Sherry Mena knew something was wrong when her father-in-law stopped eating.
In December 2013, he refused food for several days, and woke one morning with a swollen cheek. He had an abscessed tooth and the family made an emergency dental appointment.
“I felt horrible [we didn’t realize it],” said Ms. Mena, who, along with her husband, had cared for the 72-year-old, who had Alzheimer’s, for a decade at their Barrie, Ont., home.
A trip to the dentist can be an ordeal for those with dementia, and challenging for the caregiver. Those in the early stages will remember dental visits: They may have a fear of drills, needles and the loss of control while tipped back in a chair, and your charge may become agitated when leaving for an appointment.
Dr. Wilhelm Oudshoorn, who treats elderly patients, some with Alzheimer’s and dementia, at Parkwood Hospital Dental Clinic in London, Ont., says music relaxes patients. “So I might sing an old Bing Crosby song…while I work. Gets amazing results. And no one has run out the door yet due to my bad singing.”
Dr. Oudshoorn says, though, that of all the strategies for dealing with cognitively impaired clients, number one is courtesy. All of his patients, he says, “respond favourably to patience, gentleness, clarity of speech, listening [and] paying attention.”
When your loved one is first diagnosed, tell your dentist that your relative has cognitive difficulties. Discuss the patient’s level of anxiety, possible behavioural problems, and explain that they may not be able to make it through the appointment and you may have to try again.
Once the appointment is booked, caregivers should let their mother or father know — but not too soon, says Keith Harrington, director of programs and services for the Alzheimer’s Association, Rochester & Finger Lakes Chapter in New York State.
He recommends purchasing a white board and writing the appointment on it the day before. “If you inform them too soon, they will start obsessing on it.”
Tips you can use right now
If a person is frightened by the clinical environment or instruments, such as the mouth mirror and drills on the tray, Ms. Schultz recommends bringing an iPod with music, or a comfort item such as a stuffed animal.
Tipping the dentist’s chair back can make a client feel insecure, so dentists and hygienists should keep it more upright during a procedure.
If the patient begins swinging their arms or exhibits other aggressive behaviour, ask the dentist or hygienist to stop the procedure, Ms. Timler says. Take a break and try again in a few minutes.
For those who might become agitated or put their hands up to prevent the specialist from looking into their mouth, Ms. Timler suggests bringing a blanket or sweater to help patients feel cozy and relaxed.
At some point, you may want to discuss tranquilizers or nitrous oxide with the doctor and the dentist.
Start early for the dental appointment, Mr. Harrington says. And book the time of day when they are at their best.
Lara Timler, a registered dental hygienist who teaches a geriatrics dental hygiene course at Fanshawe College in London, Ont., suggests the early afternoon, because people with dementia are “often up walking at night, and in the morning they and their caregivers are just exhausted.”
Managing the environment
Talk to the office manager to see if the dentist books blocks of time for those with cognitive difficulties. Dentists who specialize in geriatrics will set aside such specific times, and minimize distractions like TVS and radios, says Mary Schultz, director of education with the Alzheimer Society of Canada.
Dr. Rick Caldwell, who is also the head of the Ontario Dental Association, says the most important thing for those with Alzheimer’s is to keep their routine and environment the same. He will book a number of AD patients to come in at the same time, to minimize the disruption of new people.
“It’s very much like I would treat pediatric patients,” he says: Being more flexible with appointments, and taking time to explain each step to the patient–especially as the disease progresses.
When small strategies don’t work
Dr. Caldwell says that once you know that teeth need pulling or a root canal, get it done right away before the disease gets more serious. That said, “If extensive dental work cannot be tolerated in a [dental] chair, it’s better to be sedated.”
If so, caregivers should consider getting a few procedures done, so the patient doesn’t need to go under general anesthetic more than once. Ms.Timler cautions that “it’s a huge risk,” that needs to be weighed against the patient’s tolerance. “Typically that would be a doctor’s decision.”
Dental professionals who specialize in geriatric patients:
Halton region, Ontario https://www.halton.ca/cms/one.aspx?portalId=8310&pageId=10302
Dr. Saari, Cherryhhill Family Dentistry, London, Ont., drsaari.com
Dr. Wilhelm Oudshoorn, Parkview Hospital, London, Ont. www.sjhcccc.london.on.ca
Dr. Michael Mayer, Rochester, N.Y., mayerdental.com
For more info, go to:
(assisting people with middle or late-stage Alzheimer’s with personal care –includes dentistry)
(the Best Practices blog. It’s a U.S. personal care worker who provides lots of practical tips)
(info from Alzheimer’s Society in the U.K.)
(info from the U.S. Alzheimer’s organization, which has specific fact sheets about cleaning teeth and about going to the dentist).
Other links: Video
(This webinar gives caregivers ways to assist their family members with oral care, including if they have resistant behaviors.)
Allison Dunfield is a Toronto-based writer