I have mentioned before that Charlie has a fixation on his teeth. And rightly so; they are deteriorating at an alarmingly rapid rate. Since I met him in 1998, he has never had to have a cavity filled; he had very good teeth.

"Had" is the key word here.

After Charlie's dementia set in, he developed the habit of swishing with every beverage he puts in his mouth; coffee, tea, juice and wine. When I noticed this strange behavior, I asked him why he was swishing. His response was that he was cleaning his teeth.

The dentist began to notice that the enamel was disappearing from his teeth. He asked Charlie about it, but he was unable to come up with an explanation. When the dentist mentioned it to me, I immediately suspected the swishing. The dentist agreed that was the likely cause of the problem.

Since that visit, every time I catch Charlie swishing, I explain that he must stop the habit. He agrees, at the time, but the dementia lets that warning slip down a rat hole in his brain. The next time he picks up a beverage, it is back to the swishing.

He had a dentist appointment last week and the dentist informed me that the enamel problem had reached crisis status and some serious dental reconstruction was going to be needed if Charlie is to keep his teeth. He said he would send us a proposal for the options available for his care.

The proposal has arrived; what a shock. The ideal treatment would be to attach porcelain crowns to the teeth, at a cost of over $13,000. The second option would be to do a "core-build-up" at a cost of over $3,000. The first treatment would probably last Charlie for whatever time he has left on this earth. The second option will be functional, will not look pretty, and is not guaranteed to last long.

The dentist did not address the possibility of dentures, because he does not do them, but suggested that the cost would be in $7,000 range. When I suggested this option to Charlie he was adamantly opposed to losing his teeth in favor of dental plates. The last option is to do nothing and deal with remove each tooth, one at a time, as it disintegrates.

We have Delta Dental, but I was informed that they would pay only about $1,500 of the cost for the most expensive procedure and less on the other options.

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When I think about the fact that the man had very good teeth until he began the ridiculous swishing habit, I want to scream. He is unable to make a realistic decision as to what treatment is best.It is a decision I am going to have to make for him. My preference would be dentures, but I don't feel I can force him to do something he so strongly opposes.

The man is 81 years old. Does it make any sense to put $13,000 into the teeth of a man whose life expectancy is probably two-three years? But surely, if we take the cheapest route, he will live another fifteen years and outlive his teeth.

What a dilemma. Dementia is such a cruel disease.