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Dental treatment for dementia patients - Carers UK Forum

Dental treatment for dementia patients

For issues specific to caring for someone with dementia.
My father (83) has middle stage dementia, but is quite lucky with his teeth as he still has about two thirds of them (most of the other residents in his care home have dentures).

He hadn't seen a dentist for a few years and had been losing his appetite, so on Wednesday I took him to the dentist for a check up. To say it was stressful would be an understatement.

Firstly, there was the discussion beforehand, where he said he had no problems with his teeth and didn't want to go. I explained it was just a check up and said we'd go to the pub afterwards (he is an alcoholic). Next, came the struggle to get him to brush his teeth. I had asked the care home to organise this before I collected him that afternoon, to save me a bit of time (and aggro, to be honest!) but Dad had refused to do it before I arrived, saying he'd brushed them that morning already and that was enough. Image Anyway, I finally persuaded him to do it, then discovered he couldn't cope with squeezing out the toothpaste and barely brushed them at all, so I'm guessing they have been poorly brushed for years. Interestingly he insisted on using hot water to brush them, so they must be sensitive.

The worst thing though, was the way Dad struggled to cope with the check up. The dentist had to take several X rays and Dad struggled to hear (he's quite deaf) and understand the instructions. He tried to get off the chair before they'd finished so they called me back into the room to help explain things to him, at which point I managed to bash my head on the overhead metal lamp and got quite a bruise. It was a bit like dealing with a child with learning difficulties, but the nurse was really kind and kept holding Dad's hand and fussing over him, so it could have been a lot worse.

Dad looked so vulnerable in that chair, it was all too much for me, I had to leave the room at one point. Image

The dentist said that 4 teeth need extracting, but Dad says he has no pain, which seems strange to me. Apparently some of them are decayed at the root, under the gum - so maybe the nerves are dead? Or maybe his brain doesn't receive the pain signals any more, due to his dementia? Does anyone here have experience in this area?

The dentist will refer him to the hospital to have the treatment done under a general anaesthetic. I'm worried about that too, as he has low blood pressure and a previous history of blood clots. He used to be on Warfarin but they took him off it when they discovered the extent of his drinking (he still has 2 cans of strong beer a day as he'd not want to live without alcohol). Dad queried whether he could just refuse the treatment but I persuaded him that he needs to have the rotten teeth removed because although he has no pain (he says) they could cause infection so we can't do nothing. But I'm worried that I'm pushing him to have the treatment when maybe there's a greater risk from the anaesthetic. Image I'd be grateful for any opinions.
Hi Shewolf

When I had to have two wisdom teeth extracted, I couldn't afford to go private in order to have a general anesthetic. The NHS would only offer me a Valium jab instead. But it worked brilliantly. I felt not a thing, and keep in mind they had to cut into my jaw bone in order to extract those troublesome toothies.
Perhaps that might be an option for your dad? Also the Valium relaxed me like mad so I couldn't care less about the dental surgery, despite being awake the whole time. Prior to the jab, I would've been quaking with fear if I wasn't so tense that I was practically rigid with fear instead.
I think your dad having a Valium jab instead of a general anesthetic could well be worth looking into.
P.S. Prior to the Valium injection they asked me for my weight. I assumed I weighed 9 stone, and they gave me too much. I then had to be left for about half an hour as I couldn't stop laughing. I even found the window blinds funny???? I nearly bit the dentist's fingers as I just couldn't stop laughing. Good stuff is Valium!
P.P.S. I had to take a friend with me as the hospital would not allow me home without an escort. I can see why now as I spent the entire bus trip home singing at the top of my voice My old man's a dustman, he wears a dustman's hat.... and wanting to lie down on the floor all the time.
I think your dad would enjoy a Valium jab if he's allowed it. I certainly did!
This is a difficult one, SheWolf. He does have to have the dental work done, but full general anaesthetic for any 83-year-old, let alone an alcoholic dementia patient, carries its own risks.

I had Valium sedation in 2003 when having cataract surgery on the NHS, and although it didn't have quite the same effect on me as it did on Sajehar (probably because I am naturally a miserable cuss compared with her Image ), it worked very well. I almost enjoyed the operation: I knew what was going on, but was fascinated by all the psychedelic patterns I saw in my eye as they extracted the natural lens and inserted the artificial one.

But cataract surgery is a relatively quick operation. The extraction of two or more molars can take a lot of time, and it is heavy-duty surgery, with a lot of banging and tugging. As it happens, I had two molars out (one a wisdom tooth) in December, and last Thursday I had the first follow-up appointment for placing an implant in one of the sockets, plus the removal of an old crown, the placing of a temporary one, and the taking of impressions, the last a process that I find hard to bear when fully conscious, as it scares me and makes me gag: 4-hour procedures both times. I had deep sedation (not valium, but I'm afraid I don't know which drug(s)), and not a general anaesthetic. One remains conscious, but calm rather than either frightened or euphoric, and has relatively little recollection of most of the events afterwards. This is all private dental work, though (and seriously, eye-wateringly expensive), so it may not be possible on the NHS for your father, but if it were available, I would say it would be the best option.

