Mom stopped brushing her teeth on her own a year ago. Her gums look horrific. When I manage to brush what little she allows, there is a lot of blood. After a few seconds of brushing, she freaks out and refuses to open her mouth. She will not let me brush her teeth properly and they will continue to rot. What will happen to her? infection = sepsis? dentures? A dentist would have to put her under to clean her teeth, do they do that?
Thanks for sharing your experience
Dad does not have dementia, yet his teeth are rotting out of his head. He brushes his teeth to some degree. He refuses to go to the dentist, last time was about 5 years ago, he had multiple minor abscesses and had the remains of several teeth removed. The procedure was painful, of course, so now he just lets them rot.
He was warned by his dentist that bacteria is getting into his system due to the poor condition of his gums and teeth. It may have contributed to an infection after the removal of a skin cancer.
But at 93 there is no point in arguing with him.
You Mom probably has gum desease if her gums are bleeding that much and they are hurting. I have been thru the process but it was 40 yrs ago. With regular cleanings I have kept it at bay. You can brush all you want but flossing and regular cleanings help to prevent gum desease. I know, not an easy task. I had to actually have my gums cut open to graphed the bone, scraping off the damage bacteria made. Your Mom will not be able to go thru this process but I would ask the dentist if putting her under would be OK. Just long enough to give her a good cleaning. As said, the poison given off by the bacteria causing the problem can make her sick. If her breath smells like rotten eggs/sulfur, she has gum desease.
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My mother had a few teeth that needed to be extracted while she lived in Memory Care AL. I had the visiting/traveling dentists come in to treat her in her recliner in her room. Surgery had to be performed to remove 2 molars, which was done under Novocaine, and she was stitched up right there. Her PCP ordered a Xanax to be given to her beforehand to keep her calm throughout the ordeal. If I could have had her sedated, I would have, but that wasn't an option. I also chose not to take her out of the MC to the dentist's office b/c she was wheelchair bound and 190 lbs, so I felt it was easier to deal with the matter in her room at the MC.
There's no easy way to handle dental issues when dementia is present. And I wouldn't fight your mother about brushing her teeth; it's too late anyway; the majority of the damage has already been done. Just treat her pain as it crops up, that's my suggestion.
Best of luck with a difficult situation.
https://www.alz.org/help-support/caregiving/daily-care/dental-care
Much of it (not all) won't apply until the current issue is brought under control. You might find the "watch me" technique worth trying, perhaps, especially with a soft toothbrush.
Meanwhile track down a sympathetic dentist and ask for suggestions. If your mother can be trusted not to swallow, a mouthwash might help to calm the inflammation that's currently there and causing the bleeding (and probably tenderness and discomfort), but take professional advice.
What happens if she continues to refuse is that her mouth will get more and more sore, it will affect her ability to eat and possibly her enjoyment of food, and she'll be at risk of local and systemic infections :(
But for her, these possibilities don't outweigh the fear and discomfort of having her teeth brushed at the moment - and as you say there's a lot of blood then I really can't blame her.
In this line of thinking here is something else to consider. When my husband was in cardiac rehab after a quadruple bypass we had classes teaching us about the new life we were facing. We were cautioned to always let the dentist know after any kind of cardiac procedure (even simple cleanings) and appointments may need to be postponed.
We were also cautioned in the classes to be sure foot care is not neglected as well. This is another entryway for bacteria to enter the blood stream leading to infections including the heart. Always wash and dry their feet thoroughly.
When looking for foot care, especially geriatric foot care, it is important not to have pedicures at places like in the mall without asking about their credentials and sterilization techniques. They may not properly sterilize their instruments properly or use other cautions. We are very blessed to have a highly trained foot specialist in our area. You can check out her Facebook page to see the type issues she cares for and high standards she holds.
https://www.facebook.com/MrsGoodFoot
My husband and I go to her on a regular basis. She has certifications above a typical pedicurist and there may be professionals like her in your area. She is not considered a medical professional but a lot of the podiatrists refer patients to her when their needs are not covered by Medicare. If you can't find someone in your area, if you private message her on Facebook, she might can provide a resource to locate someone in your area because she also does training nationally. She even does home visits as I am sure others will as well.
I took mom to a dentist for a "deep" cleaning and held her hand the entire time they were cleaning her teeth. There were frequent stops. Not sure I would do it again. Can you get your mom to swish with warm salt water? That might help calm her gums down. Maybe try a baby toothbrush that is super soft.
Alzheimer's patients have serious inflammation in the brain. Tylenol is the only pain reliever off the shlef (OTC) that goes into the brain. Not advil, not aspirin, not ibuprofen, not exedrin. ONLY TYLENOL. Note that Tylenol is indicated in liver issues. But the trick is to just give about 330mg a day TOTAL in two doses, not one huge dose. The huge dose, even food, causes spikes. So just give 100mg 3x daily. You will see a change for the better and the body won't be overloaded.
You ask a good question. It depends on the level of her condition, it can depend on the day, and it can depend on who is speaking with her and how/what they are speaking. Some persons have quite the rapport with her and some likely don't. Some nurses are able to manage it, and others aren't. In a cluster of nurses in a hospital or nursing home, their skillsets are not the same across the board. Maybe only one can get her to see how to do it or the need to do it. Here, you are at your home setting. I commend you. I stayed with my mom for 24 years after my dad died, continued my education in Psychology and Languages and the Law.
