Does there come a point when you give up on dental care?

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Does there come a point when you give up on dental care?

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What level of dental treatment is manageable for someone with dementia?
My 74-year-old Dad has always had very good teeth (just a couple of fillings over his entire life).

In the last three years or so, he seems to have stopped brushing/flossing. He has also increased his daily intake of sugary foods (this is a hallmark of his particular flavor of dementia, of which he is in an early-moderate stage). I caretake from a distance, with at least monthly drives to his state to check in on him, and since he was not complaining of any dental pain over the last few years -- and there have been other, higher-priority crises requiring my focus, time, and finances for him -- it was not until this last trip that I dragged him off to see a new dentist for a cleaning and exam to establish a "baseline" for the new reality.

The result? 13 cavities and one infected back molar that the dentist says will require an extraction (which she does not recommend for someone of his age and profile) or a root canal. She is recommending a silver nitrate + fluoride varnish treatment for the cavities, which she says will "stop the cavities in their tracks" in a painless way, but discolor the teeth where the treatment is applied. And she has recommended that he start to brush with a prescription-level fluoride toothpaste every day.

Dad is overwhelmed by the idea of having so many cavities. He is asymptomatic at the moment (i.e., no tooth pain), and doesn't quite believe that his cavities can be treated without filling and drilling. I'm not sure I quite believe it either. This silver nitrate process will require five visits to the dentist, and I'm not sure yet what insurance will cover or not ... but if it will keep those 13 cavities from getting worse without putting him through the stress of fillings, I'm for it. I'm more concerned about getting him through a root canal.

And, obviously, I'm even more concerned about the likelihood of his teeth continuing to rot because he forgets to brush and craves sugar. I'm asking his near-daily caretakers to add cueing him to brush with the prescription paste at the beginning of their shifts, so that I can be sure it's getting done at least 5 or 6 days a week and that someone is there to remind him not to eat or drink for 30 minutes afterwards ... but I can't shake the feeling that this is a losing battle.

What level of dental care is appropriate or manageable for a person with dementia? My Dad is at least still cooperative about going to see the doctor if I take him, and is cooperative and friendly with dentist and staff ... but I suspect this will change as his dementia worsens. I'm curious about other people's experiences ... does there come a point where you just have to say, I can't fix this?

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Yes. The silver nitrate will work as nothing grows around silver (a microbiology class experiment I will never forget). If he is not having any symptoms of decay, any dentist would love to work on his mouth $$, and you do not mention any dental insurance. You can purchase a dental discount plan where you get a discount on procedures (dentalplans). A root canal might start giving him pain, so maybe that one might be done now since he is still pretty agreeable. Your caregivers during the day are going to have to brush his teeth because he is going to forget. Do not buy any sweets and leave them in the house. That includes sodas, and fruit drinks. (I am in the process of dental implant work, but because of the U.S. dental prices, I travel from AZ to Los Algodones, Mexico where a lot of Americans and Canadians go for their dental work.)

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My husband also has forgotten how to brush his teeth. He keeps trying to put liquid soap on the brush. He had stopped brushing and I understand why if he was using liquid soap! That must be awful tasting! He won't brush unless I stand there with him an show him how. I have to show him how to do everything now!

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I went through this too. My husband has always had bad teeth even with meticulous care and when he got dementia his dental hygiene went out the window. He refused help with brushing and to make matters worse he started pocketing food in his cheeks instead of swallowing it all. Five years into his dementia he finally allowed my to start grooming him in the mornings and I was shocked at the state that his teeth were in. His dental implants had started falling out due to bad bones and almost all his natural teeth were rotted near the gums. I took him to a dentist, but he refused to let them look in his mouth or take x-rays. Two months later, I tried a different dentist with the same results. In frustration, I just about gave up. Then one of his natural teeth broke off at the gum line. In the meantime, he had started taking Serequel due to yelling episodes that lasted hours. I made an appointment at a dentist our daughter knew and gave him a dose of Serequel before we went in. He still didn't cooperate and I gave him another dose (I could give him up to 3 at a time but usually didn't do it). Fifteen minutes later he was calm and we got panoramic x-rays, impressions and an exam. The dentist told me he had about 6 teeth that need extraction and sixteen caps/crowns and the rest filled and he would remove the one remaining implant. An outpatient surgery room was arranged at Mercy Hospital, an oral surgeon found and both the surgeon and our new dentist worked on him for three hours under general anesthesia. Yes the cost was astronomical and thank God we had and IRA to draw from. The hospital took half off the bill after I talked to them and the oral surgeon discounted his fee. The dentist fee was put on a Care Credit card. It took me three months of pureed food and soups before I could get my husband back to eating soft foods. Any lumps would be pocketed in his cheek.
Anyway, I am very glad I did get his teeth repaired even though he refused to go back for any cleanings afterward. Since I was in charge of brushing, his teeth have been brushed and flossed and they are still in good shape 3 years later.
He is in end stage dementia now after 10 years and is bed/chair bound and at this time I wouldn't do all that again.

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My Mom is 94 and chews her teeth constantly. I was brushing her partials the other day and notice they are worn down to the metal parts in them. It is a fight to get them brushed. She only has few teeth, maybe 4 or 5, just enough to hold her partials in. Any suggestions with something like this?

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I would agree with getting a second opinion, as I've never heard of the treatment described to stop the cavities in their tracks, either. I realize now how fortunate my MIL was to have continued to have been able to address dental care until almost 90, despite her dementia. When she and her husband went into assisted living (at 90), a lot of her self-care went by the wayside. Her dementia worsened rapidly and staff did not seem to spend a lot of time helping her with personal hygiene other than a shower a few times a week. After her huaband died and she moved up to the "memory care" floor, it got even worse. After three months of further deterioration, we took her back to her home and cared for her for the last two years of her life. She was then always clean and well cared for, but dental care fell by the wayside the last two months of her life. Her sister, who will be 100 in a few months, has been in a nursing home for nearly 9 years. All her teeth have broken off and she has not had dental care in years. She doesn't complain of pain, though, but can only eat pureed food. I hope some better ways of dealing with these concerns will be discovered and the information widely shared. There is certainly a huge and growing need.

