Mom vomits when I try to brush her teeth. Should I stop?

Coughing a lot while eating means she is having trouble swallowing and the vomiting is caused by gagging . Mom needs a swallow eval by speech pathology and recommendations as to what consistencies of food and liquid that she can tolerate . She may also not being chewing enough . She may need chopped or purée foods and thickened liquids . Mom’s dementia is advancing , I would not get crazy about the teeth brushing . Or perhaps do not use toothpaste as it’s apparently going down her airway and making her cough, gag, vomit . All this food and toothpaste going down her airway could cause aspiration pneumonia , which is way worse than plaque on teeth at this late stage of life .
They also have those soft disposable foam mouth swabs for comatose patients you could try . Yes Mom can lose weight from vomiting .

Has she had a swallowing assessment? If not, ask for it to be done asap.

It sounds like she's having issues with swallowing, which can cause aspiration pneumonia and be fatal. Her doctor can test her to see if that is the issue. I'm surprised the nurse didn't suspect that as it's quite common with folks who have any of the dementias.
My late husband(who had vascular dementia)had aspiration pneumonia and his doctor said because of his dementia that his brain was forgetting to tell his throat to close when he was eating or drinking, thus allowing it all to go into his lungs and not his stomach.
And yes my husband almost died from it and developed sepsis and septic shock leaving him completely bedridden and under hospice care for the last 22 months of his life. It's nothing to mess around with.
I would make sure that all of her foods are now pureed and her drinks thickened with the product Thick-It.
And as far as the brushing of her teeth goes, I personally wouldn't worry about it at this point as I think there comes a point as the disease of dementia progresses that one has to pick their battles carefully and I don't think brushing her teeth and making her vomit is a battle worth fighting at this point. Otherwise just get her front teeth best you can.
Please have your moms doctor order a swallowing test for her ASAP.

There comes a time when dental care isn't really a priority and less than perfect is good enough, I'd go with minimal brushing just to ensure there is no pocketed food and skip the flossing altogether. Dipping the toothbrush or an oral sponge in a peroxide based mouthwash and being gentle rather than scrubbing away with gobs of toothpaste may reduce the gag reflex.

And as the others have already pointed out she needs a swallow evaluation ASAP, she almost certainly needs a modified diet.

https://www.agingcare.com/articles/dysphagia-how-to-help-a-loved-one-eat-and-drink-safely-187010.htm

https://www.agingcare.com/articles/swallowing-disorders-tips-for-using-food-and-beverage-thickeners-208048.htm

Thank you everyone. I will get the doctor on it. I didn't think about the aspiration pneumonia issue until you all brought it up.

I think that MD should be notified that mom may be suffering a swallow deficit. This is very common in end-stage dementia. It can lead to aspiration pneumonia, particularly with food being swallowed into the lung.

You may be needing to make some decisions in the near future as to whether to include tube feedings for your mother, or request Hospice or Palliative care. In some cases this marks the beginning of the end with either choice as tube feedings lead to pulled tubes, infection, diarrhea, bed sores.

Swallow deficits are often checked by OT personnel and they may in some cases even make home visit.

Agree with others--Mom might be moving into stage 6. Let her care team know.

Tam Cummings assessment tools/AD checklist
https://tala.org/wp-content/uploads/2019/04/Tam-Cummings-LLC-Handouts.pdf

"the dentist warned me about her dental hygiene and plaque."

Your dentist is insane. Seriously your mother has stage 6 Alz I think worrying about plaque build up is ridiculous. Skip the flossing and try and brush her teeth as best as you can without making her puke.

Try a swab, they make ones for this purpose.
They are foam and very slightly ribbed so they can be used for any number of things.
Clearing food from the area between the gums and cheeks. (Many people begin "pocketing" food)
The swabs can be used to brush the teeth and the roof of the mouth. BUT if this causes her to gag and begin to vomit stop. Vomiting can lead to aspiration pneumonia.
And getting to the fact that she is vomiting...is she having problems swallowing liquids or is it food? If it is liquids they may have to be thickened. With dementia often the body can not close off the trachea when swallowing so food enters the lungs. I hope the food is being cut into pieces or possibly even pureed if needed.
I think at this point you no longer have to worry about dental hygiene.
I doubt that she would sit still or be compliant for any dental work anyway. (Heaven forbid that the dentist suggests pulling any teeth! Trying to care for mouth wounds, any wounds on someone with dementia is almost impossible without them picking, poking and doing all sorts of stuff. Not even going to get into anesthesia and dementia

When I was pregnant I gagged and threw up when I tried to put a toothbrush in my mouth. The finger brushes worked well.

