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

OMG: teeth.

My mother passed 18 months ago after my caregiving her with dementia for eleven years - 5 in my own home. Teeth were a pivot point in our relationship. MOST of the answers I have read here seem to be still in prioritizing the doings of caregiving. My lessons learned were (and are) about prioritizing important places of being with your loved one. Let me explain.

I am not to minimizing the functional, but attempting to give some perspective from the other side of this herculean task you all are living.

When my diva mother, finally shed her (final) pride - it was about her teeth;she no longer cared (at about 88 and 9 years into my caregiving) it revealed that not giving here dental care was MY PROBLEM with my own pride. She had (mysteriously) lost (like she had misplaced it) her front tooth. The transformation was stunning. I took her to the dentist, and she rightly suggested it was not a good idea to worry about it. I agonized about this and found it exasperatingly difficult to let go of MY pride about being a "good" daughter. My mother, after several conversations with her about her front tooth, just did not care. Why did I care, if she did not?

I came to the point of respecting the process of her letting go, her dementia, her teeth and my story about what the world would think of a daughter that did not look like she cared.

Just be aware, dear, caregiving, sisters and brothers what are the important things. INHO, it is finding the more loving path in a changing landscape of uncertainty.

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. . .

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.

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.

Thank you all for the answers ... Yes, absolutely, I am pursuing treatment for Dad's current dental problems, and have his first appointment set up for tomorrow. The reason he is not having pain from the infected back molar is because the nerve is dead. I asked if a course of antibiotics would wipe out the infection, but the dentist says no because there's no blood supply back there anymore. She says it's the most difficult tooth to work on in the adult human mouth, and because he already has a metal crown on it to boot, it is even more challenging due to an inability to get light back there. She has referred him for this particular work to the only endodontist in his town. I will be talking to that doctor sometime today or tomorrow for his impression on whether a root canal or an extraction makes the most sense in this case. The good news is that the dentist says the best predictor of pain following surgery is current pain ... the fact that he is in zero pain right now makes it likely that he will not experience a lot of post-surgery pain. Fingers crossed!

The dentist explained to me that older people can be more susceptible to cavities forming at the gum line (all of Dad's cavities are there) because as the gums recede, they expose tooth with softer enamel. Add in the not brushing and the not flossing and the sugary foods, and it's a recipe for trouble.

I am proceeding with the silver nitrate treatment, after having spent some time reading up on it on the Web and talking further with the dentist. At the end of the treatment, we may have some small fillings if any of the dark spots bother Dad cosmetically, or if any are causing food to get caught ... but the dentist says this treatment process is so much less overwhelming to elderly patients with some mental impairment (and less expensive than traditional fillings), so it's where we're going to start.

I loved the suggestion about taking him in for cleanings every 3 months. I think I will do that. I've also got his caregivers cueing him now at the start of their shifts to brush with the prescription toothpaste, and that should work for at least a while. Basically, I asked this question because while my Dad is having short-term memory issues, he's still mostly "there" -- he knows who I am, he knows who his caregivers are, he manages his daily routines, and so on. But I know this will not always be the case. It has been challenging to talk about dental treatment with him ("If I die tonight, I won't have to see the dentist," and so on), but I can't imagine how much harder it must be with a patient who truly does not understand what is happening and is frightened and upset.

I am VERY fortunate in that it turns out Dad DOES have dental insurance through his former employer. I thought he did not, and was researching dental insurance to buy ... but he said he thought he did, even though he couldn't remember the name of the company or whether or not he had a card. I talked to the benefits department at his old company and got the info. Insurance won't cover the silver nitrate treatments, which will run about $500, but Dad would prefer these treatments to the traditional fillings that it will cover. It should cover (or at least 80%) of the extraction or root canal, and also contribute to any follow-up fillings that are necessary for the treated cavities.

Thank you all so much for your thoughts, suggestions, and insights ... I'll get him through this first round of work, get him on a three-month dental cleaning schedule, and see how things are going at that point. I feel reasonably confident I can "hold" him at the current place for a while ... I just got a little overwhelmed thinking about the future! :-)

NYtoFlagirl, I was responding to PaulaK about her 74 year old father. My mother is 85 and has dementia/alzheimers. My mother would say she washed her teeth when I first started this journey with her. I would go into the bathroom after breakfast and supervise her washing her teeth, along with other things. I will let my mother do as much as she can, it is good for her and good for me. She now will go into the bathroom and wash her teeth very well, I watch from a distance to give her the feeling of independence. She does a very good job, then I open up the Listerine child lock cap for her and she gargles. My mother at this point does well with supervision, but she needs supervision.

GA has pretty much covered everything, but I would add, get after the facility,mouth care is a very important part of personal care. Also ask them to have his mouth checked for a yeast infection. It may be possible for a dentist to get at his mouth if he is sedated

If you are willing to stop care for yourself then you can stop it for him....which sounds ridiculous.

Lucy, since he's already in a facility, ask to have him examined by the speech therapist, if there is one. If not, find out if there's a speech pathologist who can come to check him out. If not, ask for recommendations, including calling your local hospital and asking them.

Dysphagia needs to be treated by a speech therapist, although it sounds as if one is already involved b/c of the thickened liquids and pureed foods. I assume he also can't use straws?

I think your father is unable to swallow normally (happens with age and after sometimes after a stroke) and the food is collecting as a "bolus" in his mouth. He could also be pocketing the food, along the sides of his teeth next to his cheeks.

This isn't done voluntarily; sometimes it's occurring and the individual doesn't even know that his/her mouth is stuffed with food. A lack of sensation develops in that area and the person doesn't feel the bolused food. So it stays there.

One thing he'll probably need to do as and after he eats is "swish and spit", to get out the food that hasn't been chewed. It's a bacterial hazard, and can contribute to aspiration pneumonia, for which your father may already be at risk .

Before a dentist comes, I would help him get rid of the extra food so an exam can really determine if there are dental issues. Ask the facility's speech therapist or dietician for assistance if you're not sure how to do this.

I wouldn't be surprised if he has cavities that haven't yet been diagnosed, probably from all the bacteria developing in the food staying in his mouth.

Ask the dentist to recommend a mouthwash; that can help get rid of the mouth and perhaps the bacteria. If he has cavities, his teeth might be too sensitive to brush.

Even if he can't swallow (unthickened?) water, he can "swish and spit". That's the advice we were given. It sounds gross, but keep a "swish and spit" cup handy so he can do that when he's eating, if food begins to clog (even on a dysphagia diet).

If his teeth haven't been cleaned in 6 years, there probably is a lot of plaque on them. If he does have them cleaned, he'll probably have to take an antibiotic before, as some of the plaque and debris can accidentally be swallowed.

I don't know for sure if albuterol and (probably) ipratropium bromide leave a residue on teeth.

Honestly, I think it's plaque and accumulated food.

Ask about a safe mouthwash. That's what I had to use for about 6 weeks in lieu of brushing when I "fought the tree and the tree won", knocking loose 6 teeth and cracking my jaw.

And kudos to you for keeping after the staff to find out what's really happening. They'll learn that when you want answers, you need to get them!