Dental care - experience of my mother's care
Hi Nic
I have just requested and received my mother's dental care records. (She died in January, age 84, with very late stage Alzheimer's). The first entry is close to her first date of admission to the nursing home - March 2003 - when she still retained half of her natural teeth, unlike most residents. Unsurprisingly, it reads that my mother would not open her mouth for the nurse, or allow a dental mirror inside, but that taking a quick glance of her open mouth when she grimaced, confirmed that her mouth was full of worn and discoloured teeth. The next entry in the record is June 2004 when I had insisted on a domiciliary visit from the community dentist, as my mother was showing signs of pain - flushing when food was first introduced to her mouth, grinding her jaw, and rubbing her teeth.
In the interval, the hygienist called every 3 months at the nursing home, but evidently could do nothing. A nurse told me that the hygienist admitted that the teeth needed extracting, but that my Mum was probably too frail. Certainly I would have resisted the idea of extractions for my Mum, who by this time was mute and very emaciated.
I'm afraid the Society's Dental care sheet is a Wish List, in my view. The tube of Sensitive toothpaste that I bought for my Mum when she was admitted, was only one quarter used by the time she died 22 months later. Chlorhexidine gel was used a little towards the end of her life, when she was less able to push away a hand. I managed to brush my mother's front teeth occasionally by talking to her gently and persuading her to allow me, but of course she couldn't rinse, and there was a danger of choking. Her food was all sweetened, porridge, tea included. Ice cream and ice-cold yoghurts, acid fruit crumbles etc, all added to her discomfort. The principle reason that she did not develop abscesses was that she was continuously treated with broad-spectrum antibiotics for her UTI. (Co-amoxyclav, 375 mg daily). Towards the end of her life, the hygienist managed to clear her front incisors of tartar once. Her mouth tissues were an unhealthy bright red, but I could see no evidence of bleeding, and her breath smelt fresh.
I think the answer to better care lies in the daily routine. My mother's nursing home was very well staffed (4 carers and 1 nurse per wing of 15 patients during peak times). However, traditionally, teeth are cleaned while dressing and toiletting, and staff found these tasks difficult enough for my mother, without adding another. Ideally, it would be better to allow residents to forget about the stresses of being dressed before attempting to clean their teeth. Like all tasks with dementia sufferers, it is best done slowly with reassuring words, ie not at the start of the day. Meals could be finished with a cube of cheese to help neutralise mouth acids, for those residents who will eat readily. For those in the early stages of dementia, it might be possible to remind them how to rinse by using some sort of game - it would be messy! Hygienists and dental nurses could show carers what it is possible to do in the way of teeth brushing, but nobody can be expected to risk being bitten. Simple measures like taking yoghurts out of the fridge several hours before use, could help.
Why didn't I suggest these things? I reserved my "suggestions" for emergencies, as some members of the nursing staff took any comment or request as a challenge to their autonomy. However, my own dentist told me about the domiciliary service of the community dental service, and I urge anybody with serious worries about dental pain in their relative to ask firmly for a domiciliary visit from a dentist. I sat and watched while the dentist felt all the gums and lymph nodes for signs of abscess. It was reassuring for me to know that there were none, and so my Mum was not in continuous pain.
Hope this helps. Sarah
