ALZHEIMER’S AND ROSIE’S DENTAL DILEMA

September 21, 2012 — My mother-in-law, Rose, was one of the fortunate ones when it came to teeth: strong, straight

dentist working on woman

Despite strong healthy teeth and frequent dental exams, some people with Azheimer’s end up with dentures, another problem for caregivers to deal with.

and cavity free.  As my dentist Dr. T. had explained she was blessed with the good saliva that worked to keep the bacteria from making inroads — cavities — in her teeth.  However, as she neared 50 all of her teeth were extracted due to gum disease – like my dad who I wrote about previously.

LEARNING DENTAL HYGIENE

Ken’s father, Nick, managed to keep all of his pearly whites with only one missing when he died.  That was quite an accomplishment for someone born in 1892.  As a poor immigrant boy of 14 who came to America during the 1906 immigrant rush Nick was unfamiliar with the word, use or sight of a toothbrush.  Joining the U. S. Marines ten years later the Corps soon taught their new recruit the meaning of hygiene in all aspects.  So for Nick, even in his later years of Alzheimer’s, lucked out in the dental department.

ASSISTED CARE AND DENTURES

Rosie did well with her dentures as long as she was a healthy, thinking person, but as her mental health faded into Alzheimer’s, with her husband deceased, and a continuing bout with treatable bladder cancer the family found it best to move her to an Assisted Living facility.  It was here the dentures took on a life of their own.

THOSE ARE MINE

Apparently, missing teeth (and other things) are a constant problem in a facility where the residents roam free throughout the building as they visit and wander from one room to another.  Rose shared her area with another woman, who we’ll call Ada, with a form of dementia.  Rose lived on the window side and the room had an attractive divider separating the two spaces.  All spaces were furnished with a bed and a dresser.  We had been encouraged to bring a few furniture pieces to add a hint of home to her otherwise austere living quarters.  A desk, a what-not shelf and a small rocking chair were added to make her feel as if she were at home.  We also brought a few cups and saucers from her bone China collection to add to the decor.

One day Ada decided to clean – not only her side – but Rosie’s cubical as well.  The teeth in a glass vanished as well as the figurines and cups which were placed in the trash can.  Fortunately, Ken’s sister Loretta had taken Rose for a doctor’s appointment.  Upon returning Ada was still cleaning.  “Those are mine,” said Rose as she noticed her cups in the trash.  Then Loretta noticed the flat surfaces of the desk and shelves were bare.  It did take a while, with help from staff, to find everything and they did, including Rosie’s teeth in Ada’s pocket.  After a few more Ada incidents, which were excessive, Rosie had a new roommate.

DENTURES:  A FACILITY PROBLEM

Apparently, Ada wasn’t the only resident who believed that any glass filled with water and teeth was up for grabs.  Many residents wore dentures and it was difficult to identify what set of teeth belonged to what resident.

We often found Rosie’s dentures missing and more often than not she was the culprit.  The teeth were found under the bed, where they had fallen, or under the pillow or in the pillow case, where she had hidden them, or in her pocket for safekeeping.  Most of the time, thankfully, there were somewhere in her cubical.  The last time, though, they were just gone.

DINNER AND DENTURES

The facility where Rose lived was really a lovely place.  The management and staff tried very hard to retain home-like features.  This included a dining room where the residents sat at cozy round tables and their meals were served.  They visited as amicably as their demented minds would allow, and mealtime was pleasant for them.

One evening, however, Rose apparently choked on a bit food which triggered a gagging reaction resulting in everything she had eaten coming back up onto her plate and splattering over the surrounding area.  The other guests quickly removed themselves from the table and the staff ran to Rosie’s aid.  Not knowing exactly what had happened they called the family telling us she had been taken to the emergency hospital.

Ken, His sister Loretta and I arrived to find her feeling just fine and wanting to go home so she could go to bed.  The doctors found nothing wrong and assumed she had just gagged causing her to vomit.  By the time we arrived at the facility the night staff had taken over and the day staff, which included the kitchen people, were gone.

It was then Rose asked, “Where are my teeth?”  She pulled down her lip to show us that her bottom dentures were missing.  Calling the hospital we found there had been no dentures left from any of their patients.  Checking in the next day we asked the kitchen people if they had found Rosie’s denture, “Just the bottom plate,” we explained.  “We’re sorry,” said one of the staff who had helped Rose, “we just removed the dishes, wrapped everything else in the table covering and put the mess in the garbage.  It’s gone.”  So was the bottom half of Rose’s dentures.

NEW DENTURES FOR AN AD PATIENT?

george washingtons teeth

George Washington’s ill fitting teeth would have been a nightmare for an Alzheimer’s patient to wear.

 

I checked with Dr. T., asking if it would be advisable to make just the missing plate.  “I could,” he answered, “but I doubt she would allow me to take a good impression, and you know how uncomfortable that is.  And then,” he continued, “they would be a bit uncomfortable while we made the adjustments for the high spots.  I can almost guarantee that she wouldn’t wear the new one.”

Food in the care facility was on the soft side and the meat was cut into tiny pieces so we didn’t worry.  In the end it was decided that the adventures of dentures in the facility were calamity enough without making a new bottom plate.  At least Rosie’s teeth could be more easily identified as they were no longer “they.”  Rosie’s teeth, if ever missing, would be singular: uppers only.

So, once again, the moral of the story is take care of the pearly whites.  You really do want them to last a lifetime.  There are enough troubles as we grow older without constant worry and the inconvenience of misplacing one’s teeth.

* * * * *

A dentist gives his perspective on helping patients with dementia and the importance of making sure that you take care of your teeth when you’re young so that dentures don’t become an additional problem. 

Dignity & Dentistry

Dr. Tannenbaum, a well respected dentist, shares lessons in the dignity and care of the Alzheimer’s elder.

tooth

The best care for people with Alzheimer’s is to try and keep all of your teeth healthy and strong for as long as possible so dentures don’t become necessary.

 

On my first day of work in a nursing home as a young dentist, I found myself striding confidently into the home’s dental office eager to make a difference. I brought the first patient in, read the chart and asked her if she had any problems with her teeth. In a serious voice she replied “my teeth are too dark, can you make them whiter?” I approached her wheelchair, peeked in her mouth and was shocked to find that she had no natural teeth!

That patient taught me a lesson that I’ve never forgotten. Here was an elderly woman in terrible physical and mental condition who was nonetheless really concerned about her smile. School taught me dental care is important for good health, but real life taught me the crucial role of good dental care in preserving dignity.

READ MORE HERE: Dignity


There are three related articles about mouth care in this series of health care tips from About.com.

Total Mouth Care

From

In the late stages of Alzheimer’s people can become so debilitated and unable to care for themselves that the caregiver has to carry out all aspects of their nursing care.

Your job, as caregiver is to make the person as comfortable as possible, maintain their dignity and look after them to the best of your ability. Mouth care is just one aspect of caregiving for someone with Alzheimer’s disease. READ MORE HERECaregiving and total mouth care


And what happens if your loved one refuse to wear their dentures? Here’s a few tips.

Resistance to Wearing Dentures

Question:

My mom refuses to wear her dentures. What can I do?

Answer:

If your loved one wears dentures, there’s a chance you may hit a point when he or she simply refuses to wear them. READ MORE HEREResistance


Video on teething brushing for helping a person with Alzheimer’s


Here is a link to a free e-book on dental health when caregiving people with Alzheimer’s. http://www.alzbrain.org/pdf/handouts/2050.%20dental%20CARE%20AND%20THE%20DEMENTIA%20PATIENT.pdf

 

 

Originally posted 2012-09-22 07:03:26.

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