I watch with amusement while her little finger tapped the screen slower and slower until her finger just rested in place on her Christmas Tree cookie.  Then I laid her gently on the dentist chair and went to the waiting room.

The dentist made good use of the unconscious state of her patient and did a full set of x-rays, a cleaning and a fluoride treatment in addition to the four extractions.  Everything went well and it wasn’t long before they let me join her in the recovery room.  She was so groggy that I wasn’t sure if she was even aware of my presence.  Then, as I began to talk to her, she started to try to get up.  She wanted to blow that Popsicle stand!  This was comical in the extreme because she couldn’t even hold her head up!  Her eyes were still half closed!  But she repeatedly succeeded in dropping a foot off one side or other of the dentist chair.

To keep her from falling on the floor and because I thought it would be her preference, I slid her onto my lap.  She was more content there but asked for “car” and “coat” and then “I want saxophone” (don’t ask me where that last one came from but she said it very clearly).  After realizing that, at least for a short while, I would need to support her head like a newborn infant, I requested the use of the wheelchair that I had earlier declined.  I didn’t think I could adequately support her lanky 45 lbs all the way to the car plus I wanted the opportunity to get her booster in a reclined position so she wouldn’t fall out of it during the drive home.

Katherine was in much better shape after the 25 minute trip home.  Although still quite wobbly, she was able to stand and walk on her own.  Chelsea — who had stayed with Jonathan and was secured for the entire afternoon — or I followed inches away from her for another 30 minutes to prevent any falls.  Despite the residual meds and being awake from 2:30 to 5:30 AM the previous night Katherine did not have much interest in resting and none at all in sleeping.  She was obviously hungry and thirsty but was unable to find anything to her liking until she was cleared for ice cream around 2:30.  Up to that point she had tried and rejected my soft drink and Chelsea’s (we got another chuckle when it took her three tries to get a straw in her mouth) and rejected outright two flavors of jello and two flavors of popsicle.  Fortunately a little ice cream broke the ice and she was more open to other foods after that.

With motor skills recovered and eating back on track, the missing teeth are now the only problem.  She is definitely still in pain without analgesic but that is easily handled.  The main problem is that she wants her teeth back.  She is legitimately sad that they are missing and is sporadically upset about their loss.  She is also trying out various requests to get them back.  She is most persistent with “I want glue teeth” (she asks us to glue or tape anything that is broken) but she also pleads “I want help teeth”, “I want teeth” and “Oh no, teeth”.  We just keep telling her “teeth all gone” and showing her some pictures of other kids with missing teeth.  Hopefully acceptance will come soon and we’ll be able to put the whole experience behind us!