Dental care problems and worries.

[vdg]

Hi all, sorry I haven't been around much recently. I have had another chest infection so haven't been able to see Mum.This is posing problems as I have to take her to the dentist on Friday.

I'm not sure whether she will still recognize me after a 2 week break.My husband visited on my behalf and she hadn't a clue who he was, but up until then she'd usually known me even if it took a few minutes for her to work it out.

Her teeth are all rotten[ they've always been poor] and her gums are awful.The CH tried her with mouth wash but she kept swallowing it.Then they tried getting her to brush with the mouthwash on her toothbrush but it was too sore so they asked me to sort out a dentist which I have done.

Trouble is she is dentist phobic and always has been. At one point before she got the dementias I had found a private dentist who she agreed to see and she trusted but we can't afford that any more and anyway it's a fair journey to get there which Mum can no longer cope with so I have booked her with a local NHS dentist.I am worried she will panic as she hates going anywhere new,I doubt she would remember the dentist she trusted but will she remember she is terrified of dental work? I shall be with her but even so I am anticipating some real problems especially if she isn't sure of who I am.

Has anyone any similar experience and if so are there any suggestions as to how to help her through this.She absolutely has to be seen, I suspect they'll want to remove all her teeth as they are so bad and wobbly, then we may have to go down the route of dentures or not. I am not looking forward to any of this:-(

 

[Christin]

Hello VDG, I am sorry to read that you have been unwell and hope you feel better soon.

I have to admit I have something of a dentist phobia myself. I dread each visit I have spoken to our dentist about FIL before however and we did manage to take him for a check up but it was decided that the process for new teeth, for him, would be too great. This all depends on the individual of course and the level of the dementia. The dentist did mention to us however that he occasionally visited people in their own homes, or care homes, when they are unable to visit the surgery. I wonder if this might be an option for your mum. Perhaps it is worth asking.

There is a factsheet re Dential Care and Dementia which may offer some help.

http://www.alzheimers.org.uk/site/scripts/document_pdf.php?documentID=138

Good luck on Friday, I hope you feel better by then.

 

[chucky]

Hello VDG, i had this problem with both my parents, dads in CH mum still at home. I got the dentist to go to the CH to see my dad and he actually took his teeth out while sitting on a normal chair. It worked well, because dad didnt have the trauma of getting onto the dentist chair and being moved about. His teeth came out really easily, like your mum they were rotten and loose anyway. My mum got the community dentist to come to her house and again it worked well. After having 3 teeth out we persuaded her to come to the clinic and have the rest out 2 at a time. She hadnt been to the dentist for 57 years as she had a real fear, and she went faithfully every few weeks till they were out. The only downside is that neither of them could tolerate false teeth, so they are in fact gumsy. However, both can still eat reasonably easily, obviously things like granary bread or things to be chewed are out but they still have a normal diet. I think because we managed to avoid the clinical aspect of it, it didnt throw up any problems at all. I would speak to the dentist and ask if they can do this.

 

[Nebiroth]

It should be possible to get your mum referred to a hospital dental unit. They will be set up to deal with phobic patients as well as people who for one reason or another lack mental capacity and are thus unable to tolerate normal dental procedures.

The work can be done under sedation (they use a very powerful, short acting tranquiliser; the patient remains concsious but is very relaxed, also time seems to pass very quickly and there will be no memory of the event afterwards). In extreme cases a general anaesthetic can be utilised.

Some dental practises offer sedation, usually only for private work, general anaesthesia is now extremely rare outside of hospital units because it requires the presence of a qualified anaesthetist as well as rescusitation equipment.

Either your mum's GP or dentists should be able to start such a referral.

 

[vdg]

Thank you for your helpful replies.We are going this morning so I'll ask about referrals or home visits.I am hoping today will just be a "check up" so they can assess the damage and perhaps give her something to calm the gums down. I'll let you know how we get on.

 

[vdg]

we went to the dentist.....

.... and Mum was erm....."challenging"!!
She wasn't very co operative and I wonder if it had any bearing on the dentist's decision that nothing can be done. He says no extractions can be done due to one of the drugs she is on and that he cannot do a deep clean as the teeth would then drop out[ not that she'd let him anyway!]Got to go back in 12 months to see how things are which I think is a joke !

Not impressed really nor were the ch when I told them.They have great difficulty cleaning her teeth yet the suggested care plan from the dentist was regular brushing even if they bleed.
I guess we just have to wait and see when they will drop out and hope she doesn't get any nasty infections in the mean time

 

[littlebrownbird]

I worry about my husbands dental care. He has partial false teeth and will often refuse to take them out to clean them. Mimimg sometimes helps but not always. A friend who had a husband with AD reckoned he must have had mushrooms growing behind his dentures because it had been so long since he had removed his dentures.
My husband hates the dentist and hasn't been to see one for over 30 years. It wasn't until I had to help him that I realised how worn down his detures were. I asked my dentist about getting him new dentures but she said it woúld be very difficult as it would be hard to get the bite right because he would have to tell her how it felt. When he was first diagnosed with AD we had his eyes tested and bought several pairs of shoes (he has a very high instep making buying shoes very difficult) but I never even thought about his teeth. I wish I had before it was too late.
Going by my hubby (and from what Chucky says about her parents) I would suggest that if it comes to it gums are better than dentures that you won't be able to persuade them to take out.

