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My mom also has dementia and can't sit still for dental work. She lost a crown but the tooth wasn't infected. My dentist referred me to a dentist with hospital privileges, who specializes in special needs patients. Unfortunately, they were still unable to get any work done, even when Mom's doctor prescribed something to calm her. The dentist said they would need to put Mom under general anesthesia to do the work. Mom has many other health issues that warrant not going under general anesthesia if possible. Her doctor and I came up with an even list of pros and cons for going under anesthesia and we decided, since there is no infection, to do as little as possible for as long as possible. So far, so good but she will need the dental work at some point.
My husband is in an assisted living/memory care residence. The traveling dentist who visits the facility wanted to pull three teeth. Knowing this was not right, I researched and found a local dental practice that offers all dental services in their location and I stressed my husband’s condition so he would assigned to the right dentist. His new dentist is the most caring and patient person. Same for her assistant. Only one tooth was pulled, a bridge created, and treatments he needed were done without trauma on anyone’s part. Hopefully there is someone in your area who will be the same.
Often the health of the teeth and gums that support the type of restorative dentistry your husband had, cannot be maintained. Oral care is one of the first things to be neglected when one's health or capacity is failing. Lengthy dental visits are not always well tolerated by patients with dementia. That said, it is good you got another opinion. Depending on where you live, if your husband has a good dental insurance plan and didn't have to pay thousands of dollars out of pocket for the tooth extraction and bridgework, you did well, as long as the bridge outlasts him.
As my mother's dementia advanced, she had more and more difficulty with dental visits. She didn't understand what was going on or the questions that were being asked. She was in a memory care facility and also eventually refused to brush her teeth. The staff didn't want to force her to brush, and at that point, in her mid-90s, she was already on soft foods, because she forgot how to chew and then swallow her food. Eventually we stopped the dental visits and put her on hospice-type care (where we just made her comfortable, but didn't try to "fix" anything). I told staff at her facility that they didn't have to worry about brushing her teeth, better not to force her to do something she didn't want to do. Her teeth deteriorated, but it didn't really matter, since she was on soft foods. Staff told me that she lost a couple of teeth over time. Thankfully she didn't get gum disease. Maybe your mother isn't as far advanced with her dementia and you can still do home dental care and quick treatments of floride or other treatments that will keep her teeth in better shape when at the dentist. All the best to you both!
i am dealing with same problem. The caregiver hasn’t been very good about this unfortunately. She has to share a bathroom and there is no place for her to store her toothbrush in the bathroom so she got out of the habit of brushing. My Mom just got her first silver diamine treatment for the back teeth. The dentist didn’t understand why more of her extremely old patients don’t do likewise, (presumably because of cosmetic reasons as it will turn black when it comes in contact with decay but it will stop or slow the decay. At that point the black area needs a filling to cover it.) She is at risk for a gum abscess though.
there is a traveling dental van that also provides this treatment among others. I need to ask the provider about this.
I can't believe in this day and age that people still treat a trip to the dentist they way they would as a trip to the guillotine!
I worked as a dental assistant and saw the most awful mouths among many elderly folks. At this time (early 70's) it was just 'assumed' that you were going to wind up with dentures and yep, a LOT of people did.
I have a 'friend' who didn't like to brush her teeth. Same age as me--so really? I never understood it. By the age of 50 her teeth were rotting out of her head, literally. I sat at a luncheon across the table from her when one of her cuspids simply broke off and she spit it into a napkin. The few teeth she had that 'hit' each other were few and far between. She has worn full dentures (which, sadly, look AWFUL) for 15 years.
She had a lot of health issues that I personally believe had to do with the fact she had infected teeth pouring bacteria into her bloodstream 24/7. IDK, something so basic and simple as toothbrushing was just not in her wheelhouse.
Yes, it's a challenge to keep up the oral hygiene with someone who doesn't have it all going on. And many dentists simply don't have the TIME to spend an extra hour with a difficult patient.
With my elder clients, I'd lay out the toothbrush with a small amount of toothpaste on it. I'd make toothbrushing a 'no big deal' thing and didn't ASK if I could brush their teeth, I'd TELL them we were going to do it.
