Does there come a point when you give up on dental care? - AgingCare.com

Does there come a point when you give up on dental care?

Follow
Share

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?

This question has been closed for answers. Ask a New Question.
45

Answers

Show:
1 3 4 5
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!
Helpful Answer (0)
Report

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!
Helpful Answer (1)
Report

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!!!
Helpful Answer (0)
Report

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
Helpful Answer (2)
Report

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.
Helpful Answer (1)
Report

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.
Helpful Answer (0)
Report

If you are willing to stop care for yourself then you can stop it for him....which sounds ridiculous.
Helpful Answer (1)
Report

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.
Helpful Answer (0)
Report

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.
Helpful Answer (0)
Report

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!.
Helpful Answer (1)
Report

1 3 4 5
This question has been closed for answers. Ask a New Question.
Related
Questions