Is there palliative dental care for Alzheimer's dementia patient? - AgingCare.com

Is there palliative dental care for Alzheimer's dementia patient?

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How do you strike the perfect balance between getting the patient good dental care without inflicting them with an over zealous, dental treatment plan?

Some dentists can get very free with their recommendations for various treatments, procedures, etc. I want my cousin, who is 63, with Vascular Dementia mixed with Altzheimers, in Secure Memory Unit, Severe Dementia Stage 6 to be comfortable, but not overly treated with dental procedures.

She has lost most mobility and is wheelchair bound, but still is verbal and feeds herself. She's had a lot of health crisis with falls and we've been focusing so much on her medical issues, that we haven't addressed her dental. Now it's time.

She has never had good dental hygiene, so I can't imagine what condition her teeth are in. She has them all with maybe 3 fillings from childhood. None appear to be bad. She doesn't complain of any tooth or gum pain, her gums don't bleed and she eats without issue. Still, I know she needs to see the dentist. She hasn't gone in years. Her dementia progressed in May of this year and she's been in assisted living since June.

I fear the dentist will say she needs to have them all pulled and get dentures. I have talked to enough people with dentures to know it's not that simple. I don't want to create another thing for her to deal with. I also don't see the point of having her sit in a dentist chair twice a week for the next 6 months getting elaborate work done.

What should I do? Should I wait to see if she complains of a problem and then just pull the offending tooth?

Is there a such thing as palliative dental care?

She's on medicaid, so the costs is not an issue. I just want her comfortable for what time she has left.

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Jeanegibbs - I agree that quality of life is always an issue! I would not want to be stuck with a painful mouth while I progressed from stage 2 to stage 6 either!
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surprise, I would not have had dental care for my husband once he entered hospice, either. People can live with dementia for decades. (My husband had it for 10 years.) What you do along the way is usually different than what makes sense at the very end.
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Thanks for letting me know that. I guess I was getting too anxious about it. She's had so much pain for the last 6 months of her life, that I want to give her some peace.

Although we can't predict the future, I don't see a long one for my cousin. Her blood sugar and pressure are under control now, but she had very high levels for many years in which she refused to treat them.(Before the dementia and strokes.)

She can no longer walk and needs extensive assistance with all areas of her life, except for feeding herself. She has lost most of her memory and only knows me and my parents by name and I'm sure she really knows their names. At their last visit she never said their names.

She can't answer any question about date, time, season, age, etc. And has many delusions. She is convinced she works at the Memory Care Unit. Which is okay with me. She's very content. So that's what matters. She is bladder incontinent, trembling hands, poor hearing, osteoprosis, slow healing fractured spine and hand, and we are awaiting a biopsy from a lesion on her face. Her mom died from skin cancer.

So you can see why I just want her to have some peace with the time she has left.
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Mthr is on hospice with dementia. The nurse told us that the only reason to distress her with dental care would be if she had an infection or abscess in her mouth, and it was fine for her teeth to turn gray and fall out. Mthr hates the dentist anyway, so we are treating this in a very hands off fashion. She will be on pureed foods soon anyway, so there is really no reason to continue. My dentist also says it's ok for her not to get cleanings or have teeth pulled. He also lets my little kids have cavities in teeth that will fall out within a year, so I think his wisdom is stronger than his love of money! :) She has lost one tooth and had a front one break vertically, but does not want to go to the dentist when asked. I am not stressing about it at all.
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My mom's NH has a dentist and dental hygeinist who come in every month or 6 weeks or so. We had the dentist examine her because she's the type of person who went to the dentist every three months, no matter what. Her old bridge no longer fits, but we're probably not going to replace that. We've now got mom on a 4X a year cleaning schedule. Her ability to brush her teeth has diminished somewhat, even with an electric toothbrush and her teeth have gotten somewhat grey from antibiotic use, due to repeated bouts of pneumonia. She gets upset when she looks in the mirror, so having the hygeinist clean them is a way of calming her down.
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Okay. Thanks. I will look into it. I also think I'll talk to a couple of the staff members at the Memory Care Unit and see what their experience has been with other residents.

I'm not sure how well she would sit for a cleaning. She's never liked dentists and I can anticipate some anxiety. We may have to give her a Xanax for that visit. I just have visions of him saying she has to come in every week for months to get fillings.

It's good to know she's covered if she has to have work though.
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Some dentists accept Medicaid, bless their hearts. Unless the policies have changed in recent years, care is completely covered. My husband went to such a doctor for about 8 years. She was very good with him, and the entire office staff was good with the dementia or disabled patients. There was no cost or copay.

Check it out for any current updates, but I think cost is really not an issue.

Having basics like a thorough cleaning done would help prevent gum disease. My husband's dentitst never suggested advanced procedures, and if she had we would simply have declined.

Now I don't know how your loved one would react to sitting in a dental chair, holding her mouth open, etc. That might be a bigger issue than the cost. (A dentist who accepts Medicaid is probably compassionate and used to dealing with persons with dementia.)

If I were you I'd try it for a cleaning and to learn what else is recommended. You don't have to follow through on the recommendations if they don't make sense to you.
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Really? I didn't know. I was told that if the dentist accepts medicaid, the work is covered. She has no funds to cover any additional bills. She only gets $66. per month from her disability and over $40.00 of that goes for out of pocket prescription medication costs. There's not even enough to pay for her clothes.

So, I'm going to see how she progresses and not try to create a problem that doesn't exist.
Thanks for your insight.
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I agree, leave it alone, going to the Dentist now will open up a can of worms. Cost IS an issue because Medicaid dental coverage is minimal at best and most dentists now won't even take Medicaid patients. Let it be.
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I cared for my dad at home until he went into a nursing home where he died 6 months later. If it were my dad and he wasn't complaining of any tooth pain or discomfort I would leave well enough alone. I had enough to deal with without adding on something totally unnecessary.
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