I kept those preloaded small toothbrushes in the car so she could 'chew' on one after we had eaten out. The amt of fluoride was minimal, so no worries there. The ones I buy are made by Colgate, they have a little 'scrubby head' and a pick at one end.
Going to the dentist was a huge challenge. Semi-sedating wasn't a possibility since my client was tippy w/o any kind of calming meds. Mostly we got through it with me by her side, actually 'helping' the hygienist, as I knew what I was doing.
I would imagine that a traveling dentist would cost a small fortune--but then a stay in the hospital with a massive infection caused by am infected tooth would cost a lot more. IDK. It's as individual as can be.
BTW, my BIL, who is 67, has to go to a clinic where he is sedated so he can bear to have ANY dental work. I mean, knocked out, and they do everything he needs at once. I think he's a but of a baby with this, but otherwise, he'll go 20 years between cleanings.
I learned that having a 'nasty mouth' can make you look a full 20 years older than you actually are.
I am 73 and live in a small populated town. When I was small we had one old Dentist. He did not use novocaine when he drilled teeth. He would hit that nerve and I would jump a mile. Most of my caps are due to him. So, some of us older folk do not have a good experience with Dentists.
Are you talking daily brushing and flossing or getting them to a dentist?
I was told by an aide that Mom would not brush her teeth. I asked if the aide took the brush, put on the toothpaste and gave Mom the brush. No she didn't. If you did all this for Mom, she would brush her teeth.
Daily, there are little sponges, with toothpaste in them, on a stick that you can use to brush teeth. Look like lollipops. There is floss on a U shape or V shape plastic handle that is easy to use.
For the Dentist...call a NH in your area and see if they have a dentist that comes in. If so, see if he/she will do a home visit.
When my dad was in MC with vascular dementia, he developed an abscess that required either a root canal or extraction. Dad did pretty well with dental care other than anxiety so we gave him extra medication and took him in a wheelchair (since extra meds made him unstable on his feet) to the dental office. If needed, we could have taken him to the hospital where they would have sedated him for the dental procedure and either sent him back to MC (like outpatient surgery) or released him after an overnight stay. Because the hospital was involved his medical insurance would cover most of the cost. I would have gone the hospital route if needed but wanted to avoid sedation because of the possible impact on cognition, although twilight sedation for his heart stents didn't seem to cause any worsening of his cognition.
Dental care is possible with dementia. It depends on how advanced someone's dementia is and how serious their dental condition is. There are dental clinics that sedate people so they can work on their teeth. They will also give sedation for a simple cleaning if needs be. Do some research and find a clinic that uses sedation. If a person is in pain and their teeth are affecting their ability to eat then they need dental intervention regardless of their age or dementia status. If they're doing all right and able to eat and drink, then there probably is no need to get dental work done for a person who is elderly and has dementia.
The best answer here is the one Leonni gave...worry only when true emergencies arise. In the meantime do toothbrushing at home. It baffles me that family members would feel it is so necessary to subject them to such aggressive treatment when they don't know what is going on or are at the end of their lives.
I can only offer my approach. Mom resists brushing and hygiene which is typical. Insisting leads to a struggle of the wills which is not productive. Sometimes she will use on her own the gum soft dental pic’s - better than nothing (https://www.amazon.com/Soft-Picks-Dental-Picks-Original-Count/dp/B079KFZKR7?source=ps-sl-shoppingads-lpcontext&ref_=fplfs&psc=1&smid=ATVPDKIKX0DER) . I take her every 6 months for a good cleaning and it is getting harder for her to tolerate the easier sonic cleaning. My LO is 94 yo and has no short term memory but still is in assisted living because she is very good natured and does best with the staff (vs us kids). Good for her!
