My 91 yo mother has dementia & has bouts of combativeness...

(She’s on Seroquel, Namenda & Aricept)

Mom had 2 teeth extracted the other day with local anesthetic...(she had other teeth extracted but didn’t have this reaction) ....& since teeth broke off I wanted to avoid them getting infected...

So ever since extractions, acting even more strange..keeps pointing her finger or fingers up, then down, then sideways, making head movements up & down, then yes & no movements. Also refusing meds, drink & food more...I have to hide the meds until she asks for ice cream & then I can crush them & mix it in...Also she keeps talking about this “vacation” she is going on..& has to be downstairs to go to airport...& that she will eat on the plane...Also, she always used to know when she had to go to the bathroom to do number 2 ...lately, she said she has to go & once on commode, she said she don’t have to go. It takes work to put her on commode since she gets transferred with stand assist lift machine & I have to put vest on her & it’s a whole production just to get her on commode. So once she’s on commode, she wants to go back in wheelchair...Then once back in wheelchair, she says she has to go to bathroom!!

Uugghhh!! She thinks it’s a game? Also, she was letting go today of the lift machine to do the finger pointing ☝️ 👈 thing...I feel like I’m living in an insane asylum.

I’m my mother’s primary caregiver & I share hours with paid private Aide. I live with my mother & took her out of SNF 1 1/2 years ago against advice of SNF staff ...they told me this does GET WORSE but I didn’t listen...I have makeshift nursing home in the house.

Anyone experience these weird new behaviors after tooth extraction with their LO?

Thank you in advance & I appreciate all answers & advice.

First you are not in an insane asylum although it feels like that. My mom's went through a lot of behavior changes when she broke her tooth off. She is 85.
She was very anxious about it. I retrieved the tooth and put it in a container for the dentist.
She talked about it constantly until we saw the dentist. He worked on her mouth getting the sharpness down and making sure the roots nerves were dead. He checked for infection. We waited several weeks to go back.
In the meantime she talked about her childhood at the dentist and the painfulness of that because in her era there was no anesthetic over and over. Living the pain over and over--like we were there never to return. And her blood pressure all over the board. No amount of words could calm that fear. I understand the asylum as there was no reasoning.
We were blessed to have a dentist that was able to reattach that tooth that had been out a month. She settled down the minute the tooth was in. The tooth was a bridge.
I can't explain why reattaching the original tooth settled her. I do know the more she feels out of control the fear goes off the rails and the strange behaviors and desperation starts.
Helpful Answer (2)
Reply to Gratefulness
Llamalover47 Oct 18, 2018
Gratefulness: If the tooth was a bridge, how could it have been the original tooth? Perhaps the dentist bonded the tooth. Also the tooth had a root canal, e.g. your explanation of the dentist making sure the root was dead.
I was at first wondering if she was sedated or asleep for the process...but it's dementia so anything you have a neurologist involved, or someone more familiar with the effects of the drugs she is on? Could there possibly have been an interaction between something received at the time of tooth removal, if anything was given?
Helpful Answer (1)
Reply to gdaughter

Check with the dentist stat. There may have been something going on, e.g. think infection below the gumline for one.
Helpful Answer (1)
Reply to Llamalover47

Was she given any medication to help her relax before having the dental work done, like nitrous oxide. If so this could have had an impact on her, and may take awhile to resolve if it ever does. The hand signals could be something the dentist did trying to get her to move for him and she has picked it up. On the meds after doing reading on the Namenda and how long it makes things a bit more lucid for him I learned that at most it is just a few months, I had to ask myself was it really worth it for him. I concluded probably not, so I took him off of it. The aricept made his nose run nonstop and a lot, we stopped that also. He is doing fine and at this point he is only taking half an Ativan in the morning, I dissolve this in his hot chocolate or instant French vanilla cappuccino because he doesn’t want to take his medicine either, he gets a whole one about two hours before bedtime in hot chocolate. He also has pain pills for a bad back and this goes into a warm drink also. I wish he was continent but unfortunately a few months ago he started to do all his duty in his underwear, so I have just gotten used to cleaning him up. I know people on here talk about putting them on the toilet after they eat for a bowel movement but short of tying him down to it he wouldn’t stay on it. Such is life 😊
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Reply to Glendaj2
gdaughter Oct 17, 2018
It's my understanding, if she had been given nitrous, it would be out of her system by now, and is generally "flushed" out by simply increasing the oxygen one would breathe before leaving the office.
I think you will find if you look up the side effects of the medication that it is in fact the meds that are slowly but surely making your Mother much much worse.
Teeth removal is traumatic for anyone. However, anymore broken teeth Id suggest you just have them smoothed over by the dentist . Not removed. They will not cause infection just because they are broken. And as long as the edges are smooth they won't cause any problems.

Re bathroom
It sounds as if she is constipated. Again probably a side effect of the meds.
If you soak a bowl of prunes for the day in hot water, then give them to her before bed every couple of nights, this will move the bowels the next day...and prunes are rich in iron (iron deficiency 'anemia' is common in the elderly.) so this will be beneficial for her.
Ongoing constipation is going to increasing her decline
Regularity is going to improve her health & well being substantially
You might consider slowly but surely weaning her off the medications...1/4 pill reduction every 7 days. And monitor her progress. If she has problems developing that the meds are treating, then more slowly. Reduce them none the less
If you "ask you Doctor" he will advise against. However, your Mother and yourself are living with the problems these drugs create
You might watch "Death By Medicine" by Gary Null on Youtube.
This will give you an understanding of the medical system in America & how its structured. Its a very well made professional documentary
Mother may not be as 'crazy' as she seems when she refuses her meds
Also, if you look up 'potassium broth recipe' on the internet and make it for her this would be helpful. A simple fresh vegetable broth that is very rich in minerals & will nourish her and make her feel better as well as improving her physical health

