What is expected in a nursing home regarding dental hygiene?
My mother has been in her nursing home for 4 years, and although she came in with her teeth in reasonably good shape (and all her own) for being almost 89, since then several of her teeth have decayed to the gum line, particularly the front lower ones, and she has usually has bad breath. She has no pain and is able to eat her food. The staff used to bring her a type of mouthwash (blue, resembling Windex) sometimes when I was there in the evening, but I'm not sure they are even doing that any longer. She is bedridden and has lost considerable muscle tone so anything more complicated than eating or picking up a letter is a challenge (in addition to her level of dementia, probably vascular). Depending upon who brought the mouthwash, she was sometimes told to swallow it after rinsing while at other times she was told to spit it out. She was at the dentist about 3 years ago, and although the latter performed some work he mentioned that if any teeth cause problems they can be extracted. Frankly, I don't know what they could do with many of them at this point, and if they aren't causing her any problems (such as pain or infection) I'm less inclined to force the issue (and at one point she said something to the effect "well, at MY age..."). However, I'm wondering what responsibility the NH has in terms of helping her with dental hygiene; I'm not certain if they are even consistent with the mouthwash, but I intend to ask (sometimes it's hard to find anyone who can give a straight answer to any question!). I don't know whether it would even be possible to brush them (I doubt she could do it herself) without ripping up her gums or causing other damage. At any rate, what experience have others had?
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We were trying to keep my LO's teeth (she has severe dementia and is in MC unit. Unable to do any dental hygiene.) and gums as healthy as possible, to avoid losing them all and to avoid invasive procedures. She had 3 extractions and then regular cleanings. Her dentists PRESCRIBED that the facility brush her teeth twice a day and that she rinse with ACT. With the prescription, they HAVE to abide by that regimen. It there is no dentist order, I don't think they do anything regarding their dental care. That's my take on it. And, her teeth and gums look so much better. She had let her dental care go when she got dementia, but, now, she seems to be stable.
Thank goodness for a great dentist who works with dementia patients.
I managed to get a dentist to advise on prescription mouthwash which the nurses had to administer which did heal mom's gums, but they tried to get mom to swoosh and spit despite being told to use a swab, needless to say she mostly swallowed instead of spitting.🙄 Now I clean mom's teeth myself once or twice a week with a drop or two of peroxide on her brush and proxabrush just to make sure.
Better still, the "team" comprised a dentist and dental nurse who were lovely, and brilliant with my mother, and who told me not to be tentative - just get right in there with a small-headed electric toothbrush, my fears that I might dislodge something were groundless, and even ninety year old roots were a lot tougher than I might expect.
Now, admittedly this was through the NHS which in your case you do not have. But it still proves that house-calling dentists are a thing, and I will put money on it that if you keep digging you will find one.
My expectations of care settings on this point had already taken a dive when my mother's post-stroke rehab team started treating her for thrush having failed to read "partial denture" on her notes. They don't look. They evidently don't assist; and they certainly don't do it for the person. So with the routine care it comes down to "if you want a job done properly, you have to do it yourself." Get busy.
If you can't or anyway don't visit often enough for this to be practical, I should start by asking the NH what is supposed to happen with support for personal care and see what is said about dental hygiene. I mean, it should be obvious, it should be routine, but it's just possible they're operating some kind of daft exclusion clause - and if they're not, then you have a valid complaint which the NH needs to resolve.
And don't swallow mouthwash. Have you read the ingredients label???
Nothing at all from the podiatrist, and I keep forgetting to ask who exactly that is. I actually check her feet myself at times when she isn't wearing the Ted hose and do what I can to trim/file the nails. I file her fingernails and use a cream occasionally on her legs and feet; she has very dry skin.
However, as the Dementia progressed, she was no longer able to brush her teeth unsupervised. I caught her one day putting hand soap on her toothbrush, so that was when we began storing her toothbrush where she couldn't get to it, and had to assist her.
I brushed her teeth to knock out most of the food stuff, and then gave her the brush and told her to 'brush vigorously', which she understood. I then had her rinse with water from a glass.
We didn't have her use mouthwash because we didn't want her to get ill if she swallowed any. We also didn't attempt to floss her teeth because we figured that would have been too painful for her, so we decided it was more important to at least brush her teeth and gums.
We wanted to take her in to have her teeth cleaned, but her Dentist said they couldn't because Dementia patients often become combative in the chair. :-(
Also, of course, one does not wish to get bitten!
Racking my brains for something that a) is chewy; b) encourages salivation and c) is edible without being a choking hazard. Does your mother have a swallowing impairment as such, or is she fine with actual food? I dimly remember 'Tomorrow's World' doing a study of foods to find which left least plaque on the teeth and peanuts (obviously a non-starter) and cheese topping the list. Would she chew on small slices of Edam or something like that?
You've probably already tried this, but while I'm teaching my grandmother to suck eggs anyway... what about giving her the brush to hold and guiding her hand? Wondering if that might trigger a muscle memory and at least get a bit of the job done.
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