Yup, everyone is different and even more so with different people, loved ones vs strangers, etc. Sometimes there are little 'tricks' one can play and inventive ways to get the best job possible done in 20 minutes or less. In the end, they determine how much oral care can be provided and it cannot be forced safely. Once gums are inflamed it becomes more painful, thus making it more important but less likely to be accomplished. I was a dental assistant in a hospital based practice and saw every sort of patient and oral condition. The operating room under sedation was a last resort for some and the only way to even do an exam for others. Being a teaching hospital, patients were sometimes given full mouth debridement and scaling when teeth didn't require restoration, but rather had more periodontal disease of supporting bone. Others required extractions and dental restorations of remaining teeth with no likelihood of fixed or removable restoration of missing teeth simply because they were unable to maintain the prosthetics.
My MIL’s doctor answered this well, when I asked him about a mammogram for her (she had dementia). He said nothing extra is necessary at this point. No “preventive care” or dental checkups or cleanings. If she had tooth pain, that would be a different story. I had been taking her to the podiatrist every 6 months because she could get new shoes paid for by Medicare (she had Diabetes), and it was such trouble. When the shoes came in, she would say they were too big (when she said they were just right trying them on) or that she hated them. I finally realized she didn’t NEED to go to these appointments at all. It was a relief, as all these things were very trying.
I would suggest that the answer to this would vary depending from situation to situation. Advice regarding an 85 year old relatively healthy individual with moderate dementia would be much different from advice regarding a 98 ill person with severe dementia nearing the end of life. I would start by asking my own dentist or dental hygienist about his/her opinion.
A previous post mentioned fluoride tablets; I would caution against considering that. Fluoride can be toxic, that's why toothpaste for toddlers does not contain it. It can cause pretty significant stomach distress if ingested. Who knows what someone with dementia would do with a container of those? If she's in a facility, I would bet you would have to get a prescription for the aides to take care of them anyway.
My husband is in a memory care facility and I take him to the dentist for hygiene every 3 months (recommended for dementia patients.) They book a longer appointment and numb gums to make it easier. They ordered a prescription toothpaste for nighttime which is no rinse. The more the staff does it, I think the memory pattern returns. There are sonic and electric tooth brushes which work well if used. A waterpik is essential to remove plague. Bill has been cooperative. We had both been very attentive to our dental health every six months. He has a tooth we are monitoring, a cavity under a crown which may require an extraction. Dental health is extremely important. I firmly believe you don’t wait to emergencies occur from decay or broken teeth. Infections from mouth issues can poison your system.
Some localities have "mobile dental offices." Not sure if these dentist offices on wheels are available where you live, but worth checking it out.
Many Medicare/Medicaid long term care qualified facilities have mobile dental vans come to the facility. No need to travel to the dentist office. The VA also has this in may localities too; so if one is a Veteran, that may be an option. Dental care for those on Medicaid Long Term Care, may or may not be a benefit in your state. Worth checking on that too if your LO is on Medicaid.
At my mom's facility (nursing home) -- she is 86, has dementia and a host of other medical/mental issues and is on Medicaid Long Term Care coverage -- the mobile dental van comes when there is a group of residents in need of dental care. The social workers handle scheduling. A huge 18 wheeler van comes, with a back lift. Folks can be wheeled onto the lift in their wheelchairs and once up at the level with the "office" they can enter. There are aids of course to help maneuver folks.
Inside the van is a full dental office and it is set up for folks who may be in wheelchairs. They can handle most everything inside the van (including X-rays). I do not believe "oral surgery" -- which requires anesthesia -- is included. The van is heated and air conditioned, so time of year does not matter. The service that comes to my mom's nursing home; has a team specifically trained to work with those who have dementia and/or elderly folks physical limitations as that is their business. The van travels to many nursing homes around our area.
There are also private pay dental vans (at least where we live), that will come to your home if a LO is not in a facility.
My MIL , who was living at home with my FIL, let her dentition go. When I saw her, she had on tooth in her mouth. The rest were broken or rotted.
I asked why she didn’t go to the oral surgeon to take care of this and get implants. Her quality of life would improve. She said she was afraid she would die like Joan Collins. I couldn’t see the correlation. Joan Collins had cosmetic surgery, not dental surgery.
She is now in assisted living and because of her tooth problems, it has caused swallowing problems and they have to grind up all her food into a purée. That is not enjoyable. Part of living and enjoying life is enjoying what one eats.
