The Dental Side of Foster Care
I know I’ve mentioned before about all the appointments and meetings that come along with saying “yes” to a child in foster care, but one of the harder things I’ve faced in the years we have fostered is the dental work itself.
Of course they tried to explain in classes about the appointments, and if you decide to work with an agency they will tell you that they like you to be there for your foster baby as often as possible for appointments, but will certainly assist in transportation for the ones you cannot be there for.
Because there will probably be so, so many.
I don’t know why the dental part is so overwhelming for me. I mean, all the other appointments are there, too: counseling or play therapy, FAPT meetings, VEMAT assessments, behavioral assessments, school meetings, psych evaluations, doctor checkups, immunizations, eye doctors, specialists and more. There are so, so many. And they all take time, planning, scheduling, (then lots of times re-scheduling), driving, stress, gas and money.
All the children in foster care have government health insurance which means that they have some type of Medicaid, with a provider company above that, ranging from Anthem, Optima, Virginia Premier, or others. You can also request a change in that provider if a doctor you need changes their policies or switches which companies they work with. That does not cost you anything, and your case worker does all the paperwork for you to make the switch.
We have never paid a dime for any one of our foster babies’ medical bills, and if I ever got a bill in the mail for something our foster kids needed, our case worker handled all of it from the minute I handed her the envelope. That part is really so, so easy.
Finding a doctor you love (or even just trust) that accepts the insurance your foster child has and is close to where you live can be the tricky part. Maybe it is because we live in a small town, about 45 minutes away from a big city, that we struggle with this very often, and maybe because we have to travel that far to see our dentist… maybe that’s why I have so much issue with the dental appointments.
But truthfully, we face that issue with every one of the needs I listed above… they are all in the big city, and when you find one you like and start building a relationship, you’d better hold on tight and pray they don’t switch practices or insurance policies or offices, because then you start over. And you’d better realize right off the bat that they are already over-booked, over-stressed and under-paid… and you will wait a VERY long time for your appointments.
Now I will say, once we have our appointments’ scheduled, we have seldom sat in the waiting room more than 15 minutes. Truly remarkable for the schedule they keep. But I have also gone 10 months out to schedule a 6 month cleaning, and waited 8 months just to get a newly discovered filling taken care of. Those times required more questioning phone calls back to the office to clarify if there was anything sooner, and analyzing the need to make sure it wasn’t an emergency… they are just so back logged, it is hard to take a number and wait in line, especially when you see so much neglect that you are trying to catch up on.
I LOVE our foster babies’ dentist. She is incredible at what she does, a tiny spitfire with an accent that gets harder to interpret the more emotional she becomes, and it’s all because she genuinely cares so much about her patients. She considers every one of them her “babies” and loves on each one she serves, even more so lavishly on our foster babies. (She calls ALL the foster babies her babies.) She thrives on giving them the best care, and genuinely invests herself into their situations, asking each time how things are going, and always ending with hugs and high fives.
I wouldn’t give her up for the world, especially when I know she has been there for us since Day One in such a complex case.
By the time Little Buddy got in for his first appointment to analyze his mouth, she explained that he would be better off with surgery to complete the work, he was so little and the worked was so complicated.
I had never heard of such a thing.
She explained that his insurance would allow the surgery only through age 5. After he turned 6, it would be through nitrous oxide (snoopy nose) in house for every treatment, broken down over the course of 18-24 months as he could handle it.
I signed the paperwork as fast as I could and she put him on the schedule as fast as she could. She promised to save as many teeth as she could, and I promised to take care of them the best I could.
The morning I brought him to the hospital, so early the air was still biting my lungs, he stepped over the threshold to the automatic sliding doors, stopped dead in his tracks, and looked up at me frozen in a pale-faced stare, clenching his minion blanket and said, “Wait, no, am I getting more teeth pulled?”
More teeth? What was he talking about, more teeth? I had only told him that his dentist was going to “fix” his teeth or “work on” his teeth, we never talked about pulling anything, and she was going to save everything she could… I stumbled through some reply and got him to come with me, though his anxiety level was through the roof. (His behavior at any appointment has got to be left for a whole separate blog post, the anxiety and triggers and memories are so unbelievable.)
We got registered and made it to the prep room. I told them what he said, and they pulled up his file: Little Buddy had been in for surgery before, indeed: nearly TWO YEARS BEFORE when he had BARELY TURNED THREE.
