Finding help for teeth grinding

delamer

My mother has cerebral amyloid angiopathy (CAA) and the dementia that also comes with it. She has had two strokes, cannot communicate, cannot follow directions, requests, or commands, and her awareness of her surroundings varies strongly by the day. If we gently work at it, we can get her to open her teeth a small bit, but we struggle just to brush her teeth with her limitations. I should note that she is also bed-bound and cannot be moved from the house.

Within the last couple of weeks, she has started significantly grinding her teeth. We are afraid that she will cause damage to her teeth and pain to her jaw. I have tried to look online to find options for her, but most options, such as a mouth guard, require the ability to open her mouth. (She can't really get an impression of her teeth done, after all, if she can't open her mouth more than a crack.) I have seen mention of pain medication and anxiety medication, but we don't know if either are the case. We are a little hesitant with something like Botox, though would be interested to hear from anyone who has used it effectively. The mouth guard would be ideal, but again, there's no means to get an impression, and we can't risk something that might come loose and she might try to swallow. Her former dentist seems to have no other ideas.

How do I find resources and options for her, given all of her restrictions? Also, what have other people tried and found success with using?

harshedbuzz

@delamer

Hi and welcome. I am sorry for your reason to be here but pleased you found this place.

This is a tough one. Not only does tooth grinding pose a risk of fractured and teeth with resulting tissue injury and infection, the behavior can be very upsetting for her caregivers.

There are OTC mouthguards you could buy and fit at home, but it might be a battle for her to accept this strange new sensation in her mouth and for you remove, clean and reinsert it. I'd be inclined to try the Botox even if it means hiring medical transport for the outpatient appointment.

Another option would be to engage hospice and see if the team had suggestions around this. If you don't have hospice in place, I'd call for an evaluation to discuss this.

HB

Colacho10

The grinding may be a sign of unrecognised pain or distress, since she can't communicate. Maybe talk to her doctor about trying a low dose of a muscle relaxant or neuropathic pain drug. They are an option for treating grinding when the cause is neurological or unknown.

Another option could be an ear or sinus infection, as that pain can trigger grinding.

For a dental solution, look for a specialised geriatric dentist. While a custom impression is out, they may have experience with non-custom, soft bite splints that require minimal mouth opening to place and might be safer than a generic, store-bought guard you worry she could swallow

delamer

https://alzconnected.org/discussion/comment/255921#Comment_255921

Thank you — I appreciate both the welcome and your thoughts!

Believe it or not, my mother is actually not on hospice, so we do not have that resource. She was after the second stroke, but despite all of her limitations, her health is good enough that she was able to graduate from it. This is good, but it does mean that we have to work to find our own resources — and on top of that, those resources have to be able to come to see her. (We have been fortunate enough to be able to care for her at home.)

She does not seem to be too resistant to new sensations, so I'm not as worried about her accepting something in her mouth — more that it would come loose and she would inadvertently try to swallow it. I wear a guard myself at night, and I had difficulty finding ones that stayed in place until I finally broke down and got the customizable one. Then, as you noted, there's the challenge of removing it, cleaning it, and putting it back. Do you know of ones that fit more closely?

I'm hesitant about the Botox, but I'd be open to talking to a dentist about it. I haven't had too much luck looking so far. Is there a way that you know of to readily find people who do that?

delamer

https://alzconnected.org/discussion/comment/255932#Comment_255932

Thank you, these are some really helpful thoughts. We do worry about the potential of pain, especially since she can't communicate and really isn't able to express pain. I'm hoping we can get the visiting nurse to come in and evaluate her for a sinus or ear infection. We did give her Tylenol last night and she didn't grind, so while that isn't a definitive connection yet, it gives us hope that maybe this is the cause, and if so, more importantly, that it's something we can help her with. She was prone to headaches before she lost the ability to communicate or express herself, so that may be coming back into play too. Again, hopefully the visiting nurse has some answers and can address the idea of muscle relaxers or a neuropathic pain drug.

I would love to find a specialized geriatric dentist. So far I haven't had much luck, but I do live near a large city, so I feel like they must be here somewhere. Do you know of a good way to locate someone?

SDianeL

I would try another hospice evaluation. If she has dementia she may qualify. They will reevaluate every 6 months. If pain meds don’t work maybe ask about anti anxiety meds. Anxiety is common in dementia. Hope you find a solution. If she can’t open her mouth, does she have a feeding tube?