Please, oh please, let me make my Final Exit BEFORE I develop late-stage dementia or any disease that introduces the possibility of others needing to brush my teeth, the use of feeding tubes, "thickened" liquids and the like! If mom still had any awareness whatsoever, I think she'd likely be shouting "STOP!" with the toothbrushing at this point. If mom isn't already there, comfort care only (nausea/pain/anxiety meds) would be this 86 Y/O's vote.

do you think she can swish mouthwash around and spit it out? Or maybe there is a child version of mouthwash that isn't bad if you swallow it?

i think it's best to brush what you can without hitting the gag reflex button and leave the rest.

Please stop with the floss entirely and brush lightly with a soft bristled toothbrush. Your main concern is why mom is vomiting so much, not her teeth, with advanced dementia at play. She needs a medical exam to look into swallowing deficits, which are common with advanced dementia. If that's the case, it's time for a hospice evaluation for both your folks. This level of dementia alone is a Medicare approved reason for hospice, "Senile Degeneration of the Brain" it's classified as.

My mother was vomiting quite a bit towards the end of her life in Memory Care Assisted Living too. She had very bad GERD and I had to insist her PCP switch her to Prilosec which did the trick. She had been taking some mild stomach med that was doing nothing for her situation but making it worse. I have no idea if your mom is suffering GERD or something else entirely, but if you think so, speak to her PCP. You know her history and we do not.

Mom had a bad case of pneumonia in 2019 which docs thought was aspiration pneumonia, but a swallow study showed it was not.

Wishing you the best of luck with all of this.

It really makes no sense to me that old-old people cannot legally accomplish a Final Exit with their personhood and dignity more or less intact--IF that's their choice. I'm not there yet but I could find myself facing that unwelcome predicament in the foreseeable future. We have the "live to 100" crowd pushing for ever-increased longevity. Yet, there is absolutely NO plan as a society for how to care (or PAY) for the rapidly escalating population of potentially addled, frail, incontinent, hearing, vision and mobility impaired old-old people.

I'm right in the middle of The Silent Generation (YOB 1937). We were a small cohort to start with. Not many of us may see our 90th b'day. That may not be the case for millions of the Baby Boom generation, yet society is no better prepared or equipped for them to reach old-old age than it was for us Silents. Some politicians are looking for ways to CUT Social Security and Medicare. A growing number of homeless Americans are 55+. Now THAT is scary--or should be!

The vomit is very acidic and definitely makes brushing the teeth a challenge. (Peopl with bulimia often destroy their teeth from the purging.)

Give mom the toothbrush and let her do the best she can.

Can she rinse and spit? If she can do that, she can use a fluoride rinse that will help. Not as good as brushing, but better than having acidic stomach acid on your teeth.

The behavioral approach here would be to change the brush-stimulus to something that is less triggering to the gag reflex/aversive reactions.

Perhaps use a soft cloth over your finger and slowly go over the teeth to remove residue. Or, you might get creative and adapt a toothbrush to something with a wider, softer feel. Maybe by cutting a child's toothbrush bristles very short and/or putting a soft, disposable terry cloth strip around it.

If mom can adjust well to a modified "brush," then you can try slowly increasing her sensitivity levels. But at this stage in her life, maybe just going over her teeth with a gentle "swab" is the best you can do. Even using Q-tips, maybe, or larger cotton swabs, if that's what helps clean while not provoking any bad reaction.

That's just what I'm thinking here and what I might try with my own mom.

Don't they make "finger brushes" for teeth, like the ones for pets.? That could be something to try.

I love that your mom still understands and assents to having her teeth brushed. I did similar things with my grandmother, who was well into dementia when I was her caregiver, but she appreciated having her hair and nails looked after, and I did what I could for her and stopped if she showed discomfort. But mostly, she liked the "self-care," and I was happy to give her that care. I don't see teeth-brushing as so different here; it's just that the serious and problematic gag reflex must be considered and medically assessed. Flossing and rinsing are probably "out" at this stage of life. Making loved ones feel cared for and getting creative in how you handle their care is always the challenge of caregiving to elders, imo.

So sorry you are going through this, and with both parents. You are trying to help your Mom and to do everything "right". You are a good daughter. As others have said, I would think the swallowing is the bigger issue at this point. Things are progressing and sadly, there will be more changes coming that you can't control.
That being said, if she doesn't mind the attempts at tooth brushing/flossing you could try the little brushes that fit between the teeth, if you haven't already. Some of these are short handled, but I have a long handled one that you change the little brushes out on the end. I can clean behind my back teeth with it without shoving a big brush back there. I order the brush refills online from amazon as they are not avaiable here locally, but the short-handled ones seem to be everywhere. Or you say she tolerates the flossing well- just continue that and let brushing go.

I've dealt with very similar situations before. Try Q tips, children's toothbrushes, a washrag with toothpaste on it, a water pick type tooth cleaner, toothettes, or the fingertip brushes. It might be the toothpaste causing her to salivate more and it hitting the back of her throat causing it as well. Desensitizing the increased gag reflex probably isn't going to work. Maybe talk to the dentist or an occupational therapist specializing in geriatrics about other options as well.