This is probably why she is such a difficult and unpleasant person to be around. I believe she doesn’t want people to see her because she lacks teeth.
I wish that she had be open to considering the dental surgery. It would have made her time now more pleasant.
I think it is important to address the difficulty in getting teeth brushed. When someone has advanced dementia they are often resistant to having their teeth brushed because they don't understand what you are doing and/or they think they have already done it themselves. In memory care facilities the staff rarely brushes teeth. I had camera's in 2 separate facilities my mom was in and never once did anyone brush her teeth even though it was in her care plan. I repeatedly requested they do it. Because I could not get in the facility during covid, she had dental issues once I was able to get in. When I took her to the dentist, he said "they never provide dental hygiene in those facilities, I see this all the time". I have my mom home with me now and bought these great pre-pasted toothbrushes from Amazon so she can use them in her bed or while watching tv and then her caregivers can get in there and brush also. No messy foam or having to spit (she also did not understand spitting out after brushing). It is easy to say that dental care must be done but the challenges of the process need to be addressed.
Thank you for the suggestion of pre pasted toothbrushes. My mom will be moving to LTC in the next few weeks. She will use her electric toothbrush with direction and reminders only.
I think this is a time to consider the concepts of adequate vs ideal. I had a counselor suggest this to me when I was dealing with issues around my mother’s care and it really helped. Obviously, in an ideal situation, preventive dentistry and twice daily dental hygiene would be the standard. My father in law is in long term care for dementia. The facility said he needed to go to the dentist and called my 86 year old MIL to schedule an appointment to take him. This was beyond her capacity. There was no way to make this happen. We can’t transport him ourselves and managing him in a new environment. We couldn’t find a dentist to come to the facility. It was terrible and we were so stressed and frustrated. We engaged his care manager who helped us order an electric toothbrush through his benefits. We asked that the caregivers direct him to brush twice daily. I understand your situation and know how awful you feel. Dental care in the US Medicaid/ long term care space is lacking.
Mom is bedridden now and cannot move herself without a lot of help. It is impossible to get her to a dentist much less transfer her to the dental chair. She had an infected tooth last year when she was able to travel to her dentist. After the antibiotics no pain at all. She has 2 teeth that need to be pulled. I had made two appointments that had to be cancelled due to illness. Another hospital & rehab stay followed. If she has pain I don't know how this will be managed. Easier said than done. Does Medicaid cover dental visits to the nursing home?
Dental care is an absolute must. It can affect the heart, infection could set in. I had my mother purchase Delta Dental. Some of the new plans effective January 2023 include some of type of coverage depending upon which State you live in.
I have my mother use an electric toothbrush, dental floss and a "non-alcohol", no mint or whitener toothpaste and mouthwash. This is a morning and evening ritual. Twice yearly Mom goes to the dentist, I accompany her and I change her manual toothbrush and toothbrush heads on the electric toothbrush frequently.
Again, some of this medical equipment can be purchased through OTC card supplies. Absolutely, good oral hygiene is a must. Keep in mind if your loved one is on a blood thinner, this too is important for any tooth extraction.
You cannot overlook dental check-ups. It can wreak havoc on their body.
My mom doesn’t brush but is open to direction. I got her mouthwash with hydrogen peroxide in it and toothpaste for dental disease periodontix. She brushes or rinses her mouth until no food in spit at least 1 time a day. The caregiver is excellent in directions. No questions -do you want to?- just directing to the bathroom. I was there and no caregiver. Mom and I came back from the dining hall and mom shot straight for the bathroom saying “Brush teeth, brush teeth”. I was so happy to hear that. Also she wanted to go lay down and this activity is done before bed! ;)
Dental care is extremely important because if they lose their teeth, then they won't be able to eat! You need to preserve those teeth as best you can. There are roaming dentists that will come visit you. We would have them come into my fathers memory care facility once every 3 months to give him a good cleaning and do x-rays, it is very expensive but well worth it. You really need to do everything you can to preserve those teeth! Also, Amazon sells fluoride tablets, they are like little mints, you can try those in-between cleanings. Hope this helps.
