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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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This is something I posted about not too long ago. My mom only has 6 of her own teeth left and she needs them to anchor her lower dentures, yet after 6 months in facilities I was shocked to discover her gums bled profusely when I brushed her teeth. Everyone assured me that they do oral care and seemed to accept that bleeding gums were normal. No, they are NOT!! I imagine that aside from to possibility of losing her teeth mom's mouth must have been painful.
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.
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Every state has its own rules regarding this. When I worked for our dental division of the State Dept. Of Health, a law was passed to insure that nursing homes had to do dental hygiene procedures daily. Now the other issue is how well are they trained. As a dental hygienist I will tell you a lot of people are grossed out by caring for the mouth so I’m sure there are staff who will barely do it. The bad breath, bleeds ng gums are from bacteria causing periodontal disease. Dental caries at the gum line are due to plaque and food being left there long enough to break down the enamel. Two places you can call to find out what regulations the nursing home is to follow. Your dental division of The State (not county) department of health or the Board of Dentistry in your state. Hopefully you will find out. But from a hygiene point of view a mouthwash doesn’t do anything...just a bandaid. Dental plaque which is full of bacteria needs to be removed from all tooth surfaces once a day. Flossing should be once a day to prevent gum disease and cavities between teeth. You will not find aides flossing but they should brush. This is neglect if your mother is unable to do this herself. The nursing home should have a dentist who is affiliated with them. Ask who it is and get them to come and check her.
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Rather late in the day, I discovered that if you made enough piteous phone calls along the chain of command you would eventually be put through to the community dental team and they would appear miraculously at your home to see to your mother.

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???
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In June, on transfer to the facility where my mom now is, I was given forms to sign, one if we wanted dental care, another other for podiatry care, and the dates when these mobile units would come visit. I signed them and figured good, that will be done and I'll probably be billed. Turns out, neither the dentist nor a podiatrist saw mom and nobody bothered to tell me. I received a letter from the mobile dentist wanting $150 up front for a complete check-up and cleaning. The dentist had been there but never looked at her since she is private pay and they do want their money first. When mom becomes Medicaid, I'm to notify the dentist's office, and I believe they will at least check her now and again, who knows. I made a copy of that bill and proof I paid and gave it to a nurse to put on mom's chart; the dental office did cash that check, and I will be checking to be sure it gets done next time the dentist comes.  (Mom does have Aetna Medicare, and I can file a claim afterward).   She does have bleeding gums, her teeth have always been a problem but I did take mom to the dentist every six months prior to her being admitted to the NH. I did buy some of those oral sponge swab sticks from Amazon and a small bottle of mouthwash and attempt to clean her teeth a bit after dinner at times, and she likes the taste of the mouthwash. I actually found the same swab sticks in one of her drawers, so somebody has attempted. I find that some of the aides are more old school than others, and some days when I come in, she sure looks better than on other days. Mom can get very nasty, so I understand the difficulty in dealing with her hygiene. This place, probably like all other care places, is always in need of more aides.

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.
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I think places handle it in a variety of ways and I suspect that the rules and regulations of many facilities may not even address it.

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.
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My mother-in-law with Dementia lived with us, and she brushed her own teeth for a while. 93 years old, and she still had all her natural teeth, both upper and lowers!

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. :-(
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Moms facility had a dentist that came in every six months. I was asked when her last visit was and from then on the staff called him in every six months. There are sponges on a stick that look like lollypops. They have toothpaste in them. When a brush can no longer be used, these are. Mouthwash? If a person can't understand to spit I wouldn't use it. You are not suppose to swallow it. Always talk to the Director of Nursing with concerns.
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My mom in a NH gets annual oral assessment of gums by a dental team every year - she has full dentures made in 1953 which are noted as 'extremely fragile' & are professionally cleaned by them - otherwise the staff put her dentures in to soak every night - the dental team sends me a bill & write up on a form that shows what they did & how they assess her gums etc - $125 [CDN]

