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 Dental treatment 
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Joined: Mon Dec 05, 2011 9:00 pm
Posts: 1
Post Dental treatment
Hello. I am the RN at an Adult Day Health Program. We currently have at least four clients with diagnoses of either PDD or LBD. In conversation with the wife of a client with PDD, she mentioned that following his root canal and temporary crown placement a few months ago, the dentist is now pushing for the permanent crown placement. She is conflicted about scheduling the dental procedure because her husband has had both physical and cognitive declines that will make it tough (but not impossible) for him to tolerate the whole thing. She's not computer savvy enough to use this marvelous forum but was happy to have me post these questions for your input.

1. How do you, as caregivers,decide where to draw the line with things like this?
2. Is it obvious when the toll it takes outweighs the benefit?

Thank you so much.


Wed Dec 07, 2011 2:40 pm
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3366
Location: Vermont
Post Re: Dental treatment
As a former CG, if something got my dad stressed, confused and aggitated, more so than he already was, we no longer did it. For instance, there was a total meltdown the last time he went for a dental cleaning. After that it was decided by me, my sister, the caregivers and his CNP, that he would not leave the facility for anything like a routine dental or medical appt. He just could not handle it. He was very ill and nothing was going to make him better or help him, so we let nature take its course. We made sure he had good pain management and tried not to intervene with all the other natural unfolding of events.
And yes, you'll know when your LO cannot handle it, IMHO. Lynn

_________________
Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Wed Dec 07, 2011 2:52 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Dental treatment
My husband can tolerate cleaning with local anesthetic but would not be able to tolerate any longer treatment. His dentist wanted him to have all of his teeth replaced with dentures [or implants!!!] but I was advised by those experienced with dementia patients in care facilities that he would likely not wear dentures and would probably lose them. At present, he is still able to chew well enough to eat a regular diet at the SNF and we'd like to keep it that way. It would be different if he had any associated pain or bleeding gums, which he does not.

The fewer interventions, the better, as a rule. A lot would depend on his current level of function. Is he currently able to eat? Would an extraction be necessary if he does not have the root canal procedure? If so, would he be able to chew his food adequately? Also, would he tolerate the temporary crown enough to keep it in place?

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Wed Dec 07, 2011 5:12 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Dental treatment
I think it would be critical to find a dentist (or oral surgeon) who is very familiar in working with those with dementia. And I would discuss this with the neurologist. Someone who knows PDD well and, ideally, the couple could make the best-informed decision.


Wed Dec 07, 2011 8:37 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Dental treatment
Also, the ins-and-outs of dental treatment have been discussed several times recently on the Forum. You might benefit from reading the other posts. You can probably do a search of past posts containing the term "dental" or "dentist."


Wed Dec 07, 2011 8:39 pm
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Joined: Sun Jun 24, 2007 5:35 pm
Posts: 344
Post Re: Dental treatment
Ditmom, I always try to choose the lesser stressor.

_________________
Pat Snyder, husband John, dx LBD 2007
Author of [i]Treasures in the Darkness: Extending Early Stage of LBD...[i][/i] [url]http://www.amazon.com/Treasures-Darkness-Extending-Alzheimers-Parkinsons/dp/1466428228/ref=sr_1_1?ie=UTF8&qid=1334092686&sr=8-1[/url]


Thu Dec 08, 2011 12:04 am
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Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: Dental treatment
Mockturtle Pat, let me get this straight. A grownup professional dentist who has been to college and dental school and has treated patients, suggested that an elderly man with dementia might consider replacing all his teeth with implants?!! Really?

I have one implant in my mouth. There was a long wait between the extraction and the implant, I guess while the gums healed. For one tooth this was not a problem. What on earth would Derek do without any teeth for a few weeks? Or do they stage them a few at a time? How many hours at how many different sessions would he be spending in a dentist chair?

My single tooth was well over a thousand dollars. What would a whole mouth of them cost?

This whole concept boggles my mind.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Thu Dec 08, 2011 12:36 am
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Dental treatment
Jeanne, I agree it was totally impractical. I suspect greed was the motive rather than good dental care. Implants here are $4K per tooth! :cry:

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Thu Dec 08, 2011 12:42 am
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Joined: Sun Jun 24, 2007 5:35 pm
Posts: 344
Post Re: Dental treatment
I have a friend whose husband has end stage Parkinsons with LBD. The patient's nephew, who is a dentist, has done thousands of dollars of dental work on his pitiful uncle for the past 2-3 years. Poor Harry would be in the chair for 2-3 hours at a stretch sometimes and in a town an hour away.
It boggles my mind how the nephew can sleep at night and how my friend has continued to subject her husband to this aggressive dental treatment.
I guess some people just don't get it.

_________________
Pat Snyder, husband John, dx LBD 2007
Author of [i]Treasures in the Darkness: Extending Early Stage of LBD...[i][/i] [url]http://www.amazon.com/Treasures-Darkness-Extending-Alzheimers-Parkinsons/dp/1466428228/ref=sr_1_1?ie=UTF8&qid=1334092686&sr=8-1[/url]


Thu Dec 08, 2011 12:43 am
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Joined: Sun Jun 24, 2007 5:35 pm
Posts: 344
Post Re: Dental treatment
Pat, I think greed was the motive of Harry's nephew as well.

