Dental problems

ImMaggieMae

My DH who is in stage 6/7 has been having problems with his teeth for at least a year. He has several front teeth that have decay and lost a crown several months ago that the dentist was not able to replace because of decay underneath it. He said he would likely need about 7 teeth pulled. The dentist said he was unlikely not feeling pain in any of them. But this morning he lost a back tooth. He had been sort of brushing with a heavy duty floride toothpaste, just to try to keep things from getting worse. I think he is feeling pain now, but he is non verbal for the most part. I have been hand feeding him and have been since at least the beginning of the year. He won’t let me brush his teeth other than to use those little sponge things. I don’t want him to stop eating.

I need to talk to someone here who is or has been in this situation with a loved one. I am beside myself trying to figure out what to do.

M1

I honestly think I would let it go, unless he is in obvious pain. Would he have any clue what a dentist was trying to do for him, even if it were just to remove a tooth under local anesthetic? Did you mean you are hand-feeding him? I can't remember Maggie, is he on hospice?

I understand your not wanting him to stop eating, but that is inevitable at some point. Perhaps it's time for milkshakes and pureed soups. Wish there were some obvious answer.

My partner makes very little effort to feed herself now but likes it when I hand-feed her. She hasn't brushed her teeth regularly in years, sometimes I can get her to make a rudimentary effort when I get her to shower. Our MC facility brings a dental team in every six months (including senior students from a local dental school) to do some cleaning and fluoride treatments for those who will tolerate it. Other than having that done about four months ago, she has had no dental care in at least three years (since about stage 4). The radiologist who read a recent head CT after her bad fall commented on multiple dental caries, but she's not in pain. Unless she had an obvious infection with facial swelling, I wouldn't do anything about any of it.

ImMaggieMae

M1, yes, I’m hand feeding him other than a P&J sandwich for lunch with the crusts cut off that he can eat on his own. I cook regular meals, but lots of meals based on ground Turkey and lots of pasta dishes, fish and things that are easy to chew and swallow. He eats well but very slow, with me hand feeding him.

The regular dentists around here don’t pull teeth, they refer to a dental surgeon, especially in his case because of the anesthesia that would lie required. I’m not sure if he would sit still. He did sit for an exam and several X-rays at the beginning of the year. Not sure he would now. And I’ve been told that anesthetics can cause progression with dementia.

Theses teeth deteriorated very quickly. I have pictures from 2021 where he’s smiling and they look perfect. But he had stopped with the open mouth smiles at some point, and with a mustache (that I keep trimmed) I never noticed. I had to pull his lip up to see the teeth that were in terrible shape. In the fall of 2020 he had a root canal and crown done on a back tooth and everything was fine then.

He always took very good care of his teeth before dementia. He went to the dentist every 4 .months for cleaning and had any work done that was needed. He brushed his teeth religiously. But there was a period of about a year or more after dementia reached mid stages that he didn’t want to brush his teeth at all and wouldn’t let me do it. I should have found a way or been more insistent. He is generally cooperative. Now that I’m in charge, everything goes to hell. I should have checked more often. This could have a big impact on his eating and his health, or what is left of it. I’m responsible and I feel so terrible that I failed him.

He isn’t on Hospice.

M1

Maggie you haven't failed him-this is inevitable disease progression with the passage of time. You have no reason to blame yourself, and you can't keep the dam from bursting at some point.

I bet he would qualify for hospice if you feel it would help. It doesn't really address the dental issue but it would give you access to pain medication for as needed use.

midge333

Maggie: Caregiving is hard enough without blaming yourself for your LO's disease progression. You haven't done anything wrong. Your DH is reaching the final stage of a relentlessly progressive disease. None of it is your fault. Quit beating yourself up. Be kind to yourself. I agree with @M1 that hospice would be helpful to you and your DH.

ImMaggieMae

I hesitate to call on Hospice because the ones I’ve talked to around here would take over all medications and I think that means that he would lose his neurologist who has been the most helpful. One of the hospices would not treat a UTI. The other would but would not test urine samples. I don’t know what they would do about the Risperidone, Memantine and Gabapentin, but all three seem to help him. The other thing is he has a hospital bed which he needs for the raised head. After 6 months I finally got Medicare to pay for it but if he was on hospice and they decided after 6 months that he wasn’t progressing enough and released him, I don’t know where I would get another hospital bed on my own.
I guess I aso feel like I was giving up on him bringing in hospice. I can’t imagine him not being here in 6 months. Lots of people here have had their spouses live for years with dementia.

He did answer yes to feeling pain this morning and I gave him Tylenol. I also made an appoi With his dentist to at least figure out which tooth is causing the pain. And I have a video appointment with his pcp to talk about pain meds if needed beyond Tylenol. I feel so helpless.

M1

I don't look at hospice as giving up but as accepting the inevitable. Have you read Being Mortal by Atul Gawande? I highly recommend it.....

fmb

Another good book which just came out is Nothing to Fear by Julie McFadden, RN (aka Hospice Nurse Julie on YouTube and TikTok). It discusses all aspects of death and the dying process. One chapter discusses exactly what hospice is and is not and how it helps the dying and their loved ones.

@ImMaggieMae Placing a loved one in hospice is not giving up. Hospice does not mean that he will be dead within six months. The Medicare criteria for admission to hospice require that the patient have a terminal illness or condition with a prognosis of six months or less to live, but many people are in hospice care for a year or more, especial those with dementia. I am sorry that you are having trouble finding a suitable hospice provider. Please consider continuing to interview other providers.

ghphotog

https://alzconnected.org/discussion/comment/216968#Comment_216968

Dental can be tricky. My DW stopped flossing and brushing a couple of years ago. Our dental hygienist and I decided on cleaning every four months. She's 6/7 but can stay fairly still for the cleanings. Hoping no serious dental issues appear then I won't be sure how to proceed either.

ImMaggieMae

I have a dentist and doctor appointment on Monday afternoon, the soonest I could get a few days ago. The doctor’s appointment is a video. He was able to answer me when I asked if he was feeling pain. I’ve been giving him Tylenol which seems to be helping. I want to find out from his pcp if there are other pain meds he could take with the dementia meds. I want to find out from the dentist if there is anything left of the root of the tooth that came out and if so, what he suggests.

He’s still eating 3 meals a day which I hand feed. I’m sticking to soft foods, of course.

ghphotog

I hope you can find the right pain meds. I wonder if a small dose of Lorazepam could help keep him calm for a dental procedure? My wife's neuro used it for xrays and MRIs. She hasn't needed it yet for the dentist office but just a thought. It might help him stay calm enough to treat the problem tooth.