What's with this prepay business - that's rediculous because they sit with money in their account getting interest while you lose interest on the money until you can make the claim but that is after the work is done - can they not just bill you? - they don't see your mom again until you pay so with 6 months that is easy
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Never rely on the staff at a nursing home, when it's something you or someone else in your family can be doing. For my family, we brushed my mom's teeth every day.....we could not give my mom mouthwash because she would always swallow it, so we just made sure we brushed her teeth and she could swallow the toothpaste
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Dental hygiene in the nursing home where my husband is a resident does not exist. They simply do not, never have, brushed his teeth or given any mouth rinse. I try and visit my husband at least 5-6 times a week. Part of our routine is brushing teeth. He spits out blood, his teeth are not the best, but I feel an accomplishment knowing when I leave the nursing home for the day, oral hygiene has been done to the best to my ability. There are no visiting dentists. Also, please check your mom's fingernails and toenails. This is another big concern of mine. The nursing home does not do it, nor do they have a doctor come in that does. All-in-all, the best advise I could give anyone who has a loved one in a nursing home is please be observant. I have even turned down my husband's bed spread to discover there were no sheets on his bed. Another time my husband apparently had thrown-up. Instead of changing the pillowcase, one of the aides turned the pillow upside down! So, please be vigilant. Nursing homes will cut any corner they can to avoid hiring adequate staff or to keep an adequate supply of products available. I have seen aides use unwashed towels and wash clothes on several patients, personal wipes bought by family members taken out of resident's drawers to use on other residents simply to save money. Personally, I have taken several boxes of extra soft wipes---a total of 120 wipes in all. In 2 days both boxes were used up! In 2 days! When I ask the aides where all the supplies went as there should have been enough for several weeks, I get a dumb look. Nursing homes are not the best, but they are the best we can do for a loved one. You may wish to check with your mother's PCP and ask her doctor what he/she would suggest. There are also finger tooth brushes. If you brushed your mother's teeth very gently, I don't see any ripping up of the gums. Flossing is probably out, but you may like to try either a finger tooth brush or a extra soft regular toothbrush. Start out very slow and gentle at first even if you only accomplish one or two teeth being brushed. Once your mother becomes accustomed to brushing, she may be able to tolerate a more thorough procedure. Good luck.
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My mother had lost 6 of her teeth due to gum disease and stress when she was only 50. She definitely needed assistance. About 8 years before she died at age 94, she came to me when I visited from 400 miles away and asked "do I have the right toothpaste?" I said "no, mother, you haven't even taken the cap off the toothpaste." Check this elder's staff to make sure they take care of her oral health.
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Thanks, everyone, for your helpful comments so far. What I have seen in the past is that a nurse (not an aid) would come in with a medication which my mother would take, and then they would give her a small cap with the mouthwash. One nurse told her to swallow it while the other asked her to spit it back into the cup, which she did. It looked like the same kind of mouthwash to me (and, of course, without seeing the container in which it came I have no idea what kind it is). I suppose it's possible they have two different kinds, but I'm a bit skeptical. In any case, I have been given some helpful suggestions and directions that I intend to pursue.

Happy Thanksgiving to everyone! Even with all the frustrations I guess most of us still have a lot to be thankful for.
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Ask them what it is. It most likely should not be swallowed.
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I have my mom at home, so I will add a different perspective. I have been helping Mom brother her teeth for years. We used to take her to the dentist every 3 months for cleanings, because we knew she wasn't getting great brushing. Then one day we went in (about 2 years ago) and she refused. So the dentist was finished. I continued to help her brush 2-3 times a day...but she became more and more resistant. I purchased peroxide swabs and added that to our oral routine. I will tell you that now, stage 7, I do attempt twice a day to brush her teeth... She bites the brush, clinches her teeth together, sucks the tooth paste and closes her lips most of the time. Her gums bleed everytime. No, this is not great, but it is what it is. I have asked my dentist, her dentist, a friend in another state that is a dentist... No one has any good ideas. I do try to use the swabs but have to be super careful as she will be them and then I have to deal with a choking hazzard. My mom has all her own teeth. I guess I can understand the NH having issues providing dental Care because I have trouble with it and I only have one patient.
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Oh gosh yes, it is not easy, and all credit it to you for persisting.

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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We have done it all. I have a daughter who is a speech pathologist. My post was just meant to say that facilities probably do the best they can. If you really are concerned about your LO's dental Care, try taking a more active role before judging others. It is easy to want to know why "they" aren't doing it, when you don't have a clue as to the challenges.
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You may want to buy mouthwash and even toothpaste online at a company called Cari Free.com. They specialize in products used for gum disease. If you do purchase from this company, their mouthwash is NOT to be swallowed. It is dentist recommended.
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I do know about all of these options. My mom cannot spit. We have to use toothpaste that can be swallowed. I can sometimes use a water pik but have to use a bulb syringe to siphon the water out so she doesn't chock. I have had many "experts"...dentists, CNAs, doctors, speech pathologist, etc. My post was not a question, just giving the perspective of the caregiver.
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Thanks again, everyone. We're still trying to get answers from the nursing home--sometimes getting information there is indeed like "pulling teeth"! I think the use of a water pik might be an excellent option--my BIL, who has considerable experience in oral care research, suggested this option, too. However, I'd still like to get straight answers from the NH as to what mouthwashes they are using and how consistent they are. I wonder what happens to residents who have no family members to provide hands-on dental care or even advocate for their well-being!
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GrammyM,
That is why I keep my mom at home! I am lucky enough to have support and be able to do so.
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