She now needs 3 teeth removed. Dentist suggests water pik. I doubt she will let us do that. Any ideas of how to work with this problem. She does require sedation for all procedures including cleaning teeth at dentist office. She brushes her own teeth, but not too well.

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I would make sure your dentist works with people who have dementia and that he understands that dentures are very difficult for a dementia patient. If he pulls 3 now and then more down the road, she could end up with chewing issues. I would inquire about root canal, crowns, bridge, dental implant, etc., in order to preserve the teeth and prevent dentures. I would ask all possible options before any extractions.

Many dentists don't get how dementia patients may not allow you to put dentures into their mouth. And they make take them out, misplace them, refuse to use them, etc. They just don't get it. It sounds like he doesn't understand how a dementia patient may not allow a water pik either. Still, I might try one. I found something called a water flosser at CVS for under $12.00. It doesn't have a lot of pressure, which is a good thing for a dementia patient. If it's not too strong she might allow you to use this on her. I would create some story that it's a long straw and there is lemonade inside the machine. Find out if her swallowing the water is okay, since preventing that is not likely.

I would attempt it and do all she can handle. I would do the best you can and that's it. Many dementia patients are resistant to assistance with oral hygiene. Don't beat yourself up over it.
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You probably are right, your wife might not let you use the water pik on her teeth. Would she let you floss her teeth? Instead of using regular floss, try the ones that have a small green handle. And have her use Listerine or something similar that she would tolerate and not swallow. I know this will be a challenge.

Our dentist recommended a water pik for my Dad's teeth; Dad rarely used it. I also bought one for myself and my sig other, and it wasn't easy to use. A few squirts of water in the face makes one not want to use it :P Even with cleaning the device it still developed mold spores, so we threw ours out.
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