After 5 years caring (with an in house caregiver) for my 82 yo mom, and doing the best we can keeping dental hygiene, a cap fell out and a dentist visit seems essential. Has anyone had any experience with this? She is headstrong, and would surely resist probing. Although she might understand the needs, since the stroke she barely talks, and if she does, mostly unintelligently, so following instructions will be tenuous at best.
Ive been told that nitrous oxide light sedation might cause hallucinations, and a full sedation is dangerous for stroke and dementia patients, as they may wake up worse than before...
Any thought anyone?
We suspected her teeth. Because of her age, they did NOT want to do outpatient surgery on her so we arranged for an oral surgeon who was able to operate on her under general anesthesia. In order to get her into the hospital, we had to check her in via emergency room. We already had an oral surgeon picked out, however the hospital had to go through their procedures and recommend one of their oral surgeons, who we prompted rejected and told them that we already had a oral surgeon who had hospital privileges at the hospital.
Once under general anesthesia, he found 2 infected teeth, pulled them and cleaned up the infection.
The real problem occurred after the surgery. She didn't understand that she was in a hospital and basically expected the same routine that she had in MC. The problem was that the hospital was not equipped to deal with elderly people with dementia. They had no soft padding for the bed rails. They didn't have nurses who could take my Mom to the toilet every time that she wanted to go. My Mom is also hard of hearing and they didn't speak slowly and clearly enough for her to understand. My Mom wanted to wait outside her room so that someone could give her a bath. She kept on trying to get out of the bed. Thankfully, her muscles were not strong for her to get up. They refused to let me stay overnight to tend to her needs. They finally gave her a sedative (Seroquel), however, that just made her more combative and angry.
In addition, the hospital wasn't taking any chances that she would fall and hurt herself, so they put on "soft" restraints on her. The problem with the restraints is that there is a general rule that a managed care facility will not accept a person who has been in restraints within the last 24 hours (I didn't know that when I approved the restraints.)
I'm all ready to take her out of the hospital 2 days after her surgery. She is responding well to the medication and she can eat food. However, the managed care facility gets a call saying that the hospital will not be releasing her today. I go to the hospital and the doctor gets really irritated with me and says it isn't up to him as she can be released as far as he is concerned. I talk to the social worker at the hospital and he says the doctor did not sign the release. Also he says that MC rejected the release of my Mom back to them because she has been in restraints within the last 24 hours. (Think about this....the hospital put my elderly Mom with dementia in restraints, so that THEY did not have to worry about her getting out of bed and hurting herself. Therefore, my Mom would NEVER be restraint-free for the last 24 hours because of her dementia.)
MC facility wants my Mom back as they know that the hospital cannot adequately care for my Mom. So when the social worker finally shows up in the room, I call up the Head Nurse of MC, which is a real surprise to him as I hand the phone over to him and the Head Nurse says that it is okay to release my Mom into their care.
My Mom finally gets released that day.
Once back at the MC unit, my Mom gets back into her routine, and all is well.
About the Seroquel....3 months later, my Mom was hospitalized due to sepsis. However, this time, we could use an elderly friendly hospital. When we were in the emergency room, I had them do all the approvals so that I could stay the night with my Mom.
Again, once my Mom was on the mend, she started demanding her routine. However, with the soft bedrails and the fact that she didn't have the strength to climb over the bedrails, we never had to put her in restraints like the first time. In addition, since I was there overnight, the nurses did not have to tend to her nighttime dementia behavior.
Extra: Because my Mom was in a hospital, Medicare paid the bill, not her dental insurance.
We are told often that anything "left unaddressed" could cause infection, sepsis and death. And this is TRUE. But quite honestly, as this point in her life, she IS going to "go" of something at some point. It becomes a matter of what hill you wish to die upon.
I say this as someone who was worried for her brother as regards his car accident and subsequent dx of probably early Lewy's dementia. He said he wished he had gone in the accident, and to be honest, that is a rational wish in my book.
Yet and all he had a teeny open sore on his shin, and THAT is what took him. He went septic, and was gone within two weeks when antibiotics didn't touch it . He requested the fight stop, and he go home to his lovely ALF with hospice, and be allowed to go. It is what he wanted.
Whether it is a fall that is the beginning of the end, or an illness, or a tooth? At some point, compared to the difficulties of addressing something like dental hygiene with someone, I just kind of throw up my arms.
I personally love nitrous. But even it takes cooperation. They will tell you to take a deep breath to send you a bit deeper. You have to kind of "be there" for it.
Why not call her dentist and discuss. Because I sure don't have the answer you need, and only wish I did.
I called the dentist and he said that her roots are probably calcified by now and unless she complained of pain or had any swelling, to leave it alone. I did that and it's been fine for almost a year.
It's hard to tell if she's in pain or not..her pain tolerance is high and she cant really express herself, but I can tell something is wrong...just not sure if it's teeth, something else, or just a general poor condition due to an otherwise lovely winter weather.
I'll make some calls and try to capture one of those "roving" dentists :)
Thanks again.
If your Mom is on Medicaid, this is another challenge: finding a dentist who will accept Medicaid recipiets.
Another question is whether your Mom can physically sit back in the chair far enough for the dentist to actually look into her mouth. My 94-yr old Mom has pretty bad osteoarthritis in her back and can't straighten up any more... she is barely able to be lowered far back enough.
And then, can your Mom tolerate any pain from being in 1 position for any length of time? My MIL with chronic pain from a broken back could only do 30-ish minutes then had to sit up and recover.
She would probably be resistant to any work and she would probably have to have general anesthesia or at least heavy sedation.
This is difficult to recover from anesthesia even the heavy sedation is difficult. And she will be more of a fall risk for several hours if not days after.