Dental dilemma

[LuluB]

Hi all, it's been ages since I posted, but now something has come up and I need your advice please.
Mum who has vascular dementia and by all accounts is quite advanced is now unable to respond when attending her regular dental check. She has always been fastidious when it comes to her dental routine and spent a pretty penny on dental work in the good old days. I have been sure to keep up her 6 monthly check-ups, but this time it became quite obvious to myself and the dentist, that she is now at the stage where she is unable to respond to his basic requests to openwide etc. He said that she has a build up of plaque and when he tried to remove it she couldn't stand it and became quite anxious.
How on earth does someone like mum with dementia get their teeth treated and where do we go when she needs treatment like a filling for example? Her dentist has told me that he would be unable to do any work for her if needed. When I asked the manager of her care home as to what happens to residents in this case, she basically said that the teeth detiriorate and its then dentures.
It might sound stupid, but I refuse to let bloody dementia get her teeth as well!

 

[Nebiroth]

It may be worth going to the GP and asking for a referal to a hospital dental unit or specialist dental hospital.


They are far better equipped to deal with "unresponsive" or "unco-operative" patients of all kinds.

As an anaesthesiologist is available, it is possible to either sedate patients (they use a very powerful, short-acting transquiliser) if they are extremely anxious (this is done for dental phobics for example) or as a last resort it might be possible to offer general anaesthetic (although there is a reluctance to use this for dental work now).

Some large dental practises offer sedation, but hardly any will do a general now.

 

[Canadian Joanne]

My mother is also unresponsive. She is given sedation so they may clean her teeth. We're very lucky that the nursing home she is in has a dental team that comes in twice a year.

Nothing more than cleaning has been done but it's the best we can do at this stage.

 

[Skye]

John is also completely unco-operative now. For the last year at home I cleaned his teeth with an electric toothbrush, with no problems. Since the infection, he won't let anyone clean his teeth, and they are becoming very dirty. I'm scared of another infection. We've both got an appointment next month for a routine check, but I know it will be a waste of time taking him.

I'd be grateful for any suggestions too.

 

[Nebiroth]

The only thing I can suggest is the dental hospital for whenever treatment becomes necessary.

Unfortunately I can't see any way of cleaning someone's teeth if they are unwilling to have it done.

I might be worth asking someone like the GP to see if there is anything that might at least be of benefit, like a chewing gum thathelps clean the teeth or something like that?!

I keep on thinking of the special chewy treats we give our cat which are formulated to help remove plaque from his teeth.

 

[connie]

I did manage to get a dentist to visit Lionel in the care home couple of months ago.

At best all she could do was to peer at his teeth. He was uncooperative to say the least.
He will not let the staff clean his teeth every day, it is very hit and miss. When they do, just palin water, he cannot rinse and spit.

He would be unable to be transported anywhere very easily, he would need to be stretchered.

I have always managed to get him to the dentist, and in thelast year at home, had the domicilary dental service. Now 'dementia' has won. His teeth are in a terrible state, but as he objects to any form of personal care, there seems nothing to be done.

 

[Brucie]

well you've all hit on the thing I have found most difficult.

Jan always had perfect teeth - her dentist had removed all her front teeth before her teens because he said they would grow really straight and beautiful that way, and he was correct.

Her gums were more of a problem though - infections.

Now she has deteriorated so much and has been in the home so long, her teeth are in a bad way - plaque, primarily. I can't see any way bar anaesthesia that a dentist could do anything though - Jan simply wouldn't understand.

I could talk to the eye man when he tried to do an eye test, but you can't talk a dentist through cleaning the teeth of someone with such advanced dementia.

I worry that her teeth or gums may pain her but she can't tell us.

Whatever is done or not done, it seems equally cruel.

 

[gill@anchorage5]

Related dental question

Hi Connie

Where did you get details of a domicilary dental service? Dad has lost so much weight during the last 6 months his dentures are really loose and keep slipping. His lower gum looks to be quite sore (I guess where it has been rubbing) - all of which is probably not helping with his lack of desire to eat.

I would not be able to get him to the dentist and have been wondering if a dentist would visit at home. Would appreciate any guidance here.

We've tried Fixative - including the sea bond pads, but not really helping.

Any advice welcome

Love

Gill x

 

[connie]

Ours was arranged through the local dentist, but I understand many area do have visiting dentist facilities..Maybe SW or CPN could help? It must be worth a try.

 

[Margaret W]

Phew, you have opened up a can of worms for me. A year trying to arrange for mum to have a hearing test, eventually a caring lady at the PCT sorted it (another at the PCT responded to my email 3 months after I had sent it!).

Dentist, laugh a minute. No dentist in North Derbyshire visits Care Homes any more cos the NHS have withdrawn the funding for domiciliary visits. No dentist in my mum's locality is taking new NHS patients (is she new? She was registered with an NHS dentist where she used to live before moving to the Care Home). No optician does domicialiary visits. So it is down to me to find a private dentist (to replace mum's dentures lost in hospital) and optician (to replace mum's glasses, lost at the care home), and transport her there. It could be somewhere 50 miles away. Needs a full day to organise each, and as I am in a job where I cannot take time off during term time, it will have to wait till next July/August.

I don't know how people manage who don't have family to help. Presumably they manage like those who aren't capable of being treated by the practitioner - they end up with rotten teeth and gums and not able to see. It isn't good enough is it?

Rotten teeth are one thing, they can be removed, but if a person has too many teeth removed their jaw can become out of line, and as a person who has experienced that with a full set of teeth, I would not wish it on anyone. Tempora Mandibular Joint Disfunction (known as TMJ), can be excruciatingly painful. When I first suffered it my GP sent me straight to the local dentist (I was seen by him 5 minutes later), a correcting palate was made, and I was back in action in a week.

Even that wouldn't happen now. My PRIVATE dentist no longer does emergency appointments!

Think I will look for another.

Folks, it ain't good enough for our vulnerable relatives. What can we do?

Luv

Margaret

 

[Nebiroth]

No optician does domicialiary visits.

That one is solvable. There are several services that specialise in domiciliary services (in fact they do nothing else).

The largest and probably best known one of these is The Outside Clinic.

They specifically cater for persons living at home or in care homes who cannot visit an optician. You would still qualify for a free test if the person is deemed too "disabled" to do so. It would be worth calling them to see if you qualify (they do check with I think either the NHS or local authority).

They have portable equipment that will do all of the checks a highstreet optician does.

I believe they also have special equipment that measures the eyes, this is used when a patient is unable (for whatever reason) to do the normal "read that, does this look better or worse?" type things.

You could also enquire of Healthcall Optical. They do a similar service and I know they do deal with "unresponsive" patients. I got them to visit me and check my eyes (in the hope that this would persude dad to have his done...no!) and I asked about this.