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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?

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Thanks, GardenArtist...I went to the NH today to take pictures of his mouth. He was asleep, so I was able to get upper and lower. I hadn't seen the upper until today. It's the same as the lower. I took my nail and easily scraped off the gunk. It appears that they haven't been brushing his teeth. Livid, I took him right to the nurses station. Thankfully it was a nurse I like. I showed her. I also left a note for the unit nurse who will be there tomorrow. Iris knew my displeasure and promised that she would clean his teeth herself. I know they have not been cleaned in a very long time. I also realize that he is not very pleasant anymore, but cleaning his teeth is a part of proper hygiene. You know, all they would have to tell me is that he is difficult and that they can't properly clean his teeth and that a dentist should be called. I would have done just that, but no,they just didn't do anything! As for him spitting, he i s unable to. He doesn't have the strength or muscle control. I have his 3 month meeting 9/11...it will be a doozie!!!

Sounds like your encounter with the tree was terrible! Glad that you are ok!
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Even if he can't swallow (unthickened?) water, he can "swish and spit". That's the advice we were given. It sounds gross, but keep a "swish and spit" cup handy so he can do that when he's eating, if food begins to clog (even on a dysphagia diet).

If his teeth haven't been cleaned in 6 years, there probably is a lot of plaque on them. If he does have them cleaned, he'll probably have to take an antibiotic before, as some of the plaque and debris can accidentally be swallowed.

I don't know for sure if albuterol and (probably) ipratropium bromide leave a residue on teeth.

Honestly, I think it's plaque and accumulated food.

Ask about a safe mouthwash. That's what I had to use for about 6 weeks in lieu of brushing when I "fought the tree and the tree won", knocking loose 6 teeth and cracking my jaw.

And kudos to you for keeping after the staff to find out what's really happening. They'll learn that when you want answers, you need to get them!
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I am so thankful for these responses. Yes, I spoke to the speech therapist just a few days ago. It appeared that he had discomfort chewing, but when I asked him, he said No...he was fine. She also noticed it. Since he is very anxious and now on Depakote, it seems that at 4 PM the meds are wearing off and he becomes very anxious. It is also dinner time. I told the unit nurse about what appeared to be discomfort eating, and asked if he could be given his meds a little earlier so that he is not so anxious during dinner. It was agreed that he would get the meds at 4 PM and he would also be given Tylenol twice a day, just in case he had pain somewhere. 3 weeks ago he fell out of his wheelchair. That is another story. Fast forward to Wednesday. They were all outside in the courtyard. He was sleeping with his mouth open. I see this stuff on his bottom teeth. What the heck.....looked like yellowish material and patches of white. Couldn't get to see the top teeth. The aide who usually cares for him came out. Had him look at it. Oh...it's his medication. Since they have to crush it and put it in applesauce, it stuck to his teeth. My answer...if it stuck to his teeth, a full dose didn't get into his system. Oh yes, it did. The activity worker thought it was food not swallowed so she took him in to the unit nurse. Brought him right out. Would you believe he swallowed it between the courtyard and nurses station??? Look at his teeth...stuff is still there. Friday I went back...mainly to see the Psychiatrist who only comes on Friday, about his meds, as he still gets very anxious. Never got to see him, but saw the gunk on the teeth. Off to the dir of nursing I go. Come look at it. Oh...very busy...it must be plaque. I will have them schedule a dental visit. Never looked at him. Back to unit nurse....oh, yes, she comes when called and does everything right here in the building. But....he is so anxious, he gets somewhat aggressive and really can't open his mouth very far. Do they sedate him? No, I help her. He is on blood thinners and I know when I get my teeth cleaned every 6 months, my gums bleed a little. From what I can remember it is about 6 years since he has had his teeth cleaned. Now I wonder if indeed it is plaque. Could it be some sort of infection? Maybe yeast? What is the condition of the teeth underneath? Are they brushing his teeth at all? With the Dysphagia it must be hard, since he can't swallow water, but it would seem that the very least they could try and take a washcloth and go over them. Today I am going to take some pictures of the teeth. Something just does not feel right. I can't believe that that much plaque could form and nobody sees it. It looks as if someone put a substance over the teeth...you cannot distinguish one tooth from another. That is an awfully lot of plaque! Dad has been there for just a year. Was in AL living for a year before that. Oh....he also gets breathing treatments 1 or 2 times a day. I wondered if it could be from the meds. Albuterol and something else. Oh no....