I recommend you keep trying to use your knowledge of her to make her comfortable at these times she doesn't want to brush. Her mindset can often be everything. If you know how to break through her perspective to change her attitude, get her in the right attitude, and begin to broach the subject. Maybe she needs to "own" the brush so it's not a foreign object. Depending how her memory is, if you set the toothbrush where she will touch it in bed, you can tell her "That's your toothbrush." Then you can talk about if it is soft, medium or hard bristles, which type does she like. Then how does this one feel. Let her be holding it, owning it. Don't be telling her she needs to brush, directly, while you are getting her to own it. The talk around it will set her at ease about it.
Depending on the person and stage, an AD patient can remember that someone hurt them while they can't remember what day it is or where they are. The apprehension she has expressed about brushing her teeth is a type of fear, if you will, the same as can also be tied to when someone causes them pain, hurts them, even my mom's chiropractor qualified for that after he popped her lower back and she said it hurt her, told all the clients on the way out what he did, then the next week asked him point blank are you going to hurt me like you did last week. She was considered late stage at the time, in 2013. Her meds were not totally maxed out but past the 50% point.
So keep her happy, let her own the toothbrush, and if you can set a pattern by getting her to test that toothbrush if it's too hard, she just might begin to get over that problem. Toothbrushes hurt my mouth. She's probably older than I am so they will hurt hers even more. When you do all this, get the softest toothbrush you can get and have her try that for softness. Your real goal will be for her to own that toothbrush, to say she likes that one the best. When she does, she just said she LIKES a toothbrush. Capitalize on that and reinforce that pleasant experience.
Maybe teach her to brush non-traditionally. Just getting it in there and moving it around on the teeth, not perfectly up and down like a kid does. Note how she does it when she does it. Talk in comfortable ways while she does it. And do some humming around her because humming is something she most likely associates with good times in her life when her own mom and grandma hummed while they worked. To me, there's nothing like a woman humming, but I hummed for my mom all the time. She was raised around polkas, so I hummed polkas I made up or knew, didn't matter. I'd set the pace with it, know what I mean.
Most of all, the best advice is don't give up. They can stop and start something back up. By keeping vigilant and diligent, you will likely find a way. I'm sure she likes good, old fashioned water. That's one of the best ways to clean a person's mouth and teeth. Let her use her fingers, even. Rinse with water and repeat.
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The technical... Make sure it's a soft and small child's brush. Maybe in the comfort of her chair. Have on the ready a couple cups for rinsing and for the waste. Or even a little tub for waste. And something to dry her mouth or catch stuff as she goes (make that 2 dry cloths). That is much easier. Even just a large yogurt container. If that is just not doable, some child's mouthwash to swish around in lieu of brushing. Don't in any way criticize the brushing. Just be glad it is taking place. Try once a week, then work up 2x, etc. You can add in assists later, such as "Oh did you get the back?" Have a great tasting kids SWEET mouthwash for after. Say something like here's the good part! You will probably have to tell her not to drink it but swish and spit. If its a kids, it will be ok if she does accidently drink it. Reinforce with Don't you love that fresh clean feeling?? Or "I always love that fresh clean feeling". Be genuine with that. Dementia is all about sensing. If she refuses all, try again the next day. Sometime she may. Or you might even say want me to do it for you? :) Just a quick brushing, so you don't get infection. If she agrees, then truly make it a quick brushing! Don't try to get it all. You can get some one dsumy, some another. The key is to make it a positive moment and build routine.
Another idea to start is (in her chair). "Let me see that smile again". When she smiles, say domething like " Yup yup looks like you got something in your teeth there. Let me grab you a tooth brush. And then go through the above.
And then after, Ok let me so pearly whites!! Beautiful. I love that smile of yours. Hollywood smile, Hollywood smile. Whatever makes sense to you. Humor, loving, all that good stuff. Best of luck and God bless!!
Just making sure she rinses her mouth a lot (and possibly many times a day) to get the extra food particles out will help a lot. Plain water is good enough. One can get a cheapie plastic bowl to spit out the water into so that it is very easy for her to rinse her mouth. I do tap water so that if she accidentally drinks any of it, no harm is done. In addition, my Mom doesn't like the taste of toothpaste.
Once you are able to establish to take water in and spit it out, then try a brush (no toothpaste). Have her continually rinse her mouth while you are doing this (then it isn't as easy to see the blood). Don't brush hard. Don't try to be complete. The key here is that it is difficult for them to hold their mouth open or keep their tongue away from the brush while you are doing this and the toothbrush does hurt those sensitive gums. Maybe you brush 4 times a day (it doesn't matter if it is after meals or not), a quarter of her mouth at a time.
Don't worry about complete teeth cleaning, gum massage, toothpaste, mouthwash, or floss. At this point, anything is better than no dental hygiene at all, which is what happens to a lot of older folks.
P.S. Also, certain foods will help clean one's teeth and encourage saliva production. You could use those foods in-between meals or as a desert along with rinsing out her mouth.