I also suggest Organic Moringa Powder..can be bought on and
a teaspoon twice a day if 1/3 cup of distilled water before her meals will be very helpful for her well being. Its one of the plants (vegetables) highest in nutrients available with no side or toxic effects . And many side benefits. I have noticed it does improve mental clarity in the those suffering dementia. As does Distilled water

The Prognosis of "it will get worse at home"
I entirely disagree (after many years in medicine) Hippocrates himself says "Cure sometimes, treat often, comfort always". There is very little care in those centers as you are aware. And you clearly care deeply for your Mother...which is very important for her well being.
There will be days when you doubt yourself & the burden seems too much. How
However, these days pass....and you are doing what you would want for yourself
Providing a loving supportive healthy environment for your Mother
Not an easy task. However, later you will be glad you could do this for your Mother...after all she did for you throughout your life.
How fortunate she is to have such a wonderful human being for a daughter
Helpful Answer (3)
Reply to sunshinelife
Judysai422 Oct 16, 2018
No disrespect, but unless you are a doctor, it is not wise for you to advise people on medication.
See 5 more replies
First, I’m sorry for what you’re going through. I’ve been there and it’s rough. Also, i’m not a medical professional. I would speak with her doc.

That said, yes, I think having any type of procedure can be a setback for a dementia patient. Was your mom given anesthesia when her teeth were extracted? Anesthesia, I was told, can really be bad for a dementia patient and cause some type of decline.

Also, did the dentist, by any chance, give her another drug? When my dad (who had dementia) was hospitalized with a small hip fracture (he had fallen), he was very panicky while in the ER. They gave him Haldol (sp?) which a lot of hospitals give to calm down patients. It made him much worse (he started trying to communicate with me through hand signs and was slumped over). I flipped out and demanded they not give him the med. they stopped but it did cause some type of decline. Maybe the dentist gave your mom some type of seditive that had a bad effect?

Either way, i’d call her pcp who might know the answers. Good luck with everything.
Helpful Answer (4)
Reply to nerdwoman55
CaregiverL Oct 17, 2018
No she got local anesthetic & antibiotic before procedure...& her usual morning Seroquel dose
If the dentist px'd antibiotics - is a good point to consider.

The head waggling - I suppose it could be that her mouth just feels funny and she's trying to locate the problem?

Was the journey to and from the dentist's office difficult for her? Has she had time to settle down again?

Or, of course, it could be completely unconnected with the extraction - a change that would have happened anyway, and it's mere coincidence that it's now.

Time for a review of her overall condition and the care plan, perhaps?
Helpful Answer (1)
Reply to Countrymouse

Not with a local anesthetic. that wears off after a few hours and is just a local.
could be all of those psychotropics..either that a UTI or some kind of infection but chances are your dentist prescribed an antibiotic. Psychotropics has been known to cause drug-induced encephalapathy. SOMETIMES antibiotics have been known to interact with psychotropics and make them go loopy.
Helpful Answer (0)
Reply to cetude
CaregiverL Oct 16, 2018
Yes she had antibiotics before procedure..& she always takes it before dental work. She never had this kind of reaction before. She had local anesthetic
Most dentists and oral surgeons give an antibiotic after an extraction. It may be she has an infection in the jaw bone. I had one, and it affected my memory. I also had wierd symptoms like smelling tobacco smoke when there was none. Not sure any of this is affecting your mother, but I would ask for an ABX, even if there is no UTI. Sorry about what you're going through...
Helpful Answer (0)
Reply to Jimbosticks

I agree with Margaret. Your mom's behavior might be explained if she'd had general anesthesia. The elderly have trouble blowing off the anesthesia and, as Margaret said, they don't usually bounce back to where they were cognitively which sounds like what's going on with your mom except she didn't have general anesthesia.

UTI is always a sneaky culprit when there's a sudden personality change. You might consider getting that checked out. Maybe the urge she's feeling when you help her onto the commode is the urge to pee. And if she has a UTI she isn't able to pee when she has the urge.

The commode thing could possibly be the beginning of a new behavior. I used to work in hospice and that happened all the time with my patients.

Maybe her change in behavior is just a coincidence or maybe going to the dentist was out of the norm for your mom, disrupting her routine, and it affected her dementia.
Helpful Answer (4)
Reply to Eyerishlass

Might it be time to re-evaluate your previous decision to have her live with you?
It’s OK to admit to yourself that her circumstances have become too difficult to be managed at home, and feeling as you do, it may also be time to acknowledge to yourself that you need extended respite care for HER welfare but also for YOUR welfare.
Even just thinking about having alternatives helped me to make better decisions for my mother, whether I was making changes or not.
My mother at age 89, was profoundly different following replacement of her broken hip, and most of the unanticipated (permanent) change was attributed to the inevitability of needing the general anesthesia, and the subsequent effects of it on a nervous system already damaged by dementia.
A fine nearby SNF was a very positive resource for her after the surgery. I was able to visit almost every day of the 5 1/2 years she lived there.
Helpful Answer (2)
Reply to AnnReid

Those behaviours are fairly common after a general anesthetic, but perhaps not with a local. After a general, the situation often improves in two or three weeks, but frequently remains worse than before. Wait a little to see, but you may be looking at institutional care again.

The obvious - have you had her checked for a UTI, which can cause bizarre behaviours all by itself.
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Reply to MargaretMcKen

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