Oral Health Issues

[luggy]

Hello Everyone. My mum is in a care home and she has end stage Alzheimer's. She's in a very bad way and is very underweight and frail. She eats very little, and I fully understand that this is par for the course for someone at this late stage of dementia. She does, however, enjoy her nutritional supplement shakes - if she didn't have these, I've no doubt that she would no longer be with us.

My concern is that mum hasn't had her teeth cleaned for 2 years (since she first went into the care home). This is because mum has challenging behaviour issues, particularly around personal care, and is combative/non-compliant when carers attempt to clean her teeth. As a result, they have given up trying. I'm sure that mum must have some degree of decay, pain/soreness in her mouth which may well be affecting her desire and ability to eat and chew. Mum is still able to swallow at the moment, as she has no problem with liquids and her shakes. However, mum holds food of a more solid consistency in her mouth for long periods of time before regurgitating it.

Since being in the care home, mum has never seen a dentist. She was referred to SALT on 13th February, but she still hasn't been seen by them due to a backlog. No other steps have been taken by the care home to look into mum's oral health and hygiene. Apart from the difficulties with chewing, if mum has pain in her mouth caused by decay, this will also cause her distress and subsequent behavioural issues. I have raised the issue with carers and the manager on a number of occasions, but nothing happens.

In addition to all of this, mum is still being offered normal consistency meals, despite my repeated suggestions to offer meals of a soft consistency. Only yesterday, whilst I was at the care home, mum was presented with battered cod and chips, followed by apple pie. She refused to eat any of it and was given a shake instead.

I'd be interested to hear from other TP members regarding their experiences with this issue. Am I expecting too much of the care home?

Thank you for reading.

 

[Louise7]

Hello @luggy sorry to hear about your mum, is she in a nursing home? If so I think I'd discuss the dental and dietary issues with the clinical lead or nurse. It's difficult to carry out oral care if someone is displaying challenging behaviour but they should be checking for signs of pain/discomfort or other oral health issues, although admittedly this can be difficult during the later stages. They may be wary of offering soft foods before the SALT assessment, but it's good that your mum is being given nutritional drinks and is enjoying these. My mum is in a nursing home and has seen a community dentist on a few occasions but this involved taking mum to them rather than them coming to the care home so wasn't easy to manage and I'm not sure how easy it would be to get a dentist to visit a care home? I don't know what your mum's care home is like staff wise but mum's home seem to have quite a lot of agency staff and I find that speaking directly to the nurse or manager - rather than keep repeating everything to various different care staff - gets a better response. It might be helpful for you to have a conversation with your mum's GP too regarding her care as they may be able to prescribe some pain relief for her if needed. It must be such a difficult situation for you and I hope that you are getting some support for yourself from family or friends at this time.

 

[Tilly13]

Hello @luggy
I'm sorry how things are for your Mum.
I'm really interested in your post as my parent in a Care Home has not seen a dentist since being there for a year. I know my parent is difficult over Personal care and it has concerned me and I've wondered if Care Homes have visiting Dentists as they do Chiropodists
I will be interested to read replies to your post

 

[sdmhred]

Most areas will have community dental special care for the housebound. I can’t see why that wouldn’t apply to care home residents - probably many hoops to get through to Get that however.

Private dental services can also do visits in care homes.

saying that tho you need the PWD to open their mouth and allow the examination. And then if fillings or extractions needed that will then be more complex.

I don’t know the answer - my mum mid stage hasn’t seen a dentist in years - I couldn’t get her out of the car last time I tried.

 

[luggy]

Hello @luggy sorry to hear about your mum, is she in a nursing home? If so I think I'd discuss the dental and dietary issues with the clinical lead or nurse. It's difficult to carry out oral care if someone is displaying challenging behaviour but they should be checking for signs of pain/discomfort or other oral health issues, although admittedly this can be difficult during the later stages. They may be wary of offering soft foods before the SALT assessment, but it's good that your mum is being given nutritional drinks and is enjoying these. My mum is in a nursing home and has seen a community dentist on a few occasions but this involved taking mum to them rather than them coming to the care home so wasn't easy to manage and I'm not sure how easy it would be to get a dentist to visit a care home? I don't know what your mum's care home is like staff wise but mum's home seem to have quite a lot of agency staff and I find that speaking directly to the nurse or manager - rather than keep repeating everything to various different care staff - gets a better response. It might be helpful for you to have a conversation with your mum's GP too regarding her care as they may be able to prescribe some pain relief for her if needed. It must be such a difficult situation for you and I hope that you are getting some support for yourself from family or friends at this time.

Hi. Thank you for your reply. Mum's care home was a nursing home until a few weeks ago when it was de-registered. I believe the manager at the home has been looking into mum's general levels of pain during her care plan review, with a view to a prescription for pain killers (other than paracetamol). I will contact the GP to enquire whether or not there is some easy to administer pain relief specifically for the mouth/gums. Although, I do realise and understand how tricky it is for carers and health professionals to examine & treat PWD in the late stages.

Thanks again - your advice is much appreciated.

 

[luggy]

Most areas will have community dental special care for the housebound. I can’t see why that wouldn’t apply to care home residents - probably many hoops to get through to Get that however.

Private dental services can also do visits in care homes.

saying that tho you need the PWD to open their mouth and allow the examination. And then if fillings or extractions needed that will then be more complex.

I don’t know the answer - my mum mid stage hasn’t seen a dentist in years - I couldn’t get her out of the car last time I tried.

Thank you for your reply. I agree, it's not easy to examine/treat PWD. I wouldn't expect fillings or extractions to be carried out. A CHC nurse assessor told me that there is a gel available which may help to ease discomfort in the mouth, which I have suggested to the manager - but nothing doing so far.

 

[luggy]

Hello @luggy
I'm sorry how things are for your Mum.
I'm really interested in your post as my parent in a Care Home has not seen a dentist since being there for a year. I know my parent is difficult over Personal care and it has concerned me and I've wondered if Care Homes have visiting Dentists as they do Chiropodists
I will be interested to read replies to your post

Hi Tilly13. Thank you for your reply. I hope you manage to achieve a satisfactory outcome for your parent.