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Ask the doctor treating the dementia about referrals or what to do. Also, local ALZ support group might also have a referral for a dentist.

Also, my mom has the best electrical toothbrush I could buy, that has kept the plaque accumulation low. I have to prompt her to turn it on and tell her to keep brushing all her teeth until the toothbrush turns off.

I also have the best mouth wash possible. Oxyfresh is expensive, but whenever it is on sale I buy it.

Also, it has been proven that baking soda is excellent especially before bedtime. It kills the bacteria while you sleep. I buy her Arm & Hammer toothpaste.

There are dentists specialized with treating special patients. For instance, I found one here in Miami. It is important that you get a good referral, because neither you or your dad have the time or money to visit multiple dentists.

Please keep us updated. As you can see many of us struggle with the same issue.

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I found a dentist that will come to the assisted living where my husband is. He is experienced with dementia patients and will examine and clean his teeth every 6 months. I brush his teeth for him. Hope this helps.

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I would think if a tooth has gone far enough to where extraction is the only option, then he must have pain, at least when he eats or drinks. Taking him to get a cleaning to remove plaque is a start, however plaque returns almost immediately so regular brushing is very important to slow down the process. If he is in a home he should be receiving this care twice a day, in the am and before retiring for the evening. You are right about as the dementia progresses it will get to be a chore, but for now he is co-operating which is great. His clean teeth are an important of him being able to enjoy the flavor of his foods. I would have this taken care of asap as well I would speak to the head person who over sees that things are being done to your specifications. You have a right to speak up for your father and make these demands, Good luck

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By all means, your Dad does require dental care.
This will get much worse eventually & cause him to suffer much pain , possible infection, etc. if the problem is not attended to.
Unless your Dad has a separate Dental insurance plan, Medicare will not pay for dental .
Most Seniors do not have Dental insurance because it is much too expensive, therefore we need to use our savings ,which yes, is very costly but very necessary.
There are some Dental plans that offer Seniors,etc., without questions, a reduced cost plan which may be helpful to offset the cost.
The plans are at a reasonable cost.
I hope that you will consider this concern to be very important & necessary to prevent a much greater suffering for your Dad.
Best wishes.

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There is a natural gum with xylitol in it that will help keep the mouth clean and help reduce cavities it the folks do not have problems chewing. I had to do this with my Mom. It some how also kept her busy and had something to focus on. There is a good book at the PPNF . Otherwise it can be a frustrating battle for hygiene and you have to figure out how far they have progressed and what it acceptable. Look at something they can drink to wash the sugars off. Sugars and soda pops are tough on teeth.

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Foreword by Timothy Gallagher, DDS

Learn how to remineralize your teeth now with the book, Cure Tooth Decay. The author remineralized and repaired three of his tooth cavities and he healed his daughter’s cavities. You can avoid tooth fillings, tooth crowns and root canals by accelerating your tooth healing using diet.

Cure Tooth Decay provides the “best” mineralizing program for rapid tooth healing for severe cavities and tooth abscesses. It also includes dentist Weston A. Price’s original tooth mineralizing program that was over 95% effective on even severe cases of tooth decay.

I have used it myself to save my teeth from the "recoomended root canal" treatment.

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you brought up a good point. Mom has ALZ. and she won't let us take her to the dentist and we need to!! Is there dentists that can work on someone with ALZ?? i hope the best for you in your decisions in caring for your father. I hope you find the right help. The best to you!

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My mom is 78, when she was a child she loved to eat lemons. As long as I can remember she had capped fron teeth and went to the dentist 3-4 times a year to treat (contain) gum disease. When my dad died, my sister and I were torn in all directions worrying about trying to keep her happy and safe. A year went by without a visit to her dentist. The dentist discovered that she had a molar that had come out, but instead of telling us, she just kept reinserting the tooth. We were stunned and guilt ridden. Today, she is no worse for it, but, she could have choked or developed an infection. The dentist suggested pulling the rest because they are all hanging on by a thread. Her jaw bone has deteriorated to a point that implants won't work and there are no teeth strong enough for bridges. The problem with pulling them out is that she won't remember she doesn't have her teeth and that she needs to put in dentures. My sister brings her to the dentist and when he asks my mom how things are going, she says everything is fine.

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I think dental care is very important and I think it should be addressed up till death. I am not talking about getting crowns or implants, I am talking about teeth cleaned often, since he forgets to clean his teeth, schedule every three months. I make sure my mother washes her teeth very well each day at least once and use Listerine. I would take care of all the cavities and take care of the tooth that needs an extraction. I would pay special attention to his teeth and gums, he does not need painful gum disease since it is very bad for his overall health and heart. Take it slow. His teeth are his way to enjoy his food and should be taken care of now and always, and also he is only 74! Sheesh, never thought I'd say it but 74 is not that old today and he could live to be a 100. I take my mother who has dementia to the dentist to have her teeth cleaned every six months and she is 85, it was funny she said, look ma no cavities. If you can't care for him from a distance get someone who can help him.

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I think I would seek a second opinion. If you can get him to go.

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I'm interested in hearing more about this situation. My mother is having problems too. She has partial dentures and doesn't brush on a regular basis either. She has a fungial infection under her plate due to it not being removed. I'm sure it's mizerable, but I'm in another part of the state and can't remind her constantly either. Sigh. . .

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Does there come a point when you give up on dental care?

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