There will be a few parts of the body which I will not write about when speaking about dementia I promise. But the teeth are really important, and a few memories keep surfacing.
A family member was caring for years for her Hubby with Parkinson’s disease, cancer and dementia. No doubt she had little time to think about her own needs. When her Husband passed away a few years later, she fell into a deep state of dementia herself. The full-time caregiver they had hired, now focused solely on the wife. Within a very short time, Mrs. W’s (W is for wife…) teeth were giving her terrible problems. The family determined that she would be unable to tolerate all of the treatments required to receive a full mouth of implants, and all of her teeth were then pulled out by the dentist. It was ironic, and awful, because her father had been a dentist and she was so proud of her teeth in earlier years.
How did the situation become so bad? Many answers come to mind. One suspects that Mrs.W. did not pay much attention to her own health, as her husband’s issues were paramount for so many years. When the dementia later set in for her, it is likely that she neglected brushing her teeth. Unless her adult children arranged dental appointments, she surely would not have thought about doing so. One has no way of knowing if the care-giver on duty was vigilant about any of this. It is not always easy to get a person with dementia, to cooperate. Often one “gives-in” rather than fight every battle for concession.
In older people, neglecting the teeth can be very serious. An infected tooth left to fester, can bloom into an even more aggressive infection which could go to the heart. This has been known to be fatal. The patient may not identify the problem, or communicate the discomfort until it is too late. There are, sadly, dementia patients who cannot communicate at all. Someone needs to care, and to be sure such issues are not ignored.
On a lighter note, not long ago I accompanied Hubby to our family dentist. It was determined that quite a lot of work needed to be done, and Dr. D (D for Dentist), suggested that I might want to prioritize the work in order of importance as the costs would be substantial. We had two lengthy conversations about it. I determined which side of the mouth needed the work done without delay. That is the only work I authorized to begin on the next visit. When we returned a week later, we had our lovely aide with us and I was quite worn out – although I cannot recall why. I waited in the reception room as she took Hubby into the dentist’s office to begin the agreed-upon work. About an hour and a half later, they emerged. We scheduled another appointment to finish the crowns.
When we returned home, Hubby began complaining that the right side of his mouth was hurting him. I could not understand why, as it was the work on the left side which had been discussed and approved! I immediately called the dentist’s office only to discover that they had done all the preparations for a costly bridge which I had never approved. The work had indeed been done on the wrong side of the mouth! Upset is not an adequate word to describe my emotions. The first time that I did not stay glued to hubby during a medical procedure, everything went belly-up.
Dr. D. apologized profusely. Human error. He had forgotten our conversations completely and had not recorded our conclusions in the file. Dr. D. weakly suggested that he had mentioned which side of the mouth he would be working on to Hubby – who did not voice any objection. I exploded at the idea that he would consult with Hubby, with his cognition issues, rather than with me, sitting patiently in the waiting room only a few meters away. Our aide could not recall any such conversation.
It was hard to believe Hubby had endured so much pain and discomfort without the work ever being authorized. There was no option but to complete the procedure on the next visit. Dr. D. and I resolved the financial issues, which I appreciated greatly. Still, a month had passed and the correct side of the mouth which required immediate attention, had not yet been addressed.
The same dentist’s office called me this week to remind me of a cleaning appointment for Hubby and myself. Their plan was to have Hubby’s teeth cleaned first, and then for him to go into Dr. D. while I was having my own teeth cleaned. I went into panic mode when I realized that their office was planning to have Hubby in with Dr. D. without me in the room. The insanity of that idea overwhelmed me. They were treating Hubby like any other patient, fitting him into their appointment schedule. We simply cannot expect others to take our loved one’s condition into account. That is our job and neglecting it has enormous risks (as I have learned!)
The bottom line to all of these vignettes, is that the caregiver/spouse is no longer just in charge of their own health, but for that of another human being whom they love. When we are young and have children, we are really good at multi-tasking. That is, as they say…. “Why it is the young who should be parents…” The older we become, the harder it is to imagine the pitfalls that await even a simple decision, such as not sitting near the patient while the work was being done.
It was just one afternoon of relaxation in the dentist’s waiting room – an innocent, yet incredibly stupid indulgence. I think “They” would call it a one off! It will never happen again!
My grandmother of blessed memory always spoke of “They.” It deserved a capital “T” because she was paying homage to all the really smart, educated, wealthy people residing in her building in Florida. “What would They do???” “Which dress would They buy for the party?” Oh no! Have I unwittingly become my grandmother? I guess worse things could happen!