He remembered it all, and there were actually notes in the file of how awful his recovery had been, a terrible scene with his parents as he woke up from his anesthesia. And here I was today, now graced with the task of re-wiring his mind to believe that this was going to be good for him.
I never prayed so hard in a waiting room in my life. And our dentist never worked so hard in her life either, I am sure. In the end, she did have to remove three teeth, one so badly abcessed she could not believe it had not ruptured up until that point. Truly it was a miracle that we got it out when we did. The rest were caps and fillings and repair to the surgery from before. They warned me he would be exhausted, irritable and possibly nauseous for the rest of the day.
We had known that Little Buddy hated eating ice cream when we first got him, but now we knew why. I was so mad at myself, feeling so foolish: why did I not catch this problem? I had already raised five kids… I should have known better. I wrestled over and over. I mean, he had NEVER once complained about tooth pain. The nurse in recovery told me that was very common for these babies: they have never known a life WITHOUT tooth pain, so how could they address the feeling they had grown accustomed to, and most likely built up a tolerance to?
I was overwhelmed.
I drove him home in silence, floored by this universe I had never known existed. My mind and heart with all the foster babies that live like this daily…
We pulled into the driveway at home and my sons were playing outside in the sun, an unexpected sunshine warming everything a little extra that day. They ran up to the vehicle to say hello and check on Little Buddy. I turned around to caution them all on his condition, reminding him to take it easy and come inside and rest…
He was jumping out of the vehicle, completely oblivious to me. “Tag, you’re it!” he shouted to one of the other boys. I started to call him back to me, then stopped myself to watch for a moment. He was doing fine. He hadn’t puked the whole way home and he was happy to be home. The boys were happy to have him. So many moments of his life had already been defined by “not normal,” I needed to take a moment to accept this miracle of recovery and let him have the gift that he so greatly needed: to be left alone to be a boy without a label, to combat a horrible memory with a good one, to let the sun melt away the darkness and cold he had come out of…
and let the healing triumph the pain he had come from.
The surgery was just enough to take care of immediate issues and address as much decay as possible. She put caps on what she could so his mouth really looked great when he got home.
But the caps cannot cover the things underneath forever, and they cannot replace the brittle enamel from lack of nutrients and minerals.
Boys will be boys, and in time we had our share of more dental drama: caps popping off, crowns eroding, teeth chipping and fillings loosening. To this day Little Buddy only ever told me one time that a tooth hurt, and that was when a crown broke off near the front and exposed a tooth pretty largely.
Back to the dentist we go each time, and each time she loves, analyzes, checks, double checks, makes notes, works hard, schedules more, gives high fives… and we go on with the next part of our life.
I think because my mother raised us to always take care of our teeth, maybe that’s why this part gets me so good. She would daily remind us to brush our teeth, insist we do it again, send us upstairs to brush a third time if we were headed to appointments or special occasions…
When I was in grade school, we were already in the van on our way to school when she asked if we had all remembered to brush our teeth. Ugh. I could not lie to my Mama. I choked out a “no” in the middle of my sisters’ cheery “yeses” and I saw my mother’s jaw clench from where I was sitting in the back seat and felt my stomach drop to the floor. Without a word, she dropped off my sisters at school, drove me home, waited in the van while I ran up and scrubbed my teeth like the world depended on it and jumped back in the van a changed girl. It never happened again. And it forever changed my opinion of the privilege of having beautiful strong teeth.
Little Buddy says he did not even own a toothbrush before we got him.
One time he shared that he was so scared that his new teeth would grown in broken and black and yucky. I reminded him of all his hard work he has been doing, brushing all the time, flossing, visiting the Dentist and letting me help him. I pointed out his two front teeth, now coming in strong and white. We talked about vitamins and how we get strong teeth, and that our appointments were almost done to get all the work done he needed to get him on the right track. Then I told him how he’d only need appointments twice a year for cleanings as long as he kept taking care of his teeth, and we would help him do that.
Of course there are conversations about spacers and braces and jaw alignment and all the things. Those will come in time.
But we have been working so hard to heal his mouth for two years now, and to see the Finish Line and almost “normal” appointments on his list of reminders as he leaves the dentists’ office feels like a real victory in ways I cannot explain.
What I took for granted as a young child was truly a gift in the way I was raised, and I am so close to reaching that place with a child that seemed was impossible to happen. And if we can give him just one more gift of “normal” that he never had before, I count that privilege as my gift.
And I know my mom and our dentist do, too.