You need to talk to the dentist and the GP in depth about this. Failing deep sedation, I think it is going to be such a major intervention that he may need the general anaesthetic. Image

Tristesa
Just an addition. I think it was Bowlingbun who suggested on another thread that you might try to persuade your father to use an electric toothbrush. This can really help with oral hygiene. I have used one for decades, and there is no doubt that it is easier to keep your teeth clean than when using a conventional brush. But all this will have to come after the decisions and oral surgery...

Tristesa
Thanks everyone, it's good to know that the valium option is a possible alternative. I'll wait for the hospital appointment to come through then make some phone calls to see if that is an option. Dad still has savings, so if we needed to go private to have the valium then it's doable - it would just mean we'd reach the funding limit a bit quicker.

I can't imagine that the dentist would suggest 4 extractions unless there was a need - there's no profit for her in sending him off to the NHS hospital. Previously doctors have said that Dad's heart and lungs are quite sturdy for a man of his age so if the consultant thinks he can handle the gen. anaesthetic it could be good, because they might be able to do a descale etc and other minor work all in one hit.

I've had teeth removed with just the jab in the mouth, including one wisdom tooth with awkward roots. My dentist was a real expert and it was fine, but there is lot of pulling and tugging involved with extractions so in some ways I'm concerned about Dad being awake.

BB - the battery operated brush sounds interesting. I tried an electric toothbrush for a while, but found it so 'fierce' it seemed to set my teeth on edge, especially near the gums above crowns. I found I couldn't face using it so chucked it away. Are the battery ones 'fierce'?
BB - the battery operated brush sounds interesting. I tried an electric toothbrush for a while, but found it so 'fierce' it seemed to set my teeth on edge, especially near the gums above crowns. I found I couldn't face using it so chucked it away. Are the battery ones 'fierce'?
I use a simple battery-operated electric toothbrush for travelling (charging the main one is a pain, especially if travelling outside the UK). It is the same brand as the one with the built-in rechargeable batteries (Braun), but it has a substantially softer, slower action. I think a battery-operated one could suit your father.

I have had many fairly difficult dental procedures done with only local anaesthetic, for example, root-fillings, and recently I had a tiny fibroma (like a little wart) removed from my tongue under a local. The worst bit of that was the injection into the tongue, but when one is totally conscious, one can't help thinking about the things that are going on, even though one can't feel them. You can't feel cutting when anaesthetised, but of course you can feel pulling in a sense, which makes extractions a bit different. Under sedation, all consciousness of the details melts away, and it is all vague. And if you are Sajehar, you even feeling like singing songs! Image
But only on the bus afterwards!

Hi SheWolf

The general impression I got at St Tom's ossie was that valium jabs (and presumably deep sedation) was much cheaper than general anesthetic (I'm in shock, I spelt that right first go... Yippie!)
However, that was in 1983, so maybe things have changed now?
Also, maybe the jabs wear off quicker than anesthetic (I spelt it a second time.... without peeping at first spelling.... miracles will never cease) so maybe time factors come into it?
If so, maybe your dad could have several visits, taking one tooth out at a time, or something? Just kicking ideas around.

Triesta,
I think my OTT reaction to my Valium jab had more to do with the fact that I didn't actually know what I weighed, so said 9 stone off the top of my head. A couple of days later I weighed myself at the local chemist; I actually weighed 7st 10lbs. The ossie over-dosed me! I bet if you'd have been o/ded too, you too would be laughing and singing your head off, or some such thing Image
I don't think you're a miserable cuss at all; your just dead curious (by that I mean having a very inquiring mind) and that's worth it's weight in gold. Had you been placed in my OD position, I now have visions of you break-dancing up the central isle of a London Transport bus.
For the record, the song I sang is as follows:

My old man's a dustman
He wears a dustman's hat
He wears cor blimey trousers
And he lives in a council flat.
OY!
One leg, here, one leg there
One leg round the corner
One poor soul
with a bullet up his hole
Shouting out for water.
Water, water
Water came at last...

and I can't remember the rest. Nor have I the faintest idea what any of it means, or from where I learnt that song in the first place.
I suspect I sang my head off because I can't sing for toffee, and actively avoid doing so. Maybe Valium, in a high dose, acts as a dis-inhibitor, and you do things you normally wouldn't do but would secretly like too?
The weird thing is that I actually sang very well, according to my escort, hitting all the right notes and everything. And, OK, My Old Man's a Dustman is hardly Nessum Dorma, but my drug induced singing on a London Transport bus was the one and only time in my life I've ever managed to actually sing in tune.
Shame smart phones didn't exist then. I'd have liked a record of my one-off successful singing. On seconds thoughts...
Image The song was a number-one hit for Lonnie Donegan in 1960. You can remember more of the words than I can!

I can't get over the fact that you weighed only 7st 10lbs! TINY! Really they should have weighed you, not just asked!

Image Tristesa