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Her diet is horrible; she basically eats sweets/baked goods all the time. In the last few months three of her front teeth have broken off. I suspect that they are full of cavities and that’s why they’re breaking off.
She is willing to go to all of her other doctor appointments without too much reluctance, she’s scheduled for cataract surgery in March, she has congestive heart failure that requires her to have a cardiologist visit every 6 months, etc. But she refuses to go to the dentist.
I called her dentist, it’s been going on 3 years since her last visit, they are adamant about getting her in, but she won’t budge.
Is it vanity/embarrassment, or is it a sign of early dementia? I’m looking to change her primary care physician, as she never seems to discover any of the real problems when my mother visits.
My biggest fear is that her gums may become infected.
Is there a way to force someone to go to the dentist?
Thanks for any suggestions.

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I can't tell you how to get your Mom to the dentist but I can say that rotting teeth and bad gums can be dangerous. My Dad got sepsis last year and they believe it was because of his teeth. He almost died and the damage from the sepsis has debilitated him permanently. So yes it is a big risk to ignore dental problems.
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Rugged, if you do manage to get mom to the dentist have only the minimum work done so she can eat and is healthy. At her age it doesn't make sence to have cosmetic or complicated bridge, caps, 6 visits etc. My moms dentist has been great. He builds up tooth stumps so she can eat, keeps an eye out for infection and keeps things as simple as possible for her.
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Hi Ruggles, I am guardian of my aunt who has severe senile dementia. I used to think that was an old term...but it unfortunately still applies. Sadly, we were having the same issues similar to yours. She is in an assisted living facility, so I try to keep us all on the same page regarding her health. As for her teeth, which were atrocious, I would set up the appt., fill them in on her demeanor (biting, scratching, hitting...so sad) and what works for me and how to go along with me when we get there. They are ALL my best friends from high school ( so she is more apt to trust them) I smile, sing to her, keep her focused on me until they knock her out. But before we go, I tell her we are going out to her favorite restaurant for lunch...once we arrive at the dentist office, I run in quickly while the attendant is wheeling her into the office, and remind them that they will all be getting hugs from me and to just follow my lead. I, in turn tell my aunt that we are stopping to visit my girlfriend quickly and will be on our way to eat shortly. Once I get her in the chair (she will only let me touch her...very sensitive and yells and screams if anyone else does it) I tell her my gf wants to look at her feet ( always the feet...and she's good with that, thank goodness), I sing to her her favorite song, they start the I.V, knock her out and an hour or so later it's complete...and she's none the wiser. Each moment is a new moment for her. She won't ( doesn't ) remember any of which transpired. So grateful for that...then it's back to assisted living. We never do go out to eat, because I never know what she might be apt to do. Upsets quite easily..I've been smacked a few times, no biggy...I know that it is the disease...not my aunt any longer. Just a thought for you...oh, and I had to find a specialist that deals with dementia, cerebral palsy, special needs children, etc. Well worth every minute to have her teeth done by professionals that deal with it day in and day out. Hope this helps...Good luck to you and God bless!! :)
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Ruggles, Tell your mom not to worry what the dentist will think of her teeth, because he/she already knows. Tell her that her mouth is nothing earthshaking that the dentist hasn't seen a hundred times. Make sure she knows that it won't hurt her because she can be sedated so that she won't care what they're doing in her mouth. Be sure that you've had her blood checked for infections that she may have already gotten as a result of her mouth decay. Take the worry and embarrassment about going to the dentist out of the equation and she'll probably go.
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Also make sure your cardiologist and any other specialist you see is Board Certified in their specialty.
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That cardiologist! Always bear in mind that the person with the lowest gpa from the worst medical school is...a doctor. There are great doctors and there are horrible ones. If a doctor provides your mom with questionable care, don't hesitate to look for another one. She is entitled to quality care!
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Try and get her teeth taken care of before the cataract surgery. You don't want her eye to get infected and she will have mobility restrictions after the cataract surgery for a while.
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I won’t know about the type of arthritis until next Tuesday. Her doctor did say it seemed like it wasn’t symmetrical, so he doesn’t think it is rheumatoid.

Veronica, I agree that at 90 years old, and in the advanced stages of CHF, opening up more cans of worms is probably just going to make her last years more miserable.

I like your suggestion about the dentist, will mention it to him when I call next week.

She actually wants to do the cataract surgery, and she got the referral for the appointment with the rheumatologist from her PCP on her own.