His right eye is mostly closed. When I questioned why....it appears to happen when he is anxious. They gave in and scheduled the eye doc to come in Sept 5th. That should be an interesting visit too. I am so upset with this NH, if I find out what is on his teeth is some sort of infection, there will be H*ll to pay. All I expect is proper treatment of my father. 97, stroke 2 years ago, carotid artery 70 to 90 percent blocked, Dysphasia, on pudding thickness pureed food, anxious, aggressive at times and what they end stage Dementia...I hate to think what will happen if they start to mess with his mouth. I thank you all so much for your feedback. I swear this site is what keeps me sane!!!
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GA has pretty much covered everything, but I would add, get after the facility,mouth care is a very important part of personal care. Also ask them to have his mouth checked for a yeast infection. It may be possible for a dentist to get at his mouth if he is sedated
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Lucy, since he's already in a facility, ask to have him examined by the speech therapist, if there is one. If not, find out if there's a speech pathologist who can come to check him out. If not, ask for recommendations, including calling your local hospital and asking them.

Dysphagia needs to be treated by a speech therapist, although it sounds as if one is already involved b/c of the thickened liquids and pureed foods. I assume he also can't use straws?

I think your father is unable to swallow normally (happens with age and after sometimes after a stroke) and the food is collecting as a "bolus" in his mouth. He could also be pocketing the food, along the sides of his teeth next to his cheeks.

This isn't done voluntarily; sometimes it's occurring and the individual doesn't even know that his/her mouth is stuffed with food. A lack of sensation develops in that area and the person doesn't feel the bolused food. So it stays there.

One thing he'll probably need to do as and after he eats is "swish and spit", to get out the food that hasn't been chewed. It's a bacterial hazard, and can contribute to aspiration pneumonia, for which your father may already be at risk .

Before a dentist comes, I would help him get rid of the extra food so an exam can really determine if there are dental issues. Ask the facility's speech therapist or dietician for assistance if you're not sure how to do this.

I wouldn't be surprised if he has cavities that haven't yet been diagnosed, probably from all the bacteria developing in the food staying in his mouth.

Ask the dentist to recommend a mouthwash; that can help get rid of the mouth and perhaps the bacteria. If he has cavities, his teeth might be too sensitive to brush.
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Just came across this post and at the opportune time! Dad, 97 with advanced Dementia in a NH. Also on pudding pureed diet. Noticed that he grimaces while chewing. He says nothing hurts, but who knows. Noticed what looked like white food on his bottom teeth. So thick that you can't define each tooth. Is this the reason he grimaces? Who really knows, but the NH scheduled a visit with the dentist. She comes to the home. He can't have anything but thickened water or juice. Does anyone know how a dentist can work on the teeth of a dementia patient that is totally uncooperative? He is also on blood thinners. The only reason I noticed this teeth was because he was sleeping with his mouth open. He'd never allow me to look in his mouth. Also makes me wonder if the NH is even attempting to brush his teeth.
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If you are willing to stop care for yourself then you can stop it for him....which sounds ridiculous.
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Great question(s) and more difficult for you because of your distance. Requests from caregivers may fall on deaf ears.

From my experience, and in managing my Mother's dental care, (she had a bridge), the back tooth that the bridged hooked on to became decayed. It had to be removed. Initially however, the Dentist wanted to do a rook cannel. I took her to a specialist, and he recommended that it may not work....wouldn't do it. We elected to have it removed, and repositioned the bridge to the next in line tooth. So, we got some more life out of the bridge.

