Jan 9, 2012

Dental Care for People Living With Alzheimer's

The way it worked was a geriatric dentist and a hygienist did a first visit to the residence to assess the health of their mouths and teeth. I was informed my husband needed a filling and some x-ray work.

By Mary Gazetas
Alzheimer's Reading Room

When my husband went into a steep decline and ended up in a 24/7 care facility two and a half years ago - the last thing on my mind at that time was how his teeth would be looked after.

After a lengthy adjustment period I realized his teeth weren’t being well maintained.

Nothing like before that is.

He was the kind of guy who was good about looking after his teeth and was super disciplined about regular cleanings with a periodontist.

However that part of his life was over.


Subscribe to the Alzheimer's Reading Room
Email:

My initial concern was how could he ever understand simple instructions like open your mouth. Tip you head back. Rinse.

Our family dentist and his periodontist had practises on 2nd floors in buildings with no elevators.

Eventually I did start to make inquiries to see if there were any dentists who might have a ceiling hoist to help him get up out of his wheelchair into a proper dentist chair. And more important - who had a dental team trained in how to deal with patients in the late stages of Alzheimer's.

Some friends who had parents in long term care facilities admitted there wasn’t a whole lot that could be done. It was an area that tended to be ignored.

The care-aides as far as I could observe were doing the best they could. Some didn’t know what a proxy brush was! I ended up feeling that there were days they had so much to do to get the residents breakfast, cleaned, shaved, dressed ... that teeth were not a number one priority.

What is interesting to note is that compared to 10 years ago, and with a healthier aging population, way less people in residential homes have false teeth. Many of them have their real teeth which introduces a need for a higher level of dental care than before.

About a year ago I received a letter in the mail. The residence had formed a partnership with a geriatric dental program at a nearby university. Would I sign a consent form to have my husband be in this program.

You can imagine my response.

It was a huge YES.

The way it worked was a geriatric dentist and a hygienist did a first visit to the residence to assess the health of their mouths and teeth. I was informed my husband needed a filling and some x-ray work.

I arranged for a taxi that could take wheelchairs and off we went for his first visit to a very professional first class dental program that was part of the University of British Columbia’s Dentistry School attached to a larger hospital complex.

They had the special equipment, compassion and training to know what to do.

The filling was done. The film work though was impossible and they yielded to the fact my husband was having difficulties to undertake this procedure.

Since then the UBC team has come to the residence twice. Once for an emergency dental problem when some of my husband’s upper teeth broke off at the roots. Nothing could be done and the good news is there has been some healing and he has learnt how to chew on the other side of his mouth.

I was told by the friendly dentist if cleaning is tricky at times, at least make sure the residence staff are cleaning inside his mouth to kill bacteria with a product like Listerine.

Plus he told me he wrote in my husband’s chart – DENTIST’S ORDERS as a push to make them pay attention to the importance of a cleaning program that can’t be ignored.

I do NOT leave a pile of almonds on his table to enjoy anymore. Our family dentist told me later that was not a good idea when he knew his teeth by now are like a “house of cards.”

I have taken away a set of crayons for him to draw with because one day I showed up and he was chewing something crunchy in his mouth. I had to get a finger in there to figure out what he was chewing. It was a crayon!

An excellent hygienist comes in every three months to do a cleaning. Her name is Janice and she showed me how she can actually get a patient like my husband to cooperate.

He opens his mouth and doesn’t bite the equipment or try to stop her work by grabbing her arms.

She uses what is called a “bite bar.”

It is a hard white foam thing about 6 inches long and 2 inches wide. She explains slowly and softly to him to open his mouth and bite down. Then a space is made so she can get in and do her work. Amazing. None of the nurses nor care-aides knew of this technique.

They do now.

It’s not perfect. But the level of cleaning is way better than before which is a big relief for me.




Mary Gazetas is an artist, writer, volunteer who lives in Richmond B.C. Canada. Four years ago she knew nothing about Alzheimer’s. In fact she didn’t even know how to spell that word. At first she and her husband were overwhelmed by so much information available. Looking back it was a slow learning curve. Once diagnosed (February 2008) the progression of her husband’s Alzheimer’s was fairly slow until he went into a steep and sudden decline. Since then, Mary has continued to learn more - especially in the context of how to provide the best care in a residence environment.

More Insight and Advice for Caregivers

Original content Mary Gazetas, the Alzheimer's Reading Room