Are you kidding me-no dental care? Call the dentist and get some professional advice.An infected tooth can be deadly.Eating could be affected by poor dental hygiene.
Really disappointed to hear these responses. Brush with fluoride toothpaste and electric toothbrush. Get regular dental cleaning if possible. Dental infection and pain can cause more suffering including delerium.
The time to worry is if/when the patient is in pain from a tooth that needs to be extracted. Then you'll have to figure out how to get them to a dentist or oral surgeon for the work to be done. My mother lived in a Memory Care AL so I hired a traveling dentist/oral surgeon to come to her room and do the extractions when necessary. She was given Novocaine and a calming medication prior to the work being done. It all went off without a hitch, aside from the exorbitant costs associated with a traveling dentist. Before the dementia got bad and she was living in regular Assisted Living, I'd drive her to the oral surgeon's office to have 2 molars extracted that had gone bad. She was SO nervous and high strung, the whole event was horrible to be honest. But it had to be done b/c the teeth were infected and she was given antibiotics beforehand to treat it.
I wouldn't worry about routine dental care or cleanings, however; just treat emergencies as they crop up.
Hi, Lealonnie1. It is nice to get assurance from someone who has experience in this matter. I will follow the advice in your last sentence and will only worry about true emergencies. Thanks
My mom had dementia and dental problem at 90y. Because she couldn't elaborate all the discomfort in her mouth when caregiver helped feeding her, so sometimes she was blamed for some "wrong doings". That‘s really sad.
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(Dental assistant for 30 years)
(copy & paste)
https://www.youtube.com/watch?v=6gLrH8mioCw
Also, Waterpik came out with a combo floss/toothbrush called "Sonic Fusion." Husband started using this because he forgets to floss.
there is a traveling dental van that also provides this treatment among others. I need to ask the provider about this.
I worked as a dental assistant and saw the most awful mouths among many elderly folks. At this time (early 70's) it was just 'assumed' that you were going to wind up with dentures and yep, a LOT of people did.
I have a 'friend' who didn't like to brush her teeth. Same age as me--so really? I never understood it. By the age of 50 her teeth were rotting out of her head, literally. I sat at a luncheon across the table from her when one of her cuspids simply broke off and she spit it into a napkin. The few teeth she had that 'hit' each other were few and far between. She has worn full dentures (which, sadly, look AWFUL) for 15 years.
She had a lot of health issues that I personally believe had to do with the fact she had infected teeth pouring bacteria into her bloodstream 24/7. IDK, something so basic and simple as toothbrushing was just not in her wheelhouse.
Yes, it's a challenge to keep up the oral hygiene with someone who doesn't have it all going on. And many dentists simply don't have the TIME to spend an extra hour with a difficult patient.
With my elder clients, I'd lay out the toothbrush with a small amount of toothpaste on it. I'd make toothbrushing a 'no big deal' thing and didn't ASK if I could brush their teeth, I'd TELL them we were going to do it.
I kept those preloaded small toothbrushes in the car so she could 'chew' on one after we had eaten out. The amt of fluoride was minimal, so no worries there. The ones I buy are made by Colgate, they have a little 'scrubby head' and a pick at one end.
Going to the dentist was a huge challenge. Semi-sedating wasn't a possibility since my client was tippy w/o any kind of calming meds. Mostly we got through it with me by her side, actually 'helping' the hygienist, as I knew what I was doing.
I would imagine that a traveling dentist would cost a small fortune--but then a stay in the hospital with a massive infection caused by am infected tooth would cost a lot more. IDK. It's as individual as can be.
BTW, my BIL, who is 67, has to go to a clinic where he is sedated so he can bear to have ANY dental work. I mean, knocked out, and they do everything he needs at once. I think he's a but of a baby with this, but otherwise, he'll go 20 years between cleanings.
I learned that having a 'nasty mouth' can make you look a full 20 years older than you actually are.
I was told by an aide that Mom would not brush her teeth. I asked if the aide took the brush, put on the toothpaste and gave Mom the brush. No she didn't. If you did all this for Mom, she would brush her teeth.