Over the years I’ve noticed she likes to cherry pick the things she wants to have done, she had this pre-cancerous growth on her forehead that she wouldn’t agree to have removed. I forced her to have it removed, which improved her appearance so much, and prevented another possible health issue.

It must have also made her feel a little bit more self-confident.
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CM some he'd just as soon not see too! I'd rather clean the poop than the teeth!!!!!!!!!!!!!!!
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But this is what makes me so CROSS! - "The x-ray technician said to her in an authoritative, but not sadistic, way, "I know this hurts, but you’ve got to do this so we can get a picture of your hip; that’s what you’re here for.”

Of course what she said was true, but there are ways and ways of helping the patient get into the right position. I just wish they'd take a little extra time and a lot more trouble to go gently with elderly people.

Veronica, asking the dentist to make her feel like an important patient - "He was so worried about me he called specially!" - and reassure her about her visit is a BRILLIANT idea. Hope the dentist will play ball: he'd have new patients queuing round the block, well worth his trouble!
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I just lost power and my post disappeared. -Wail
Having difficulty rising has more to do with the weak knee than the hip.
How ever bad the x-ray looks don't consider surgery unless it is very painful. Hip surgery is very hard on the body as there is a lot of blood loss, knees they can tourniquet. Does she have OA or RA? R/A is inflammatory O/A is plain old wear and tear. There are treatments for R/A other than surgery to reduce the inflammation.
You also say she is on multiple drugs and the cardiologist just added Digoxin. Did he also tell you to check her pulse before she takes a dose. The usual recommendation is to with hold the dose if the pulse is less than 60. if it's too low she may pass out.
Does her A Fib come and go ie is her pulse regular at times and at others fast and/or all over the place difficult to count.
As my infirmatys progress drugs are changed and discontinued and I get some side effects.
I made myself a chart with the list of drugs down one side and then I looked up the side effects for each and for each drug listed the side effect I could recognize across the top. When I had finished I was able to see which drugs had many side effects in common and understand better what was happening and question the need for the worst medications. You also need to note the interactions so you don't give the wrong things together. I know this is a lot if you don't have a medical background
Many drugs your mother is probably taking may contribute to her weakness/dizzynes so it really helps to be aware.
Now to the dentist. do you think he would be willing to call her and invite her in. He can tell he already knows how bad her teeth are and how painful they must be and wants to help. Dental infections are definitely a risk to all hearts healthy or not. Sedation or anesthesia will allow him to get the job done quickly with fewer visits. He may want her to be on an antibiotic for a few days before he starts.
As far as the x-ray experience is concerned I would be inclined not to mention it unless she does. If she needs more then is the time to tell her you will be in the room and make sure they don't hurt her again. There is no reason you can't be at her side and help position You just need to go out while the film is taken - a few seconds. As was suggested get another opinion about the cateracts, they can indeed progress very quickly but only go ahead if she really wants it and you really feel it will improve her quality of life.
Resist any further investigations unless you are sure you want to treat the condition that is uncovered. Remember old people are great money makers.
if a colonoscopy was recommended would you put your mother through that and proceed with bowel surgery and a possible colostomy. I wouldn't I would call Hospice ASAP. I know people want their parents to live for ever but do they want them to suffer forever too?
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Thanks for your insights, Countrymouse. I’m so sorry to read about your elder family members being "manhandled" by their health care providers.

A panic attack would explain my mother's behavior, as it was extremely OTT.

The x-ray technician said to her in an authoritative, but not sadistic, way, "I know this hurts, but you’ve got to do this so we can get a picture of your hip; that’s what you’re here for.”

The good thing is, the x-rays are done.

I speak to her rheumatologist on Tuesday about the x-rays and blood tests.

I guess I need to do a little work on detaching myself from the situation so I don’t slide down a rabbit hole.

Have a great weekend!
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??? I'm not sure your cardiologist was completely paying attention… Broken teeth, not a problem, no; rotting teeth and active infection? - I can't think what he was thinking. That's a cardiac risk even if you haven't got CHF to start with. I'm sorry he wasn't more help.

