Sep 3, 2010

Alzheimer’s And Oral Hygiene

By Barbara Pursley
+Alzheimer's Reading Room

Maintaining good oral hygiene was most important to Mom. Daily preventative care included proper brushing and flossing at least twice a day. I can remember her saying, “If you don’t take care of your teeth then you won’t feel like smiling.”

In the early stages of Mom’s disease, brushing her teeth with an electric tooth brush was not that difficult, but I can’t count the number of times that she bit my fingers when trying to floss. And, I learned early on that I definitely couldn’t depend on the nursing home for this duty.

Every year, I took Mom to the dentist for her routine check up and cleaning and each year became more and more difficult. I was angry that I never could get a dentist to come to the nursing home.

It was on Tuesday, September 25, 2003 when the horrid dentist appointment took place. Mom was in her tenth year of Alzheimer’s. She had a broken tooth with the root embedded in the gum and we had an early morning appointment to see an oral surgeon. I had made arrangements with the nurse in charge to give Mom a mild sedative for her anxiety before the appointment.

I explained to the dental technician that Mom has Alzheimer’s and doesn’t understand instructions. They didn’t listen. They told her, “Lift your head and rest your chin on the plastic brace and sit still while we get some x-rays.” Right!

The surgeon put the x-rays on the light box and said, “I’m surprised. We actually got some good x-rays.” As he studied the x-rays, he pointed out the problems saying, “This is the broken tooth which has a slight infection and these dark spots on her five teeth are cavities.” He sat on the rolling stool holding Mom’s hands as he began to give me his opinion.

“Barbara, this is my honest opinion. Your mom is 83 years old, she’s had Alzheimer’s for ten years and she has been eating pureed food for one year. She doesn’t need her teeth and they’ll continue to get worse. I think it would be best to put her in the hospital under anesthetic and pull all of her teeth!”

I never expected that pulling all of her teeth would be an option. I started to cry while telling him, “I could never put her through such trauma.”

He replied, “I understand. But, I’d like for you to think about it.”

I took Mom back to the nursing home and drove home crying with my primary concern being…IS SHE IN PAIN! I was desperate for help.

I was too upset to think clearly, but I needed to talk to someone so I called the Houston Alzheimer’s Association and spoke with the social worker. The first thing she said, “This is a major ethical issue. Alzheimer’s research has shown that Alzheimer’s patients who are completely anesthetized usually decline in their disease and sometimes do not wake up.”

I didn’t need to hear anymore, but I wanted to ask one last question. “Have you ever had anyone call with this situation?” She answered, “No. I’ve had people call about pulling one or two teeth, but not all of them.”

I called my friend, Mary, who was a dental hygienist and explained everything. She said, “If the tooth is dead, meaning rotten, then she has no pain. If the tooth has an infection, it will be red, swollen, pus pocket and sensitive to foods and liquids. It takes as long as six months for a cavity to show up on an x-ray. Once the decay of the cavity gets close to the nerve is when the pain begins, but sometimes a cavity doesn’t advance that far. Just because a cavity shows up on an x-ray doesn’t mean she’s in pain. Pay close attention to her facial expressions to see if she reacts to food or cold liquids.”

Mom never showed any pain and that was our last visit to the oral surgeon I really wanted to call him and give him a piece of my mind, but I let it go.

Barbara Pursley was born in Galveston, Texas and is the author of EMBRACING THE MOMENT. Barabara attended Santa Monica College, studied photography, and worked as a commercial photographer before returning to Texas to care for her mother. Barbara also taught journal writing to women in Texas rehabilitation facilities. She put her God inspired journal entries and photographs into book form in 2009.

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Original content Barbara Pursley, the Alzheimer's Reading Room