Daily, there are little sponges, with toothpaste in them, on a stick that you can use to brush teeth. Look like lollipops. There is floss on a U shape or V shape plastic handle that is easy to use.
For the Dentist...call a NH in your area and see if they have a dentist that comes in. If so, see if he/she will do a home visit.
There are dental clinics that sedate people so they can work on their teeth. They will also give sedation for a simple cleaning if needs be. Do some research and find a clinic that uses sedation.
If a person is in pain and their teeth are affecting their ability to eat then they need dental intervention regardless of their age or dementia status. If they're doing all right and able to eat and drink, then there probably is no need to get dental work done for a person who is elderly and has dementia.
A previous post mentioned fluoride tablets; I would caution against considering that. Fluoride can be toxic, that's why toothpaste for toddlers does not contain it. It can cause pretty significant stomach distress if ingested. Who knows what someone with dementia would do with a container of those? If she's in a facility, I would bet you would have to get a prescription for the aides to take care of them anyway.
Dental health is extremely important. I firmly believe you don’t wait to emergencies occur from decay or broken teeth. Infections from mouth issues can poison your system.
Many Medicare/Medicaid long term care qualified facilities have mobile dental vans come to the facility. No need to travel to the dentist office. The VA also has this in may localities too; so if one is a Veteran, that may be an option. Dental care for those on Medicaid Long Term Care, may or may not be a benefit in your state. Worth checking on that too if your LO is on Medicaid.
At my mom's facility (nursing home) -- she is 86, has dementia and a host of other medical/mental issues and is on Medicaid Long Term Care coverage -- the mobile dental van comes when there is a group of residents in need of dental care. The social workers handle scheduling. A huge 18 wheeler van comes, with a back lift. Folks can be wheeled onto the lift in their wheelchairs and once up at the level with the "office" they can enter. There are aids of course to help maneuver folks.
Inside the van is a full dental office and it is set up for folks who may be in wheelchairs. They can handle most everything inside the van (including X-rays). I do not believe "oral surgery" -- which requires anesthesia -- is included. The van is heated and air conditioned, so time of year does not matter. The service that comes to my mom's nursing home; has a team specifically trained to work with those who have dementia and/or elderly folks physical limitations as that is their business. The van travels to many nursing homes around our area.
There are also private pay dental vans (at least where we live), that will come to your home if a LO is not in a facility.
I asked why she didn’t go to the oral surgeon to take care of this and get implants. Her quality of life would improve. She said she was afraid she would die like Joan Collins. I couldn’t see the correlation. Joan Collins had cosmetic surgery, not dental surgery.
She is now in assisted living and because of her tooth problems, it has caused swallowing problems and they have to grind up all her food into a purée. That is not enjoyable. Part of living and enjoying life is enjoying what one eats.
This is probably why she is such a difficult and unpleasant person to be around. I believe she doesn’t want people to see her because she lacks teeth.
I wish that she had be open to considering the dental surgery. It would have made her time now more pleasant.
Easier said than done. Does Medicaid cover dental visits to the nursing home?
Dental care is an absolute must. It can affect the heart, infection could set in. I had my mother purchase Delta Dental. Some of the new plans effective January 2023 include some of type of coverage depending upon which State you live in.
I have my mother use an electric toothbrush, dental floss and a "non-alcohol", no mint or whitener toothpaste and mouthwash. This is a morning and evening ritual. Twice yearly Mom goes to the dentist, I accompany her and I change her manual toothbrush and toothbrush heads on the electric toothbrush frequently.
Again, some of this medical equipment can be purchased through OTC card supplies. Absolutely, good oral hygiene is a must. Keep in mind if your loved one is on a blood thinner, this too is important for any tooth extraction.
You cannot overlook dental check-ups. It can wreak havoc on their body.
I hope this helped.
Brush with fluoride toothpaste and electric toothbrush.
Get regular dental cleaning if possible.
Dental infection and pain can cause more suffering including delerium.
I wouldn't worry about routine dental care or cleanings, however; just treat emergencies as they crop up.