General anaesthetic risk ?

[Victoriag77]

My Mum has advanced vascular dementia and Alzheimer's (8 years in). Her teeth are in a dreadful state, rotten and broken and she is clearly in pain (makes me very sad as she used to have a beautiful smile) . She is in a care home and I don't think they were brushing her teeth properly until I nagged about it.
It took me 9 months of badgering before I got a dentist appointment. There is only one NHS dentist in the entire county that will see dementia patients - private dentists can't or won't see them.
She is now on a long wait list (a further 9 months in) to have at least four teeth removed but will need to go under general anaesthetic as she is completely uncommunicative and will not respond to open her mouth etc.
I understand there are risks with GA for dementia patients (the dentist said it could worsen her symptoms) so I feel unsure of what the right thing is to do. She can't communicate how much pain she is in but her cheek is a bit swollen and she's always poking her tongue around her mouth. I feel quite upset that no-one can advise me on what to do and I am either choosing for her to continue in pain forever or risk her dementia worsening.
It is heartbreaking how once someone has dementia, it is like society treats them as no longer human - they can't see a dentist, no regular general medical checks etc.
Does anyone have any advice?
Thank you

 

[nitram]

Is there a dental hospital near you?
It may be possible to get an appointment in under your quoted 9 months.

 

[Bunpoots]

Hello @Victoriag77 . Im not sure what I’d do but pain can also make dementia worse so it’s a case of which you think is less bad. Personally I think toothache is horrendous.

9 months is a long time to wait and a lot can change in that time - unless you can get an earlier appointment as @nitram has suggested.

 

[Rayreadynow]

Request a Best Interests Meeting to be organised. If opening mouth is a problem I expect its a way of indicate a problem without verbalising it and guess the care home staff skipped the teeth brushing. I read if a person refuses any aspect of care ( ie tooth brushing ) they don't have to continue.

 

[Victoriag77]

Hello @Victoriag77 . Im not sure what I’d do but pain can also make dementia worse so it’s a case of which you think is less bad. Personally I think toothache is horrendous.

9 months is a long time to wait and a lot can change in that time - unless you can get an earlier appointment as @nitram has suggested.

Thank you - I know - when I'm in pain I can just pay to see a dentist, but private dentists won't see dementia patients. I'm told she is getting closer to the top of the list but the NHS strikes have added a few months on. This country is a mess!

 

[Victoriag77]

Request a Best Interests Meeting to be organised. If opening mouth is a problem I expect its a way of indicate a problem without verbalising it and guess the care home staff skipped the teeth brushing. I read if a person refuses any aspect of care ( ie tooth brushing ) they don't have to continue.

Thank you - I will try. It's overly complicated because I am not Mum's power of attorney as I was living overseas when she was diagnosed - and my stepfather is elderly and not very engaged . But yes - the staff say 'she doesn't like having her teeth brushed!' - as if that's fine to leave it then !

 

[Victoriag77]

Is there a dental hospital near you?
It may be possible to get an appointment in under your quoted 9 months.

Thanks - I think it is the same place. The dentist she initially saw was really good and understood the issues so not sure i want to start the process again. but will look into it!

 

[Jaded'n'faded]

But yes - the staff say 'she doesn't like having her teeth brushed!' - as if that's fine to leave it then !

Well, they can't hold her down and do it forcibly - surely you wouldn't want that? All they can do is keep trying.

My mum was much the same. She went to a care home following hospital - they lost her upper dentures leaving mum with just 4 decaying damaged teeth at the centre bottom. I got mum on the community dentist list and chased it several times but nothing came of it - in 3 years! Amazingly mum still managed to eat and fortunately didn't seem in pain but she lost 3 of her remaining 4 teeth and died with just one left. Nobody cared.

 

[Rayreadynow]

Survival of the fittest in this country now to get to see a Dentist so those in care homes don't stand a chance.

Sometimes depression can mean you don't have the energy to engage in the little things like cleaning teeth. And come to think about it, most people in care homes now were born in the 1940's when NHS dentistry began.

 

[Weasell]

I notice you said her cheeks are swollen?
I am wondering if she needs some urgent antibiotics now!
Don’t worry about dentists get the doctor to
Look urgently.
I would lean towards getting the teeth removed dispute the delirium risk, but as you are very sensibly doing I would also take advice from anywhere I could get it
Good luck!

 

[Victoriag77]

Well, they can't hold her down and do it forcibly - surely you wouldn't want that? All they can do is keep trying.

My mum was much the same. She went to a care home following hospital - they lost her upper dentures leaving mum with just 4 decaying damaged teeth at the centre bottom. I got mum on the community dentist list and chased it several times but nothing came of it - in 3 years! Amazingly mum still managed to eat and fortunately didn't seem in pain but she lost 3 of her remaining 4 teeth and died with just one left. Nobody cared.