_________________
Pat Snyder, husband John, dx LBD 2007
Author of [i]Treasures in the Darkness: Extending Early Stage of LBD...[i][/i] [url]http://www.amazon.com/Treasures-Darkness-Extending-Alzheimers-Parkinsons/dp/1466428228/ref=sr_1_1?ie=UTF8&qid=1334092686&sr=8-1[/url]


Thu Dec 08, 2011 12:45 am
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Joined: Tue Feb 23, 2010 10:32 am
Posts: 215
Location: Kalispell, MT
Post Re: Dental treatment
Please read all the posts on necessary and unnecessary medical procedures and interventions. The caretaker needs to be REALISTIC about the LO's short term and long term conditions as well as projected lifespan. I think too many caregivers do stuff to the LO trying to turn back the clock and/or treat him/her as normal. I had two of my husbands teeth removed to prevent future pain and infection, but saw no reason to replace them. Please, please, BE REALISTIC. Why do things for dying people (yes, they're all dying) which are not necessary for their comfort?


Fri Dec 09, 2011 12:32 am
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Joined: Sat Oct 06, 2007 4:28 pm
Posts: 736
Location: LA
Post Re: Dental treatment
Mr Bobby had to go to the hospital because of an infected toe. The surgeon came in and asked how mobile Mr Bobby was. I told him that he came down the hall to watch TV and also to take his shower. He still walked to the bathroom which opened off his bedroom. "Dr Cut it Off" [not his real name, of course] marked off above the knee where he planned to remove the leg {to keep it from spreading}. I stood between him and Mr Bobby and let him know that was not why we were there. ... With surprise the surgeon then decided maybe we could get by with just removing two toes. We made plans to put dye in the veins the next morning to see how much fresh blood was running to the foot. I agreed to that. ... Dr Walker, our family doctor had powerful antibiotics filling his body and I asked the nurses to bring some epsom salts to soak his foot to draw the poison out. With a smile one answered, "Hon, we don't have any here". I turned to my son and asked him to go to my house and bring the large carton sitting on my kitchen counter. The attendents at the hospital could not administer the soaking, I understood that, but they did not stop me from doing what I wanted to do. All nightr long I soaked the foot at intervals. The next morniing when Dr Cut it Off came in and looked at it, he thought maybe we could just keep close watch of it and not do the dye thing quite yet. A few days later, I brought Mr Bobby home with his foot intact. That happened about six years before his death.. Everyone at the hospital, including the doctor, rejoiced with me.

I thought so many times how much harder his life would have been if he had to be confined to a wheel chair.

Stay extra vigilent when caring for your loved ones who can no longer make the decisions for themselves. Weigh all decisions carefully.

Dorthea

_________________
"See this lady she's 85 but she's nice" When I joined in 2007 this is the way Mr B. introduced me to the people only he knew,he added "You need to listen to her" he was 89 then, death due to Lewy Body Dementia/pneumonia in 2009.


Fri Dec 09, 2011 1:36 am
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Dental treatment
DrP,
That's quite a story. You are one strong lady. Mr. Bobby was a lucky man!
Robin


Fri Dec 09, 2011 2:56 am
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3366
Location: Vermont
Post Re: Dental treatment
Depending on our LO's overall health (or lack thereof) even transporting them can be a huge stressor. For my dad, who had been wheelchair bound for about a year when the last dental cleaning incident occurred, just getting him in his wheelchair, getting that into the special services bus, taking him the 20 miles to his dentist, then getting him out and into the waiting room was a really bad situation. So, even if the dentist had been the best one in the world for dementia patients, things had already gone awry before he even got to see the dentist.
I was concerned about him having gum infections or an infected tooth because his dental care was one thing that really wasn't taken care of at the ALF. I'd ask them to please make sure his teeth got brushed but I don't think that was happening when I wasn't there. So, being concerned about his dental health, I made his cleaning appt. Bad, bad choice, as it turned out.
As Gail says, think really carefully about any medical interventions of any sort before committing to anything, particularly if their health is already very compromised. Lynn

_________________
Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Fri Dec 09, 2011 11:46 am
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Joined: Mon Feb 14, 2011 10:22 pm
Posts: 190
Location: Portland, Or
Post Re: Dental treatment
I second everything that Lynn just said, and Kudos to you, Dorthea! I admire your resolve and courage to stand up to that doctor for your Mr Bobby. I agree that we need to carefully examine all medical/dental procedures and ask ourselves " How important is this, how is this going to affect our LO's comfort at this end of their life?" and I know I have to stop and ask myself what my mother would want me to do, because it's not always the same thing that I want. I want to fight tooth and nail to keep her here as long as possible, but she's already let me know how tired she is and that she's ready to die. Sometimes I have to take a deep breath and just say "no, that's not what Mom wants". Thank you for reminding me that the doctors aren't always right, and that we know our LO and what's best for them.
Ellen

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Ellen 59, caregiver for mom Marion 81,dx LBD Feb 2011


Fri Dec 09, 2011 11:51 am
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