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Husband moved to memory care 3 months ago. At the original assessment and subsequent and numerous meetings, discussions and phone calls I indicated he needed one-on-one cueing for showering and brushing his teeth. I even wrote out instructions for the caregivers on how to walk him through the brushing process. In 3 months his dental health has declined such that he now needs an intensive periodontal cleaning which is very expensive. He has never needed any periodontal work prior to his move to AL. The last dental exam shows that he is only doing the front teeth — my instructions show them the process for getting him to move the brush around the entire mouth. It is obvious to me that they are not following the procedure nor are they cueing him to do a complete job. The AL Director and social worker indicate that they are limited in how much they can do. I want to avoid further damage to his teeth. What options do I have and how should I proceed?

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If your husband's facility even tries that is a victory. My mother's does not. Even though there is a sign to Please brush...etc.
I have learned with my mother's AL that I carefully have to pick my battles. I appreciate everything the hands on caregivers do.
Here is my strategy. My mother can stand (kinda) at her sink and stare at the mirror. I place the toothbrush in her hand and stand behind her so she can see me. I go through the motions and she follows (kinda). That's the best I can do.
Going to the dentist is incredibly difficult but we recently managed a visit there with the assistance of some hired help.
Mother still has 2/3 of her teeth. The teeth she lost was before I took over. For me, so far so good.
I have considered a powered brush but I am concerned it might freak her out.
Hang in there. Your concern indicates to me you are doing your best.
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Dental hygiene is imperative in the elderly.....harmful bacteria can build up very quickly and cause a multitude of health issues. That said, periodontal disease treatment is VERY expensive. Other have stated and I agree a battery operated toothbrush will do a much better job of cleaning and stimulating the gums ...certainly worth a try. Plus there are many great care products out there (rinses, toothpaste etc.) that will help. In addition see if you can get him to brush his tongue....also helpful in fighting germs.
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janpatsy1 Dec 28, 2019
I have been trying to get husband to brush etc, how to get them to use without swallowing toothpaste or mouthwash? my husband just swallows even with my coaching not to swallow.
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What your father may do for his son/daughter is very different from what he may choose to do for someone he knows "works for him."

Sometimes, caregivers can get people to bathe when they won't for their family member, but other times, they know they can refuse or, like your father is doing, just do a cursory job of it.

Your father, despite his dementia, no doubt has the 'muscle memory' of how to do the brushing the way you dictate, but he may simply not choose to do it for the caregiver.

Do his teeth give him pain? If not, I would (and did) just let it go.
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I wonder if a Water Pik can be purchased by you for him? Those are really good and come in all kinds of brands/types. Once he has his teeth cleaner, suggest switching to Periodontax toothpaste. Also there are online products for expert dental rinses.
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You can Perhaps Look into a Better Nursing Facility, Many of them are very Laxed in Doing the Dental. Maybe you will have to come in to Help a little, But what Shame they get Paid to do this.
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the CNAs have the entire hall to take care of, so oral care may not so good; another reason your husband may be clenching his teeth and resisting. why don't you try
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I would not do a deep clean. Those are sales jobs. A cleaning with an ultrasound machine is more than good.

That is the new scam being perpetrated by dentists and it is overly invasive and almost never a good idea. Get a second opinion and find a hygienist that has an ultrasound.
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My goal is to do all I can to keep him from having to undergo any procedures. So far so good. Not so much decay, which isn't very likely. I'm pretty sure we'd have to knock him out and I don't look forward to what that would do to him cognitively, but there wouldn't be any post-procedure restrictions. but anything that would require an extraction? having had them myself, I cannot see any way that we could manage the socket with him. (He also still has all 32 teeth, at 87!, and was determined to keep them, so I want to honor that. But the main thing is prevention, for as long as possible.)
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It's difficult to ensure the quality of someone's teeth brushing, but, I had my LO's dentist write a prescription for her to brush her teeth daily AND to rinse twice a day with a plaque fighting mouth rinse. I taped the prescription over her nightstand, so, the attendants didn't forget to do it. This was to keep her from further decay and extractions, which has worked so far. I take the toothpaste and rinse to the MC, but, now that she is end stage, I don't think she has the ability to rinse anymore, even with assistance.
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We take my husband to have his teeth cleaned every 4 months, and amazingly he still lets the hygienist do it although it takes a lot of coaching & patience since he hasn't the faintest idea what she's doing anymore. I was asking her what her other elderly cognitively impaired patients were like and was shocked and saddened to hear that dental hygiene generally seems to fall by the wayside with these folks, so she rarely has a patient like this. I think this is just awful. But I'm very fortunate in that hubby is at home with caregivers and they are charged with the daily maintenance and they take it very seriously. So far, he lets them do it. I guess if he stops allowing it I'll have to decide then what to do about it. I am guessing that you won't be able to change the facility so the alternative seems to be either to do it yourself or to hire somebody to come in.
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I had the same problem with my mother, but she is 96 years old and has advanced dementia. She's now on soft foods, and needs to be fed. She is in hospice-type care, which means we do only things to keep her comfortable. She bites people if she doesn't like what they are doing, including tooth brushing. It wasn't worth fighting with her. We decided just to let it go. Every day I lower the bar...
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againx100 Dec 24, 2019
That is sad but it makes sense that it is not worth fighting over many things when your mom is on hospice. Just keeping her comfortable is the key and at that point her oral health doesn't seem to rise to the highest level of priority any longer.
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The facility where my mom was, she fell once, or maybe twice. Lost a tooth at the top of her mouth, lost her right hearing aid. This was all in the span of 4 months. They would never make sure that she went to the bathroom routinely. Like someone else said, maybe the facility needs to change things. I just don't understand how she could have lost a tooth when it was her real tooth. At least where she is now, as far as I know, they are helping her relearn the basics of how to do different things.
I even bought some mouthwash for her with the hopes that they might be able to help her use that but obviously that didn't work either.
It will take time to help them learn again. Patience is the key,right?
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They need to take over the job of brushing his teeth.
I suggest an electric toothbrush.
Discuss this with the care team possibly with the director at the next meeting you have. Do they have any options that would help facilitate proper oral care? How often do you visit? Is it possible that you could brush his teeth during your visits? I know it is not the way you want to spend your time when you visit. At least that way you will know it is being done that often.
I had the same "problem" when my Husband was in rehab, I brushed his teeth each morning I was there as well as shaving him.