Good luck finding a solution. Yes Alz care is tough and heartbreaking. My heart goes out to you all.

I have similar issues with my Mom and these ideas have been helpful
FOR PREVENTION: not giving foods that tend to get stuck between her teeth or adhere to her teeth
Possible culprits: cottage cheese, scrambled eggs, tuna, chicken or meat unblended fruit and vegetables chocolate peanut butter tahini. So instead of cottage cheese I give her protein yogurt and instead of omelets I make hard boiled eggs and blend them and also blend salads and soups (with meat)
Avoiding sweet foods.
FOR ORAL HYGIENE
1.Mouth swabs dipped in water or salt solution (1 tsp salt dissolved in 1 cup water) Also cleaning in the pockets between the teeth and cheek Can be purchased on line
2 Very gently cleaning between teeth and around tooth-gum interface with a rubber tipped gum massager or a very narrow toothbrush Take care not to cause bleeding
3 Gently using a children's small electric toothbrush on low setting
4 Using a mild toothpaste i.e.. children's strawberry flavor
5 If she can't rinse her mouth not using toothpaste just dipping the toothbrush in water or salt water
6 WITH CAUTION because this can be dangerous (CAUSE ASPIRATION) if she has swallowing difficulties
Use a small syringe( 1 -5ml without needle) with a cup of water to rinse teeth and pockets between gums and teeth Start with very small amounts (1 ml at a time to see if she can handle it.. This is like a very gentle, manual, water pick
and although my Mother also coughs when eating she can handle this when its done gently .
Your parents are truly blessed to have such a caring daughter
Wishing you happiness good health and fortitude and remember you can only do your best and your best is a lot!

Toothpaste is irrelevant at this stage. It may smell nice for us but she doesn't even notice. Her comfort is the most important thing now. My mom lasted for 26 years until she died at age 95.
We ignored her teeth for a few years because she was on a feeding tube so teeth slipped my mind! I eventually took her to a hospital clinic for all types of people (even children) who needed to be put under anesthesia, That's when we had major dental care to do. In the meantime, take care of the basics, without causing her discomfort. Good luck and be strong.

Did you ask her dentist or doctor??

My mom’s teeth are permanent dentures. Very hard to clean since the real gums have shrunk and there is plenty of room for food to get under the dentures. Her hygienist, I take her about every 6 weeks, gave me a soft, silicone toothbrush and long q tips. So our routine is now: mom rinses her mouth with peridox mouthwash and spits until there is no more debris, then I use or she uses the soft brush that I dip in the mouthwash, she rinses her mouth and spits again until no more debris and then I take the q tip dipped in the mouthwash and run it along her gums. Her last visit was so much better and her gums were not sore. Between brushings, during the day, I have her rinse her mouth with the mouthwash. Because she can see the debris in the sink, she is willing to rinse until clear.

Try using a pediatric mouth rinse (safer to swallow) for oral hygiene. Also use a pediatric tooth paste if brushing is continued. You might only be able to minimally clean the outside of her teeth.

As others have said, Mom needs a swallow eval and it may be time for pureed foods.

Try a child's toothbrush.

Forsuchatine: Pose your questions to a dental professional.

DeniseV: Your situation--and that of your parents'--sounds like an absolute total nightmare for ALL concerned! It certainly would be for me. I'd consider requesting hospice or palliative care if they aren't already receiving these services. As I understand it, some medical providers may support the option of VSED if the patient has sufficient capacity and/or a detailed written directive. It sounds like your mom may lack legal capacity to decide on VSED--or a trip to Switzerland--but these could be options for your dad (there are costs, of course).

To my mind it makes absolutely NO sense to prolong the existence (IMO, it's no longer "life" at some point) of old-old, very ill people approaching EOL who are more than ready for their Final Exit. I hope your situation can change for the better.

Amazon carries some products that might be useful to you. On their site look up "self flossing tooth brush" and "water flosser." When my youngest had braces he used the water flosser and found it very helpful. He created his own short cut by adding a capful of mouth wash to the water tank before using. Pretty sure that isn't endorsed by manufacturers but it worked for him lol

This is a question to ask her PCP and, the PCP should have been informed about these observations in changes with your mother; a new " level of care needs assessment" should be performed for mother and father to further assess options for their current care needs. Frankly it sounds like they may be ready for a higher skilled care facility than ALF. Or, possibly even your mother may qualify for hospice care; call a hospice of your choice,discuss her changes etc and speak with the hospice clinical supervisor about options going forward.

Try a WaterPik - that uses pressurized water to clean teeth. You won't touch the back of her throat to induce vomiting.

Since she is coughing a lot and having vomit - please ask the doctor to have her swallowing evaluated by a speech therapist. She may not be able to swallow well and food may be going into her airways and lungs rather than her stomach.