The technician had probably done something dumb like manhandling your mother without realising that she was hurting her. I know these people are busy and have a long patient list to get through, but I still wish they'd take just a couple of seconds to think what they're doing. Frail little old ladies hurt all over and get frightened. Do they not learn? Your poor mother. We've had similar problems with a blood pressure cuff that had a fold of skin caught in it (and the **!@! idiot nurse couldn't understand why my mother yelled her head off when it inflated), a cardiac physiologist who actually left her bruised after an echocardiogram (I reported it); and the worst incident I've seen was when two ambulance drivers came to transfer my 95 year old great aunt from one hospital to another. It was the end of their shift, they were in a hurry, but when they moved to haul her up from her chair without warning I said "hey!" and put my hand on her shoulder. They looked a bit shame-faced and started again; but if I hadn't happened to be there? She was recovering from a fractured pelvis, they'd really have hurt her just by being in too much of a rush.

It sounds to me as if your mother had a bit of a panic attack in the x-ray room; and I think it's understandable. Leave it a couple of days and then bring it up gently: "goodness, that x-ray wasn't any fun, was it..?" - kind of thing.

Whatever you do, don't clap your hands and say "Well if you think that was bad just wait 'til we get to the dentist..!" - lol. Any luck with that?
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I took my mother to her cardiologist, I explained to him the odd behavior she displayed at her eye exam (reading from right to left, leaving off the last letter of each chart) but he insisted that she didn’t have the symptoms of having suffered a stroke, and wouldn't give her a referral to a neurologist. He also said her broken teeth aren’t an issue with her CHF.

She was experiencing an episode of atrial fibrillation during her visit; so he added digoxin to her drug cocktail, and then said she’s doing really well. Okay, whatever. He also insisted that she goes through with the cataract surgery, and that it shouldn’t be dangerous for her and will improve her QOL. I agree, QOL is very important at this stage of the game. He did think it was a good idea to switch her primary care physician to a geriatrician, and he gave me a name of one in the same town.

The next stop was the arthritis specialist. He suspects that she has inflammatory arthritis in her right hip. Oddly enough, my mother never mentioned any hip pain before, lots of complaints about her shoulder, hand, and knee, but never, ever, a mention of her hip having pain. A hip arthritis diagnosis would explain a lot about her condition, as she has a hard time standing from a seated position, and she walks very slowly. She also refuses to sleep laying down –which I thought was more related to her CHF, and the possibility that she can’t breath while lying down.

Is it possible that she just doesn’t understand her own body? She’s not particularly articulate, but she doesn’t seem to be able to communicate very well. Sometimes it feels like she’s playing a game, and doesn’t want anyone to really know how she feels.

I then brought her to get the x-rays of her joints. I normally stay by her side at all of her procedures, but I figured I couldn’t be in the x-ray room, so I stayed in the waiting room. The technician came out after a few minutes and asked me to help her get my mother on her side on the table, as she said she was refusing to move into this position. I went into the room and my mother was hysterical, screaming like a child that she was afraid she was going to fall off the table, and that she couldn’t stand the pain. She was totally rigid and wouldn’t bend any of her limbs. With the help of two other attendants, and by showing her how to hold onto the edge of the table, we were able to slowly turn my mother onto her side, although she continued to wail.

After the final x-ray was taken, we sat my mother up, and helped to get her to her feet; she quickly calmed down. By the time we got home, about 10 minutes later, she never mentioned what happened again.

I want to talk to her about it, but I don’t want her to have to relive what seemed like a truly terrifying experience for her. Her doctors don’t think she shows any sign of dementia, but her behavior in that room has me really puzzled.
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Ruggles I'm sure you can tell her with perfect truth that the dentist will have seen worse. Could you print off a rogues' gallery of nightmare teeth worse than her own from the internet for her to gasp over, would that help? There's also the obvious point that delay will only make the dentist even more critical, unless she's planning on dodging him forever. Or that the dentist will be pleased to see her anyway, just as parents are so pleased to see their lost-and-found children that they rarely scold them. Plus that since she's done this to herself, it's time to own up and take the punishment..?! All true - would she, er, bite on any of them? (Sorry!)
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Care4mama, she doesn’t have a fear of dentists, she told me she’s embarrassed for the dentist to see what has become of her teeth.
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Care4Mama, I've noticed that advice on the Steradent label too (and thought "Oh. Whoops!"). But actually I've decided this is their way of selling more denture tablets. You don't sterilise your own teeth, do you, so why should you need to do dentures daily? I brush mother's dental plate while she does her teeth. Actually I was hoping that the time I take to do it thoroughly would encourage her to keep going a little longer, but if her dentist's happy then I suppose she's doing well enough. Then I sterilise the plate once a week or so; unless she's been sick, or seems otherwise ill, in which case it seems worth doing just to be on the safe side.

