What level of dental treatment is manageable for someone with dementia?
My 74-year-old Dad has always had very good teeth (just a couple of fillings over his entire life).
In the last three years or so, he seems to have stopped brushing/flossing. He has also increased his daily intake of sugary foods (this is a hallmark of his particular flavor of dementia, of which he is in an early-moderate stage). I caretake from a distance, with at least monthly drives to his state to check in on him, and since he was not complaining of any dental pain over the last few years -- and there have been other, higher-priority crises requiring my focus, time, and finances for him -- it was not until this last trip that I dragged him off to see a new dentist for a cleaning and exam to establish a "baseline" for the new reality.
The result? 13 cavities and one infected back molar that the dentist says will require an extraction (which she does not recommend for someone of his age and profile) or a root canal. She is recommending a silver nitrate + fluoride varnish treatment for the cavities, which she says will "stop the cavities in their tracks" in a painless way, but discolor the teeth where the treatment is applied. And she has recommended that he start to brush with a prescription-level fluoride toothpaste every day.
Dad is overwhelmed by the idea of having so many cavities. He is asymptomatic at the moment (i.e., no tooth pain), and doesn't quite believe that his cavities can be treated without filling and drilling. I'm not sure I quite believe it either. This silver nitrate process will require five visits to the dentist, and I'm not sure yet what insurance will cover or not ... but if it will keep those 13 cavities from getting worse without putting him through the stress of fillings, I'm for it. I'm more concerned about getting him through a root canal.
And, obviously, I'm even more concerned about the likelihood of his teeth continuing to rot because he forgets to brush and craves sugar. I'm asking his near-daily caretakers to add cueing him to brush with the prescription paste at the beginning of their shifts, so that I can be sure it's getting done at least 5 or 6 days a week and that someone is there to remind him not to eat or drink for 30 minutes afterwards ... but I can't shake the feeling that this is a losing battle.
What level of dental care is appropriate or manageable for a person with dementia? My Dad is at least still cooperative about going to see the doctor if I take him, and is cooperative and friendly with dentist and staff ... but I suspect this will change as his dementia worsens. I'm curious about other people's experiences ... does there come a point where you just have to say, I can't fix this?