Your Dad needs to brush, and also someone needs to continually use a water pick to flush out what brushing will not touch..and this needs to be after every meal...plus antiseptic mouth washes after nevery water picking and brushing. Otherwise, things build up very fast..and in a declining state, will only next worse. I don't know what to tell you about the cavities, other than to get a second opinion by a specialist...Endo Dentist. If I listened to the first Dentist that wanted to do the root cannel (his partner..not an endo) I would have had major problems to handle...not to mention my was 89 at the time...and didn't need more pain and uncertainty. Someone has to be "on top" of the dental issues on a daily basis.
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I just remembered there are some fluoride lozenges available from the dentist (prescription) that my boss had us order for two brothers who were mentally challenged...neither of them did very well brushing ....wouldn't hurt to ask your dentist...tell Mom it's candy...best to suck on them if she can do that...otherwise they won't help much...Yes, there definitely comes a time.......so sad.
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Awwww Debi58 I'm sorry about your mother. All of us that have a parent with ALZ. really need something to keep our spirits boosted. Imagine a beautiful young woman having to go thru such a disease. Doesnt seem fair. I wish I could see her young again. Meantime, no matter what I will always love my mother with all my heart. I hope everyone that has a parent with ALZ. feels my hugs!! :) My father is so good to my mother. They've been together for over 60 years! He's a good good man! I'm proud of my father. Just wanted to add that!.
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My mom is in a nursing home. She doesn't speak, she can't follow instructions, she can't rinse, and she refuses to open her mouth for anyone. Both the nursing home dentist and the dentist she used to go to said that at this point, there is not much anyone can do for her teeth. She grinds them incessantly, it must be painful. I feel so helpless, but with 2 dentists telling me the same thing, what can you do? Not sure if this helps. Mom has Alzheimers, and is in a wheelchair.
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Dental care is important for everyone no matter what age or condition. Dental problems cause pain and suffering and can lead to infection.
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Mom has a full upper denture and a lower bridge, and 6 of her own front teeth. I or HH worker clean the dentures, floss her teeth, brush them, and give her mouthwash 3-4 times weekly. She also has regularly scheduled dental cleanings, and is on my dental discount plan. All of this contributes to a happy eating experience and smile for Mom!
I just started this regimen about 6 months ago after taking Mom to the dentist, and finding out that her dentures were a mess. I didn't realize she had stopped cleaning them. This journey has a learning curve!
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Good post. It is nice to see that quite a few of us struggle with this issue. I don't know what the answer is, I do believe that dental care is important regardless of the dementia. In my particular case, we took my mom regularly, until she would no longer sit in the chair....wouldn't have it....I am now going through this with the hair stylist she has had for years. She will not sit to have her hair done. She has also started not allowing me to even touch it.
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NYtoFlagirl, I was responding to PaulaK about her 74 year old father. My mother is 85 and has dementia/alzheimers. My mother would say she washed her teeth when I first started this journey with her. I would go into the bathroom after breakfast and supervise her washing her teeth, along with other things. I will let my mother do as much as she can, it is good for her and good for me. She now will go into the bathroom and wash her teeth very well, I watch from a distance to give her the feeling of independence. She does a very good job, then I open up the Listerine child lock cap for her and she gargles. My mother at this point does well with supervision, but she needs supervision.
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Go to the U K. Nobody there receives good dental care. They're not dying either. The average guy there thinks that Americans are obsessed with their teeth. Are we? I'm a believer in good dental health habits. I am not a promoter of dental implants, however, with titanium rods. Nothing wrong with an open space. An Orthodontist can help.
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Remember folks...dental problems only get bigger, never smaller....Whatever you can do to encourage daily oral care can make a big difference in the long run. There will come a time where you or someone else needs to try to brush for them but at least try as long as you possibly can to have the patient brush with some kind of routine...such as "you brush while I make your bed..." or something like that....I am a dental hygienist with a husband with advanced dementia. It killed me that he had to have a molar extracted last year....ANYthing you can get them to do will help...Brushing is of the utmost importance, and the sugary snacks that are sticky or that stay in the mouth the longest, like hard candies...are the WORST. Perhaps sugarless candies can be substituted but use caution at first. Some artificial sweeteners cause diarrhea. Using the prescription strength toothpaste is an excellent idea! Also, having fluoride varnish treatments is totally painless and doesn't taste bad and are very effective. That does not stain the teeth. You must have meant that the silver nitrate stained the teeth. I am not familiar with that treatment. I just know I want my husband to be able to chew comfortably and have his teeth as long as possible. He has been robbed of so many other pleasures.... The fungal infection under a denture can be eliminated...but perhaps when your mother needs to have someone helping her at home...then they can have it as part of the daily routine. I know it must be very hard to manage everything long distance, certainly not brushing!! Good luck to you both. Be creative....this is a challenging job and you just have to invent new ways of doing things to help your loved one. You will never regret the love you gave them.
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Please et a 2nd opinion...a tooth that is so bad that it requires extraction is likely to become painful/sore at some point. Extraction is easy but i don't know your fathers overall health. My neighbors dad with advanced VD had an extraction...sometimes that's all you can do. Remember, if its so bad it is a candidate for extraction it could et infected, abessed (sp) and become painful.

I would also get fillings for cavities. Also, I've heard alot about geriatric care managers who might offer sugestions.

Oral health must be continued as it does affect overall health including the heart. We need our teeth for chewing as well as speaking. The ability to chew is part of the digestive process.

