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Recently my 95-year-old mother had her teeth cleaned and I doubt if she drew a full breath the entire time. I could tell she was extremely tense and have to give her credit for cooperating with the hygienist and the dentist. By the time we left, she was exhausted to the point she declined my suggestion to stop for ice cream, a first for her. She just wanted to get home.

Mom describes herself as a "worrier." On a normal day she is anxious and jittery, on top of the dementia. So it does little good to try and reason with her and actually can make it worse.

Meanwhile, we have an appointment later this month (August 2013) with Mom's primary care doctor to see about a medication which might help her through the dental appointments and other such situations. In the past, I’ve eagerly researched drugs and then cringed at the possible side effects and gave up the idea.

So, I would greatly appreciate hearing from other caregivers who have had similar experiences. Please tell about medications which have worked. All responses will be appreciated. Thank you.

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Just a thought: some medications have to be reduced gradually. Instead of just stopping the Seroquel you might want to gradually reduce it. Seroquel was the first drug prescribed for my mom. It made her sleepy later in the day but didn't really reduce her anxiety during the morning bath. The doctor then changed to Ativan. We also had to try more than one dosage. We also tried giving the dose with different amounts of time between dose and bathing. My mom only gets the Ativan on bath day and we give her half a tablet later that day so that she doesn't "crash" when the meds wear off.
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Thank you! I’m grateful to receive so many helpful comments.

Since I posted the question, Mom has been to her doctor who says giving something right before a dental appointment could backfire and make her worse, as some of you have noted.

Meanwhile, based on her other behaviors, the doctor prescribed Seroquel. During the time I’ve been here with Mom (10 years tomorrow), I've resisted this type of medication. However I agreed to try it because now she spends a lot of time in an agitated state, pacing around the house, trying to get out and go to her mother's, saying people are following her, etc. (Her mother, by the way, passed away 70 years ago and never left Pennsylvania. We now live in Florida.)

Mom has been on 25 mg of Seroquel three times a day. Last evening -- the 7th day -- her legs started to hurt badly and she looked awful. Her speech was slurred and she wasn’t able to focus on anything. So I'm stopping it to see if she gets better.

Her only other prescription is half a 25 mg Metropolol tablet twice a day for blood pressure. Plus I give her liquid children's Tylenol and Musinex with each meal and a liquid multi-vitamin each morning. She has Pepcid and/or Gas-X if needed. And that's it. (The Tylenol is for arthritis pain and Musinex to reduce phlegm which she gagged on regularly when I first got here after Dad died.)

The doctor also wants her to take Namenda so I guess we’ll try that after Mom has settled down from the other medication.

I appreciate all the cautions about strong drugs and I agree. I believe our help is going to come from herbal remedies and other alternative interventions. We’ll keep trying. Blessings to you for caring enough to contribute your thoughts and experiences.
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Personally, I have not seen a Dentist for quite some time and I am going to have some work done very soon for broken teeth. I hope the place i have chosen will work out because I am not up to shots that do not work and having pain for work that sees to prolong the problem. I can see where your mom can have lots of discomfort. May be there is a way to get her in a good mind set before she goes, relaxation exercise and breathing techniques might help. work with her until she can relax then the whole Dentist thing will be a better experiance for the both of you.
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I was wondering the same thing not just about a dentist appointment but about that time in the evening when they become anxious or anxiety ridden from dinner to bedtime. My Mom's GP gave my Mom an RX for Ativan! I was in shock as that dose .50 knocks me out in about 15 minutes so how can that be used? I would have thought that Xanax .25 cut in half. or something like it would have been better.

Sometimes I really worry about these doctors, so many of them don't seem to know what they are doing, especially with the elderly.
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I don't want to disagree that these drugs CAN be very dangerous. But so is sitting there for an hour with your blood pressure through the roof! Ask the doctor for something, and then give her a quarter of the suggested dose. Just because something can cause a side effect doesn't mean that it will. I'm not a medical person, but if the doctor will give it to her, there's a low - real but low - risk it will be damaging, especially at the lowest possible dose.