 

[piedwarbler]

My mum is in the same boat. Regular swabbing with corsodyl gel is what is recommended for her, no brushing as it makes her bleed. You use a mouth swab like they use in palliative care.
Mum went to hospital twice for treatment but refused so is living with her rotten stumps.
Good luck xx wish you well xx

 

[vdg]

I see what you mean about getting dentures out. I was also wondering how they would make the moulds for them as I reckon she would gag on the gooey stuff in her mouth. Looks like we'll be definitely doing the wait and see option.

Corsodyl gel is a good idea. I bought a very soft toothbrush yesterday and some Corsodyl toothpaste but will also get some of the gel and some mouth swabs and see how they get on with any of those options.

Trying to explain to Mum about her teeth made me chuckle a bit as she is obviously very proud of her new look gappy smile and would cheerfully show all in the waiting room, unfortunately she wasn't so keen on showing the dentist. We had to do a copy me game! so I was stood in front of her like a right nutter with my mouth wide open saying ahhhhhh and she copied me .The nurse behind her was in stitches watching me trying to keep my mouth open long enough for the dentist to get a bit of a look at Mum's mouth.

Good job we can see the funny side of things isn't it? If I didn't laugh I'd weep.

 

[Nebiroth]

Is your mum on a blood-thinning or anticoagulant drug, such as Warfarin?

It may be that the dentist is concerned about bleeding. Tooth sockets after extractions are notorious for potential bleeding, if someone is on Warfarin or similar it can be very difficult to stop. Normally in those circumstances the treatment would have to be done in a hospital.

 

[Sue J]

Hi vdg

Sorry to hear of your Mum's dental difficulties - just a thought - you said the 'copy me' game worked in the dentist and I confess it did make me laugh too but do you think she would also copy you using a mouthwash, when you visit? A friend of mine uses diluted L******** as I think it is not so powerful as the C one alrrady mentioned. As patients suffering with dementia are very sensitive, I think their immune systems are too so I would always tend to use a gentler, less treatment than some of the more 'powerful' ones. Only a thought which you may have already tried but I do hope you find something that works. A 12 month gap til seeing dentist again doesn't sound very helpful. I wonder if anyone is aware of any dentists that visit homes or have any understanding and advice for dealing with patients suffering with dementia?

Best wishes
Sue

 

[cragmaid]

Sue has suggested the same as I was about to do. listerine, but quite well diluted and if you can use the mouth swabs, (the lollipop ones) and she sucks it off, then it win't, or at least shouldn't, harm her.

 

[vdg]

I could have a go at getting her to copy me with the mouthwash.It's certainly worth a try. It was L******** we tried the first time and I think she's still got some left, I'll check with the ch.They keep it locked up with her meds.

I'm not totally convinced by what the dentist said so will see if there's any that go in to visit.A second opinion wouldn't go amiss.

 

[gigi]

Hello vdg,

My husband has had some problems with his teeth recently and I take him in a taxi to visit the dentist.

He had 2 roots left in which were rotting. The dentist said if she couldn't get them out she would refer him to hospital to have them out under a general anaesthetic..fortunately between me, the dentist and the dental nurse we persuaded him to have the injections and the roots were quickly removed.

I'm just wondering if your mum would be a candidate for hospital dental referral and have all of her teeth out and be done with it?

My husband is having impressions made for a new set of dentures..now he has no teeth whatsoever..but how successful this will be is anyone's guess.

It is possible to live life and eat without teeth...

Hope this helps.

Love xx

 

[Nebiroth]

To do that you would need to convince the dentists and doctors that the patient's teeth were more of a risk to her health than the trauma of multiple extractions, particularly if this has to be done under a general anaesthetic.

That might be the case if there was a high risk of infection, possibly developing into blood poisoning, otherwise, not.

Certainly in the past it was possible to simply demand to have all your teeth taken out (my grandad did it!) but there has to be a real medical need to have it done now.

 

[EllieS]

If the gums are sore you could rub bonjela gel on them. Tastes nice too!

 

[vdg]

Mum can't have an anaesthetic as she has lung disease and her chest couldn't cope with it:-(

The ch are worried about will happen if she ends up with toothache and is in pain. I am worried about the risk of infections:-(
Mum however is ecstatic that they said they couldn't do extractions!