I had to discontinue the electric toothbrush with mom but she is compliant when i use a regular toothbrush. The trick for me was being at her level, explaining what i wanted to do, then approaching her slowly...when she resists which she sometimes does at the onset i wait and try again. This always works. Sometimes I have to do 2 or 3 tooth brushing applications as she doesn't always let me brush everything all at once.

My mom no longer knows how to swish so no mouthwash as it should not be swallowed. Only a minimal amount of toothpaste should be swallowed so i use a teenie tiny amount. I then use a glove and my fingers to apply water to the teeth to sort of wipe them off and then she can swallow any water in her mouth. I repeat to try to get as much of the toothpaste off as possible.
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MADEAA YOU SAID "I make sure my mother washes her teeth very well each day at least once and use Listerine. I would take care of all the cavities and take care of the tooth that needs an extraction. I would pay special attention to his teeth and gums, he does not need painful gum disease since it is very bad for his overall health and heart." Does your parent have ALZ. how can you get her to brush her teeth. Mom always said, "i did already" and wont let me help her. HOW DO you do it?? ;) *(do both your parents have dementia? you said 'he' and talked about your mom, your dad is 74 and your mom 85?)
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One filling at a time, as in one day at a time, keep it in the here and now and all will work out fine.
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Sorry, "Here's looking at you kid!" (Casablanca)
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Hope you are feeling a little bit calmer now that you have enough advice from this panel of well-wishers, and hope teeth issues get resolved. I forgot to mention if anyone else is interested in Mexico dental prices. In AZ, I was quoted at least $30K for implants and crowns, and my fee is going to be $5500 when I finish in Los Algodones, Mexico. Here' looking at you kid!
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mongomay I am very interested in your answer. What is PPNF? Please inform about the product. I am scheduled for a root canal. Thanks
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Just wanted to add....mite be helpful to someone!
when I took ma on, she had dentures for many years that she never wore cuz they hurt her too much. She kept going back, over n over, I remember then just gave up??? anyway I would make her wear em in public cause I was embarrassed..all that did was cause us to lose one somewhere...
her doctor sed if she can eat fine, getting proper nutrition etc.... don't even bother replacing them they will get lost again...I agreed with that and she hasn't had teeth since... ours was easy cause low threat of infection, so far????
I just give her mouthwash everyday but now she is swallowing it sometimes, ickkkk, so I need to look for those sponge/swabs to cleanse her mouth.
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OMG: teeth.

My mother passed 18 months ago after my caregiving her with dementia for eleven years - 5 in my own home. Teeth were a pivot point in our relationship. MOST of the answers I have read here seem to be still in prioritizing the doings of caregiving. My lessons learned were (and are) about prioritizing important places of being with your loved one. Let me explain.

I am not to minimizing the functional, but attempting to give some perspective from the other side of this herculean task you all are living.

When my diva mother, finally shed her (final) pride - it was about her teeth;she no longer cared (at about 88 and 9 years into my caregiving) it revealed that not giving here dental care was MY PROBLEM with my own pride. She had (mysteriously) lost (like she had misplaced it) her front tooth. The transformation was stunning. I took her to the dentist, and she rightly suggested it was not a good idea to worry about it. I agonized about this and found it exasperatingly difficult to let go of MY pride about being a "good" daughter. My mother, after several conversations with her about her front tooth, just did not care. Why did I care, if she did not?

I came to the point of respecting the process of her letting go, her dementia, her teeth and my story about what the world would think of a daughter that did not look like she cared.

Just be aware, dear, caregiving, sisters and brothers what are the important things. INHO, it is finding the more loving path in a changing landscape of uncertainty.
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Thank you all for the answers ... Yes, absolutely, I am pursuing treatment for Dad's current dental problems, and have his first appointment set up for tomorrow. The reason he is not having pain from the infected back molar is because the nerve is dead. I asked if a course of antibiotics would wipe out the infection, but the dentist says no because there's no blood supply back there anymore. She says it's the most difficult tooth to work on in the adult human mouth, and because he already has a metal crown on it to boot, it is even more challenging due to an inability to get light back there. She has referred him for this particular work to the only endodontist in his town. I will be talking to that doctor sometime today or tomorrow for his impression on whether a root canal or an extraction makes the most sense in this case. The good news is that the dentist says the best predictor of pain following surgery is current pain ... the fact that he is in zero pain right now makes it likely that he will not experience a lot of post-surgery pain. Fingers crossed!

