How do you strike the perfect balance between getting the patient good dental care without inflicting them with an over zealous, dental treatment plan?
Some dentists can get very free with their recommendations for various treatments, procedures, etc. I want my cousin, who is 63, with Vascular Dementia mixed with Altzheimers, in Secure Memory Unit, Severe Dementia Stage 6 to be comfortable, but not overly treated with dental procedures.
She has lost most mobility and is wheelchair bound, but still is verbal and feeds herself. She's had a lot of health crisis with falls and we've been focusing so much on her medical issues, that we haven't addressed her dental. Now it's time.
She has never had good dental hygiene, so I can't imagine what condition her teeth are in. She has them all with maybe 3 fillings from childhood. None appear to be bad. She doesn't complain of any tooth or gum pain, her gums don't bleed and she eats without issue. Still, I know she needs to see the dentist. She hasn't gone in years. Her dementia progressed in May of this year and she's been in assisted living since June.
I fear the dentist will say she needs to have them all pulled and get dentures. I have talked to enough people with dentures to know it's not that simple. I don't want to create another thing for her to deal with. I also don't see the point of having her sit in a dentist chair twice a week for the next 6 months getting elaborate work done.
What should I do? Should I wait to see if she complains of a problem and then just pull the offending tooth?
Is there a such thing as palliative dental care?
She's on medicaid, so the costs is not an issue. I just want her comfortable for what time she has left.
Although we can't predict the future, I don't see a long one for my cousin. Her blood sugar and pressure are under control now, but she had very high levels for many years in which she refused to treat them.(Before the dementia and strokes.)
She can no longer walk and needs extensive assistance with all areas of her life, except for feeding herself. She has lost most of her memory and only knows me and my parents by name and I'm sure she really knows their names. At their last visit she never said their names.
She can't answer any question about date, time, season, age, etc. And has many delusions. She is convinced she works at the Memory Care Unit. Which is okay with me. She's very content. So that's what matters. She is bladder incontinent, trembling hands, poor hearing, osteoprosis, slow healing fractured spine and hand, and we are awaiting a biopsy from a lesion on her face. Her mom died from skin cancer.
So you can see why I just want her to have some peace with the time she has left.
I'm not sure how well she would sit for a cleaning. She's never liked dentists and I can anticipate some anxiety. We may have to give her a Xanax for that visit. I just have visions of him saying she has to come in every week for months to get fillings.
It's good to know she's covered if she has to have work though.
Check it out for any current updates, but I think cost is really not an issue.
Having basics like a thorough cleaning done would help prevent gum disease. My husband's dentitst never suggested advanced procedures, and if she had we would simply have declined.
Now I don't know how your loved one would react to sitting in a dental chair, holding her mouth open, etc. That might be a bigger issue than the cost. (A dentist who accepts Medicaid is probably compassionate and used to dealing with persons with dementia.)
If I were you I'd try it for a cleaning and to learn what else is recommended. You don't have to follow through on the recommendations if they don't make sense to you.
So, I'm going to see how she progresses and not try to create a problem that doesn't exist.
Thanks for your insight.