Derek wouldn’t hold still for me. His large hands kept pushing my hands away from his mouth. Once I finally got his mouth open, with help from an assistant, I still had a very difficult time getting my instruments in to clean his teeth.
I could tell he was trying to help us. When I’d say, “Open wider, Derek. Open bigger for me,” he tried to comply. I could see his eyes narrowing in concentration. Then he’d look at me. His brown eyes widened to see if he was doing it right. We kept praising him. “That’s good, Derek. That’s good. Can you open just a little more?” I looked at the assistant. She was mirroring the same feeling I was experiencing: The poor guy. He’s trying so hard. What should we do?
But despite his efforts, and the assistant and I using every hand muscle we had to open his mouth, the man’s lips were too strong. I was sweating with the effort. I could only imagine how Derek was feeling. I needed to get inside his mouth. His oral hygiene, like that of many mentally challenged people, was very poor. They often don’t have the manual dexterity to brush well themselves. And sometimes, a family member or caregiver can’t, or won’t, help them. Usually it’s the former. If the dental assistant and I were having this much trouble getting him to open to strong, stubborn lips, I could only imagine a lay person trying to do the same on their own.
I was concerned about his dental health. If we couldn’t clean his teeth, they would become decayed. His gums and the bone surrounding them would deteriorate. He would eventually have to have all of his teeth extracted. Sadly, this happened all too often with our mentally challenged patients. For his benefit, I was determined to clean his teeth that day. However, it wasn’t going very well.
Our office was extremely busy that day. There was no one else available to help us. What I really needed was a third person to hold Derek’s head still. He kept thrashing around. He wasn’t afraid; he just couldn’t control his movements on his own.
“I’ll help you.”
I looked up to see the round face of Andy, the patient I had just completed in the next dental chair across the room.
“He’s my buddy. Let me help.” I could barely understand his slurred speech.
I had serious doubts about Andy being able to help us. Like his friend Derek, Andy had trouble controlling his own movements. When I cleaned his teeth, I had trouble getting him to hold still. I was afraid Andy’s “help” would only make my job harder. I couldn’t turn him down, though. The intense look in his blue eyes told me he really wanted to try.
“Okay, Andy. Thanks, we could really use your help.” Before I could instruct Andy on what he could do, he reached out both hands and placed one on either side of Derek’s head.
“It’s okay, Derek. We just want you to open your mouth,” said Andy.
I was stunned.
Derek looked up at Andy and smiled. He squinted his eyes shut and opened his lips just a little. A fraction. It was all I needed to slip in my mirror and scaler to begin cleaning his lower front teeth. Then, the strong lips snapped shut again. Drat! I tried again. Andy soothingly talked to Derek as the assistant and I tried to pry open the lips of steel.
“That’s good, Derek,” I said. “Just a little wider, okay?” I was able to take a few strokes on a couple of lower teeth. We went through this scenario for the next thirty minutes. Mouth opening just a hair. Me sneaking in. A few swipes with my scaler. Mouth clamping shut.
I won’t say it was the most thorough cleaning I’ve ever performed. Far from it. But I felt good that we were able to get a least some of the plaque and goo off of Derek’s teeth. It was a beginning. Even that little bit would help his gums start to heal. Unfortunately, Medicaid in Indiana only pays for patients like Derek and Andy to get their teeth cleaned once a year. So next year, same time, same place, I’ll be doing it again. But if we can help them keep their teeth just that much longer, all the better.
After the dentist examined Derek’s teeth (which was a challenge all on its own), I helped Derek out of the dental chair. Andy was still standing behind me. I turned around.
“Thanks Andy. You were such a big help today!”
Without a word, Andy threw his arms around me. I had tears in my eyes. So did the assistant. Oh, and did I mention? Until that day, Andy had never allowed a health care provider anywhere near him without being pre-medicated first. I was informed later that they had forgotten to give Andy his meds that morning. I do believe a miracle had just occurred.