The other rip-off is denture fixatives. I got excited about an advertisement for them and asked mother's dentist. She told me very firmly that as my mother had invested in a very good plate, it fitted her properly, would not deform, and required no glue. With dentures, it seems to be one of those purchasing decisions where you really do get what you pay for.
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Thanks again everyone, I am working on finding a new primary care doctor that is a geriatrician. I’m also going to get her a referral neurologist. The cardiologist appointment is this Friday.
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Ruffles, does your mom have a fear of the dentist? Many people do! We want to do our best to help our parents and when they fight us it's frustrating! Maybe explain to your mom if she wants to enjoy sweets with her own teeth she must get them examined/cleaned every six months? My mom has dentures and I watch her struggle with having to eat certain foods certain ways or not at all......your mom is lucky to still have her own teeth! My mom lost all of hers in her 20's!
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My mom wears dentures....top and bottom....only has one tooth left that's her own. The problem is she never.ever.ever wants to soak them. It's to the point now that I just get everything ready and say "hand them over please." My question is how often do most denture wearers soak their teeth? The packaging says soak fifteen minutes or overnight meaning it could be done daily......I certainly agree.......any thoughts?
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PS - She likes him? This dementia can get really serious, eh…

It is possible for cataracts to gather speed and worsen rapidly; but if there's a field of vision that's gone awry I agree with PS, I'd be wondering too. If she's leaving the letters off both end of the line, there is something very wrong going on and it could be brain, or it could still be eye - but this needs to be assessed by an ophthalmologist, not a surgeon, let alone a high street technician. There are all kinds of degeneration that could be causing it.

Have you noticed any behavioural or mood changes in your mother? Chronic CHF, I'm afraid, over time does tend to damage brain function. With my mother it was very subtle for a long time before she had a minor stroke in February, 17 years after the CHF first presented. Try keeping a record for a while, it might make small differences easier to spot; and maybe ask if an MRI would be a good idea (unless she's got a pacemaker?).

Anyway, let's hope she won't have to put up with toothache as well for much longer! Best of luck x
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From Mayo Clinic's site: "Cataracts can also be caused by other eye conditions, medical conditions such as diabetes, trauma or past eye surgery. Long-term use of steroid medications, too, can cause cataracts to develop." Has your mom changed medications or does she have diabetes? Those could cause her cataracts to develop more quickly.
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countrymouse- Nobody could talk her out of cataract surgery, nor did she listen when I told her not to get the retina repair. She is still seeing the same quack who blew her retina out. She likes him.
Ruggles, tell the cataract man to take a hike. He's in it for the money if he ignored all those warning signs.
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Pstiegman, what you have written is so interesting as I suspected at first that my mother may have suffered some type of stroke. She is acting odd in other ways. When she was getting her eye exam she would read the eye charts from right to left, instead of the conventional way, left to right. I thought that was really odd, but the technician giving her the exam didn’t seem to think it was unusual. My mother would also leave the end letter off each line that she read. I asked them if they thought if this was unusual, but they really didn’t answer my question definitively and said it was the cataracts. She had her eyes checked a little over a year ago and she was fine, is it possible that cataracts could get worse that quickly? I agree that she needs to be checked for a stroke by a neurologist before this surgery happens. Thanks so much for your insights.
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If refusing to go to a dentist is a sign of dementia, the statistics for the number of people who have dementia just tripled!

Sounds like you have a good plan to get the cardiologist involved.

If you are changing her primary doc, I urge you to consider a geriatrician.
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Brilliant, Veronica. I hope that dentist learned some respect for his patients!
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PS - I hope you had the cataract surgeon taken out and flogged! What the heck did he think he was doing, not checking beforehand for glaucoma as a matter of routine? For heaven's sake, it takes seconds. B*st*rd!
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Before you go for cataract surgery, have her eye pressure checked. If she has glaucoma (high pressure in the eye) the cataract surgery can blow a hole in her retina. Also check with the neurologist, if she has had any stroke or TIA that affected the vision part of her brain, surgery is a waste of time. We found out the hard way, did the cataract surgery, then the retinal repair, finally we found out she had brain damage at the back of her head and nothing was going to fix it. Meanwhile the surgeons got richer.
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I just called the cardiologist’s office, and they made a note in her chart to specifically talk about this with her without me having to bring it up first. Fingers crossed.
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Thanks for all the helpful responses. At this point in her life, fear is her only motivating factor. I will try and have the cardiologist explain to her the dangers of getting a mouth infection with her heart condition. We have an appointment with him on Friday.
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