Side note.
Your husband will at some point become non compliant at the dentist and an exam will be difficult.
Even at this point he may have to be given a light sedation for the periodontal cleaning. Most dementia patients do not do well with sedation. It takes a long time to get back to baseline "normal" for them if they get back. And as he declines even for a simple exam he may have to be sedated. It can be a vicious circle. When dental work is done it can hurt either from just a cleaning or if it comes to it extractions and trying to deal with open wounds in the mouth in a normal situation can be difficult but when a person has dementia the care of the open wounds can be more difficult. (and I bet the facility would not comply with what needs to be done so you are looking at the very good possibility of infections) I guess what I am saying is at some point you have to let go of "normal expectations" and while oral care is important it will not be at the top of the list as other things decline. (and as he eats softer food and pockets more it will get more difficult to brush the teeth, the focus will be getting the food out of the mouth to prevent aspiration not brushing the teeth)

By the way switch to a toothpaste that has no fluoride in it in case he swallows it. And if he is using a mouthwash switch to one that has no alcohol.
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againx100 Dec 24, 2019
Excellent point re not fluoride in the toothpaste. There are many good ones out there.

I also agree with using an electric toothbrush.

And that you can not expect the staff to do a good cleaning of his teeth on a regular basis. Typically they seem to be understaffed and very busy.

Does anyone go visit him that can do it? Or hire an aide to come in and do it once a week?
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The aides will do their best but are always stretched to the limit. Please help your hubby brush his teeth when you are there. I agree with others that talking to his dentist about mouthwash would help.
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againx100 Dec 24, 2019
Mouthwash won't work with someone with dementia - they won't remember not to swallow it.
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Electric toothbrushes do a better job than manual, and can actually be easier to use. They are also better at getting in around the gum line. Of course the person would have to get acclimatized to the sound. If your husband is willing to have an aide help him, the electric toothbrushes are also easier for the aides.
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The RN at mom's nursing home tried to tell me that bleeding gums are normal 🙄.

It isn't realistic to expect staff to perform anything but the most cursory dental care, the reality is that they have many more people to look after than there is time allowed for. I went to mom's dentist and got a prescription mouthwash - because it was prescribed they had to comply - but after that things went back to the status quo. I then brought in a peroxide mouth wash (colgate I think) and cleaned mom's teeth whenever I was there, I figured once a day was better than nothing.
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My patient stopped brushing his teeth, so I took over. After the first resisted times he accepts it better and each time It gets better. Problem now he still swallows some toothpaste.
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My mother's dental hygienist told me that nursing homes never take care of their teeth. She used to visit her mother daily to help her clean her teeth and also helped her roommate. Mom loves clean teeth, but needs the mental prompt to remind her, just as your father does. Between my siblings and myself, Mom has a visitor daily to do so. However, not everyone can do that. I also printed an image of a chimp with a wide grin and added the text BRUSH YOUR TEETH at the top and I taped it to the corner of her mirror.
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Judy79 Dec 24, 2019
I like the picture idea! Something for me to think about IF she isn't doing it at the new place...
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They ( nursing home) can not force him to do anything. It’s the law. My mother in law has gone months without bathing. They finally had to get approval from her GP to medicate her to relax her enough to let them wash her. This was only after the care workers complained about the smell in the room.
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mterpin Dec 24, 2019
My Mom went a full year without bathing. Finally we have her on a schedule, but truth is she was feeling modest before. My housekeeper told Mom her room was not smelling good, and literately guilt-ed her into the shower. After that, she has accepted help.
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Does he use a good anti-plaque mouthwash? It might be easier to have them hand him the mouthwash in a small cup then cue him to rinse his mouth than to get him to brush his mouth properly. Might be less expensive (than the periodontal cleaning) to schedule an extra tooth cleaning(?)
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oskibear Dec 21, 2019
He was using a mouthwash successfully for awhile, but began swallowing it so we stopped using it.
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When you’re there can you make sure he brushes his teeth properly? This would at least give him regular good cleanings.
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I'm no dentist however seems kind of odd that his gums would deteriorate that quickly, usually takes years for this to happen.

I would talk to the director about this, perhaps they can change his care needs.
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superstring Dec 24, 2019
Maybe not. My husband's dental care degenerated between two 6-month appointments with his hygienist, from "you are doing a great job" to "Oh, this is terrible" (from a hygienist with no bedside manner, obviously--we changed hygienists!) that's when we changed his appointment frequency to every 4 months and his caregivers took over at first helping him and now they do all his oral care.
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They can’t force him to brush his teeth the way you want him to. Have you tried helping him brush his teeth since he entered memory care? Perhaps he has declined and cannot brush his teeth. If that’s the case then I think the facility needs to change his care plan & use a diffferebr approach to cleaning his teeth!
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It could be he is not complying with aid instructions. Does the facility have a dentist that has rounds there?
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