Husband moved to memory care 3 months ago. At the original assessment and subsequent and numerous meetings, discussions and phone calls I indicated he needed one-on-one cueing for showering and brushing his teeth. I even wrote out instructions for the caregivers on how to walk him through the brushing process. In 3 months his dental health has declined such that he now needs an intensive periodontal cleaning which is very expensive. He has never needed any periodontal work prior to his move to AL. The last dental exam shows that he is only doing the front teeth — my instructions show them the process for getting him to move the brush around the entire mouth. It is obvious to me that they are not following the procedure nor are they cueing him to do a complete job. The AL Director and social worker indicate that they are limited in how much they can do. I want to avoid further damage to his teeth. What options do I have and how should I proceed?
I have learned with my mother's AL that I carefully have to pick my battles. I appreciate everything the hands on caregivers do.
Here is my strategy. My mother can stand (kinda) at her sink and stare at the mirror. I place the toothbrush in her hand and stand behind her so she can see me. I go through the motions and she follows (kinda). That's the best I can do.
Going to the dentist is incredibly difficult but we recently managed a visit there with the assistance of some hired help.
Mother still has 2/3 of her teeth. The teeth she lost was before I took over. For me, so far so good.
I have considered a powered brush but I am concerned it might freak her out.
Hang in there. Your concern indicates to me you are doing your best.
Sometimes, caregivers can get people to bathe when they won't for their family member, but other times, they know they can refuse or, like your father is doing, just do a cursory job of it.
Your father, despite his dementia, no doubt has the 'muscle memory' of how to do the brushing the way you dictate, but he may simply not choose to do it for the caregiver.
Do his teeth give him pain? If not, I would (and did) just let it go.
That is the new scam being perpetrated by dentists and it is overly invasive and almost never a good idea. Get a second opinion and find a hygienist that has an ultrasound.
I even bought some mouthwash for her with the hopes that they might be able to help her use that but obviously that didn't work either.
It will take time to help them learn again. Patience is the key,right?
I suggest an electric toothbrush.
Discuss this with the care team possibly with the director at the next meeting you have. Do they have any options that would help facilitate proper oral care? How often do you visit? Is it possible that you could brush his teeth during your visits? I know it is not the way you want to spend your time when you visit. At least that way you will know it is being done that often.
I had the same "problem" when my Husband was in rehab, I brushed his teeth each morning I was there as well as shaving him.
Side note.
Your husband will at some point become non compliant at the dentist and an exam will be difficult.
Even at this point he may have to be given a light sedation for the periodontal cleaning. Most dementia patients do not do well with sedation. It takes a long time to get back to baseline "normal" for them if they get back. And as he declines even for a simple exam he may have to be sedated. It can be a vicious circle. When dental work is done it can hurt either from just a cleaning or if it comes to it extractions and trying to deal with open wounds in the mouth in a normal situation can be difficult but when a person has dementia the care of the open wounds can be more difficult. (and I bet the facility would not comply with what needs to be done so you are looking at the very good possibility of infections) I guess what I am saying is at some point you have to let go of "normal expectations" and while oral care is important it will not be at the top of the list as other things decline. (and as he eats softer food and pockets more it will get more difficult to brush the teeth, the focus will be getting the food out of the mouth to prevent aspiration not brushing the teeth)
By the way switch to a toothpaste that has no fluoride in it in case he swallows it. And if he is using a mouthwash switch to one that has no alcohol.
I also agree with using an electric toothbrush.
And that you can not expect the staff to do a good cleaning of his teeth on a regular basis. Typically they seem to be understaffed and very busy.
Does anyone go visit him that can do it? Or hire an aide to come in and do it once a week?
It isn't realistic to expect staff to perform anything but the most cursory dental care, the reality is that they have many more people to look after than there is time allowed for. I went to mom's dentist and got a prescription mouthwash - because it was prescribed they had to comply - but after that things went back to the status quo. I then brought in a peroxide mouth wash (colgate I think) and cleaned mom's teeth whenever I was there, I figured once a day was better than nothing.
I would talk to the director about this, perhaps they can change his care needs.