Along the lines of the suggestion for nitrous, what about a small glass of wine? I guess my point is that if she is suffering, give her something for it.
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Has she always been anxious about going to the dentist? Anxieties like this do worsen with age. As noted by others be very careful with prescription medications. Even if she is given a "safe" dose if such a thing exists she may be very unsteady on her feet so be prepared to guard her from falling. a calming aroma may help. Would the dentist allow you to light a candle while her teeth are done? lavender has a calming effect. Another would be to give her a chair massage in the waiting room. if you can stay with her hold her hand and gently stroke her arm unless that really annoys her. How lucky that she still has teeth to take to the dentist and usually enjoys the treat of going for ice cream after her treatment
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You haven't listed which medications your mother might already be taking. And although Xanax is a tranquilizer and probably would work, dax is absolutely correct that it is a bad drug for elders. It has an anti-cholinergic effect which can contribute to drug-induced dementia and NO studies of which I am aware have been published about the affect of alprazolam (Xanax) on someone already with dementia, but common sense should be able to tell us that any anticholinergic in a dementia patient is not a good idea.

Hylands (Standard) Homeopathic Calms - available at almost any health food store - could be of help prior to the dental appointment. They are non-toxic and don't interact with any prescription or over-the-counter medications, so they are safe. Mind you, they are not used like aspirin: have a headache, take an aspirin, headache gone in 30-60 mins. NO. You'd follow package directions for a couple of days before the appointment. Calms come in regular and Forte, which is supposed to be more for relaxing at night before bed time. In my experience, the Forte can be used for more relaxing if needed in the daytime. It does not put you to sleep.

Now, thyme has given the PERFECT answer. Nitrous Oxide was recently given to my 94 year old mother by our oral surgeon to have two lower molars removed. She new her teeth hurt and new she wanted them out but with her dementia became anxious and fidgety at the last moment. He had a very calming voice, put the apparatus on her nose, let it go to work a little bit, and everything was fine. He said it was perfectly safe and didn't interact with anybody's medications.

I had a problem just once many years ago at the dentist where the anesthetic injection wasn't taking so he gave me NO(2) to proceed. I don't know if all dentists use it but some do and you need an experienced one with the proper apparatus that goes over the nose and doesn't interfere with work on the mouth.

The only other thing I could suggest in addition to Calms and Nitrous is don't tell her you're going to the dentist. Just be getting her ready for some fun little outing. The more I would tell my mom what we were doing in advance of doing it, the more anxious she would become, if she were inclined to be anxious over what we were going to do. Just make the outing about something else and don't give her time to ruminate about it. Arrrrrgh, you have to get sooooo creative when it comes to managing a dementia patient's schedule.
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The problem with nitrous oxide in a lady of this age is not knowing the correct amount to give her, what condition her heart and lungs are in, and if the dentist is also an anesthesiologist or has one on staff just in case she stops breathing. This age category does not do well being anesthetized. Try a dentist that has earphones for listening to music or watching a video through glasses. Deep breathing also helps.
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Would a very small dose of nitrous oxide be out of the question for an old person? It was a tremendous help for me when I was younger but I also know it must be very carefully administered by an expert
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Be very cautious about using prescription drugs with older people. Please check on-line for "Beers List" (Xanax is listed as dangerous) to check out any drugs for "age risk".

I absolutely agree that there are many other natural solutions to your problem - like music etc.
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As a nurse, just know any medication to slow the nervous system systemically (all over her body) increases constipation and slowing of the brain connections which are already affected by the dementia. My suggestion would be non-pharmaceutical and more homeopathic. You can try calming teas, milk which contains tryptophan a sleeping neurochemical, a warm bath, massage, acupuncture to name a few. When my husband gets anxious, I leave him alone. Too much stimuli makes him anxious and angry. Your mother can take a walk with you as exercise will increase endorphins in the brain and be calming. Outside greenery or water (ocean) also is calming. Good luck!
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My mother-in-law became anxious with her Dementia. The doctor placed her on a low dose of Xanax and it helped tremendously. She was less anxious and wasn't as worried about things she couldn't have done anything about anyway. I hope you get your mom the medication she needs - even if just for the dentist visit. I would think it would be terrible to be anxious all the time. Good luck!!
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