Yes fair enough - I know how hard it is having tried to do it myself! So sorry for your Mum, it's awful to always be fighting for someone who is now voiceless

 

[Victoriag77]

Survival of the fittest in this country now to get to see a Dentist so those in care homes don't stand a chance.

Sometimes depression can mean you don't have the energy to engage in the little things like cleaning teeth. And come to think about it, most people in care homes now were born in the 1940's when NHS dentistry began.

Totally. I am lucky that I can pay for a private dentist but I think care home reisdents are at the bottom of a (very long) list!

 

[Rayreadynow]

I notice you said her cheeks are swollen?
I am wondering if she needs some urgent antibiotics now!
Don’t worry about dentists get the doctor to
Look urgently.
I would lean towards getting the teeth removed dispute the delirium risk, but as you are very sensibly doing I would also take advice from anywhere I could get it
Good luck!

Oh, GP's hate dealing with things they think Dentists should be dealing with !

 

[Victoriag77]

I notice you said her cheeks are swollen?
I am wondering if she needs some urgent antibiotics now!
Don’t worry about dentists get the doctor to
Look urgently.
I would lean towards getting the teeth removed dispute the delirium risk, but as you are very sensibly doing I would also take advice from anywhere I could get it
Good luck!

Thank you - it's been like it for months to be honest and the dentist thinks it's due to her grinding her teeth - which is another issue! But worth me getting a second opinion, thanks

 

[Sphynx]

My Mum has skin cancer on her neck which we know is causing her some pain. She can’t talk, but she points at it and grimaces. We have been to the specialist and he said that the risk from a GA is so increased because of her age and dementia that it’s not worth having the operation to remove it. Like your Mum it would be a straightforward local anaesthetic job if she would allow them to treat her but she definitely won’t. It’s slightly easier for me because my Mum hates doctors and has lived with a kidney stone rather than have it removed for many years so I am not convinced she would choose to have the op could she make the decision for herself. She also has lost multiple teeth whilst in the care home and refused to wear her dentures after a year or so. There is only so much you can do. My mum won’t even take any pain killers so we are trying to find a solution to that without much joy.

 

[Weasell]

My Mum has skin cancer on her neck which we know is causing her some pain. She can’t talk, but she points at it and grimaces. We have been to the specialist and he said that the risk from a GA is so increased because of her age and dementia that it’s not worth having the operation to remove it. Like your Mum it would be a straightforward local anaesthetic job if she would allow them to treat her but she definitely won’t. It’s slightly easier for me because my Mum hates doctors and has lived with a kidney stone rather than have it removed for many years so I am not convinced she would choose to have the op could she make the decision for herself. She also has lost multiple teeth whilst in the care home and refused to wear her dentures after a year or so. There is only so much you can do. My mum won’t even take any pain killers so we are trying to find a solution to that without much joy.

It may be worth asking about pain patches?

 

[mdr107]

I have dementia and went to dental hospital for treatment, I had a choice , they saw the D word and said they would have to Section me under Rule 42 as I didn’t have capacity. Needless to say, when I got home I wrote on “Care Opinion“ website my opinion. To be fair , got back to me within the week and grovelled.

 

[Jdc54]

My Mum has advanced vascular dementia and Alzheimer's (8 years in). Her teeth are in a dreadful state, rotten and broken and she is clearly in pain (makes me very sad as she used to have a beautiful smile) . She is in a care home and I don't think they were brushing her teeth properly until I nagged about it.
It took me 9 months of badgering before I got a dentist appointment. There is only one NHS dentist in the entire county that will see dementia patients - private dentists can't or won't see them.
She is now on a long wait list (a further 9 months in) to have at least four teeth removed but will need to go under general anaesthetic as she is completely uncommunicative and will not respond to open her mouth etc.
I understand there are risks with GA for dementia patients (the dentist said it could worsen her symptoms) so I feel unsure of what the right thing is to do. She can't communicate how much pain she is in but her cheek is a bit swollen and she's always poking her tongue around her mouth. I feel quite upset that no-one can advise me on what to do and I am either choosing for her to continue in pain forever or risk her dementia worsening.
It is heartbreaking how once someone has dementia, it is like society treats them as no longer human - they can't see a dentist, no regular general medical checks etc.
Does anyone have any advice?
Thank you

Sorry to hear about your mom. I am still learning so much but thought I would share that my dad (96 years old) has same situation with his teeth. Surgeons/dentists don't seem to want to take on the risk of GA. Family doctor has him on Meloxicam (an anti-inflammatory drug) to help with teeth and when he gets an infection, the dr gives him an antibiotic. He also uses Sensodyne toothpaste. He was told to take his finger and spread toothpaste on a sore spot if needed. Don't know if this will help but thought I would share.

 

[backin]

My mother was hospitalised last month with sepsis. Face puffed up like a balloon.
It was touch and go for a while if she would recover but she is now back in the nursing home

They thought it might have started from an infected tooth but weren't sure.

It did have me wondering if someone with dementia should have all their teeth extracted before they got to the later stages.