The dentist explained to me that older people can be more susceptible to cavities forming at the gum line (all of Dad's cavities are there) because as the gums recede, they expose tooth with softer enamel. Add in the not brushing and the not flossing and the sugary foods, and it's a recipe for trouble.

I am proceeding with the silver nitrate treatment, after having spent some time reading up on it on the Web and talking further with the dentist. At the end of the treatment, we may have some small fillings if any of the dark spots bother Dad cosmetically, or if any are causing food to get caught ... but the dentist says this treatment process is so much less overwhelming to elderly patients with some mental impairment (and less expensive than traditional fillings), so it's where we're going to start.

I loved the suggestion about taking him in for cleanings every 3 months. I think I will do that. I've also got his caregivers cueing him now at the start of their shifts to brush with the prescription toothpaste, and that should work for at least a while. Basically, I asked this question because while my Dad is having short-term memory issues, he's still mostly "there" -- he knows who I am, he knows who his caregivers are, he manages his daily routines, and so on. But I know this will not always be the case. It has been challenging to talk about dental treatment with him ("If I die tonight, I won't have to see the dentist," and so on), but I can't imagine how much harder it must be with a patient who truly does not understand what is happening and is frightened and upset.

I am VERY fortunate in that it turns out Dad DOES have dental insurance through his former employer. I thought he did not, and was researching dental insurance to buy ... but he said he thought he did, even though he couldn't remember the name of the company or whether or not he had a card. I talked to the benefits department at his old company and got the info. Insurance won't cover the silver nitrate treatments, which will run about $500, but Dad would prefer these treatments to the traditional fillings that it will cover. It should cover (or at least 80%) of the extraction or root canal, and also contribute to any follow-up fillings that are necessary for the treated cavities.

Thank you all so much for your thoughts, suggestions, and insights ... I'll get him through this first round of work, get him on a three-month dental cleaning schedule, and see how things are going at that point. I feel reasonably confident I can "hold" him at the current place for a while ... I just got a little overwhelmed thinking about the future! :-)
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@jujubean - for nail fungus try coconut oil (solid type). It worked for a nail I had damaged that became infected, and it has worked for several others I know. Just apply it twice a day. The coconut oil can be bought in any grocery store, or online cheaper some places. I out some in a small container for my nail and for friends, and used the rest for cooking. Chapman farms is the cheapest I have found.
@ferris Would you mind letting me know where you go in Mexico for dental treatment? I am Canadian and the prices for implants and other work in my area are horrendous.
PaulaK - re infected teeth - infections can travel to other places in your body e.g. your heart and cause trouble. I do think it is better to get them dealt with properly. You might want to Google silver nitrate treatment for teeth. I gather it is done in some cases. A second opinion doesn't hurt. Good luck!
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Mom is 91 (92 in another month) and sees her dentist every six months. She has developed OCD as a result of her vascular dementia so she grinds her teeth when she gets anxious. She's lost her two lower front teeth due to her grinding. When she starts to grind, we give her a half of stick of sugarless gum--I've heard chewing it can also help prevent tooth decay. Although during her cleanings she may clamp her mouth completely shut, the hygenist is able to clean the outer parts and check for any kind of infection. About 2 years ago, she did have to have an infected molar extracted by an oral surgeon and she handled it quite well. He also used Computed Tomography to take her x-rays which made it easier since she grinds and gnaws -- can't keep still. After meals, she rinses her mouth several times before brushing--then I brush the outer teeth and ask her to brush inside top/bottom, etc. Sometimes she will but oftentimes she will just bite down on the toothbrush. I tried using a water pick flosser to remove food from her teeth but she was very uncomfortable using it. So we do the best we can and at this point I won't give up helping her with her dental care---too important.
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It is a struggle, I know that mom does not brush as thoroughly as she once did and does have to be reminded to brush at all. Bad teeth can end up poisoning ones whole system. I remember back in my day as soon as a woman became pregnant the doctor always advised her to go to her dentist and have a thorough check up and get any cavities taken care of because any infection would end up in the blood stream and affect the baby...so knowing that, I have always made sure that my family, including mom now, take care of their teeth. Especially knowing how infections can affect the mental state of someone with dementia too! Nobody said it would be easy!
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I have the same question with toe care...mom has had nasty toe fungus for many years.. I mention it a lot to her dr and he doesn't say much, kinda dismisses it...it bothers me cuz it looks ugly but I have been hearing snippets here that It is really not important at this stage.
Any thoughts
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