By Dr. M. David Tannenbaum, DMD
Special to Alzheimer's Weekly
Week of March 2 - March 8, 2008

My memories of treating nursing home patients as a young dentist were filled with a sense of being truly honored. I was spending time with people many years my senior who were responsible for shaping the world which we all inhabit.

On my first day of work in a nursing home as a young dentist, I found myself striding confidently into the home’s dental office eager to make a difference. I brought the first patient in, read the chart and asked her if she had any problems with her teeth. In a serious voice she replied "my teeth are too dark, can you make them whiter?" I approached her wheelchair, peeked in her mouth and was shocked to find that she had no natural teeth!

That patient taught me a lesson that I’ve never forgotten. Here was an elderly woman in terrible physical and mental condition who was nonetheless really concerned about her smile. School taught me dental care is important for good health, but real life taught me the crucial role of good dental care in preserving dignity.

Below follows a few brief tips on dental care for patients who are mentally compromised:

 Be exceptionally open to your dentist’s advice.

Caregivers and families need to take an earnest and sober look at their loved ones.  When a dentist does NOT want to treat a complex condition, it is usually wise to accept his recommendation for a number of reasons:

1. Dental treatment requires patient cooperation—a difficult proposition for elderly people who have lost much of their mental acuity.
2. Complex treatment needs someone to assume responsibility for it after completion. Someone must maintain the denture, filling or whatever treatment the dentist did. More than once I encountered roommates exchanging custom-fitted dentures (despite my writing their names on each denture), because no one on staff was responsible to keep an eye on dental work.

Insisting on having the dentist rehabilitate an entire mouth may be a difficult and even cruel thing to do to a patient with dementia.  Allow the dentist to make the call; he understands what the treatment and follow-up entail and is able to evaluate whether the patient is a suitable candidate for treatment.

 Understand the situation.

1. Professional healthcare staffs are often overburdened with loads of patients and may legitimately be unable to give your loved one complete care.
2. Even if staff has the time to devote to maintaining the good oral hygiene which is critical to good oral health, a patient suffering from dementia may not always cooperate.
3. Many of the medicines which seniors frequently take for other ailments may cause mouth dryness. Dry mouths do not have the requisite saliva needed to wash teeth and other oral tissues causing bad breath and damaging existing teeth.

 Take extra care to prevent denture loss.

A common and almost tragic problem in many Nursing Homes is denture loss. Some patients have been wearing the same dentures since the time gas was 42 cents a gallon! Then one day they are gone. Frantic searches are usually fruitless.

I remember my Alzheimer’s stricken Grandmother losing her dentures on the boardwalk. My Mom made us walk ignobly up and down the boardwalk asking people “Pardon me, did you see any teeth?” To this day my sisters and I are convinced that there’s a fish swimming off Rockaway Beach with a killer smile.

It is extremely difficult to fabricate replacement dentures with satisfactory results. Even new dentures with patient’s names etched inside frequently get lost. A common reason for the problem is patients leaving their teeth on the food tray which is cleared away and disposed of at the end of the meal. Caregivers and staff need to be extra careful at mealtime to ensure that the dentures are not lost.

 Deep Satisfaction

Elderly patients stricken with dementia present unique problems to the dentist and their families. It is particularly painful to see people of great accomplishment humbled by Alzheimer’s to the point that routine dental care is a huge challenge. It is deeply satisfying and rewarding helping an Alzheimer’s patient re-establish their level of dignity by restoring their smile.

I remember a denture on an elderly, Alzheimer’s-stricken patient. She had once been one of America’s leading chemists having worked on the first atomic bomb in the Manhattan Project. She was reduced to the point where following a simple instruction such as, “Open,” was a major victory. After restoring her smile with new dentures, she literally had tears of joy.

Here’s wishing everyone more satisfying moments and fewer frustrating ones when we care for our loved ones.

M. David Tannenbaum, D.M.D.

Ask Dr. Tannenbaum a question or leave/read comments:

Dignity & Dentists

Byline:

M. David Tannenbaum, D.M.D.
Special to Alzheimer's Weekly

Reviewed for medical accuracy by
Dr. B. Ancselovits, MD, Geriatrician, Alzheimer's Weekly

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