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My Aunt has her own teeth and since she has worsening dementia, she has had dental problems with decay and gum disease. The facility she is in does not brush her teeth regularly, even when asked again and again in the care plan. After one (very difficult) trip to the dentist I reported to the facility nurse that it took the hygienist one and a half hours to simply clean impacted food from around my Aunt's teeth, She ordered the teeth brushing, but it is still hit and miss.
Because of the difficulty of going to the dentist, the lack of a traveling dentist, and the nature of my Aunt's oral health, which concerned the dentist given she had soft spots and decay, added to the ongoing trauma of that type of care for a person with dementia, the dentist applied silver nitrate to my Aunt's teeth. It's painted on. This stops the decay, reduces sensitivity and gives my Aunt relief from mouth pain. She eats better and is much happier. While this is not used in the United States (the affected spots on the teeth turn black, which is not a concern to us), it's used in Australia and Japan and is an option for elders where dental care is difficult, dementia is a factor or mouth pain is interfering with nutrition. If anyone has any other tips for dental care in dementia patients, I'd appreciate hearing about it. My mother's teeth calcified and she did not have pain, but my Aunt still has "live" teeth and toothaches are awful for anyone, but worse when you can't get to a dentist because you can't travel. My Aunt did not have to transfer to a dental chair for the procedure, and she was able to stay in her wheelchair for the whole trip as we paid for medical transport..

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Thank you for your comments. My Aunt's dentist researched silver nitrate, as I did and we did not find the side effects mentioned. I'm sure it isn't a perfect solution, but it works for us.

My Aunt is 98, she has dementia and has had excellent oral health habits her whole life, which is why she still has her teeth!
Up until a few months ago I (or anyone) could hand her a toothbrush and she would brush for an hour or so. Gradually the time she worked on her teeth diminished until she would forget about the brush after a few minutes. She is very compliant and lets anyone brush her teeth. They just don't. And she is very willing to go to the dentist and agrees to it. It's just that sometimes she is too weak for the outing.
The rinsing and spitting was something we grappled with a few years back. The oral rinse to "spit" somehow got mixed up in her head with water, or milk or any liquid, and she would refuse to drink because she wasn't supposed to swallow.
(The best intentions....right?) So we stopped with the rinses and the toothpaste and opt for the mechanical brushing with water. I've worked hard to reassure her it's okay to drink, but once in awhile she'll take liquid into her mouth and spit it out saying she isn't supposed to swallow.
Nothing is harder for us than to know there is a loose tooth or decay below the gum line necessitating a tooth pulled. The referrals, the visits, the traveling etc. We had to do that twice. The worse part was afterward, the gauze in the socket that was meant to stem the bleeding; she would chew it! I stayed with her to replace the gauze and keep her from swallowing it until the bleeding stopped. As always she was very compliant, just not sure what she was supposed to do and not able to remember what I just said.
The water pik is a good idea, with just water, it would be OK to swallow, and I know she would allow us to do it if I told her it was to help her teeth stay clean. I do know, the staff at the facility will not do it. But I could do it on days I visit. I couldn't get staff to hand her the toothbrush.

I finally learned that the procedure to inform staff is to write an ISP. That direction is put in a notebook that resident assistants and med aides read at the beginning of their shift. Then that ISP gradually works itself to the back of the notebook as new ISPs for the residents are added. After a few weeks, the back ones get put in her personal notebook and no one ever looks at that. So instructions from the ISP are followed for a few days or a week or so, and then forgotten.This explains many instances where care is good for awhile, then falls off and soon, nobody remembers. I have asked for her ISPs to be migrated from the back of the book to the front of the book weekly so that they are still "on top".. I don't know if that will work, but it's worth a try.
Thanks for the ideas.
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Is she in a NH or AL? Why are they not assisting with oral hygiene?

Do you attend or call into thebcare conferences? Is she resistent? Can they give meds to calm her while they brush or use a water pik?
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Your post prompted me to do a little online reading on the subject. I saw no data detailing the side effects Angel mentioned, not saying it isn't out there though.

I can recall visiting my Aunt in the nursing home in the afternoon and often her cheeks were so full she couldn't talk. (Back in those days I didn't know about pocketing food, today I would probably be asking an aide to take care of it.) Those who can manage to feed themselves and are not taken to the bathroom after meals because they are in incontinence briefs probably are lucky to have their mouths checked once a day, and a lot of damage can be done to teeth left in my Aunt's condition through the day. Often the only recourse for people like my Aunt is to have their rotten teeth removed, it is good to hear of an alternative.
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When I broke my jaw and could only eat soft food for several weeks, I also was under restrictions not to brush the teeth that had been knocked out and surgically re-implanted.

The dentist who performed the surgery prescribed a mouth rinse which I used regularly. Perhaps your mother could use a similar rinse. I'm not current on which ones are good and which ones are not as good, but I'm sure your dentist could offer some suggestions.

Maybe you could make a game of it - swish and spit, swish and spit - see how many times she could do that to get all the food out.

The other option is an electric toothbrush, but it might be harder to use.
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Silver nitrate is not used in the US because it destroys the intestinal tract and causes neurological disease....so....ya not something I'd allow on my loved one.

I think the problem with the home she is in is that you can put it in the care plan, and the caretakers can attempt to clean her teeth, but if she refuses and is violent or excessively stressed by the procedure, they will discontinue attempting it. Will she allow you to clean her teeth rather than the caretakers? That is one possibility. Would she use a mouth rinse like Clo-Sys...this can be very very helpful even if she refuses the brushing...but she would have to be aware enough to understand instructions not to swallow it.

Angel
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