Dentists - Alzheimer's - and a Catch-22

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May I vent, crab, bend your ear for a bit??
This may get long…

Some of you know that my dear wife has been battling Alzheimer’s dementia for some time now. She is, in an advanced stage of the disease and is, for all intents and purposes, bed bound though I am able to move her from bed to chair - living room to bedroom etc.
Interestingly - over the last few weeks / months she has shown some improvement in eating, level of activity, trying to talk etc. She reaches for things, smiles more, even gives me hugs and just seems to display an awareness that I hadn’t seen in some time. Naturally I’ve encouraged these things (especially hugs ;)).
I even entertain the idea that these things might be part of God’s plan - could he be granting us a healing? Most likely not…but one never knows does one. 🤷
I just try to trust Him and move forward…

Anyway - A new issue has come up…Teeth. a few months ago her one bridge came loose and I got her to the dentist and he was able to remove it. Now it looks as though she is having problems (with pain) on the other side of her mouth and I’m thinking that I might need to take her in again…but here’s the rub.
If I do this it will need to be for a cleaning, an evaluation and possibly one or two fillings or extractions - I just don’t know…and this will require an IV sedation (something her dentist does regularly). There is just no other way.
The problem is that elderly and dementia patients often do not recover well from such sedation. So - I’m presented with something of a "catch-22’…

If I don’t take her to the dentist, we’ll likely need to use some antibiotics for gum infections and pain-killers while her teeth slowly rot…but maybe she has a few more good months (or dare I say, years?) of lucidity - depending of course on the strength of the pain killers…
If I do take her to the dentist, We can get some things under control (fixed) so that she is much more comfortable for her time left…but the anesthesia might destroy the potential for “good months” and leave her completely “out of it”…and even send her spiraling down to her earthly end.

I want so much to do what is best…

Then there is the matter of the expense. I HATE that this is a factor, but it is. Our resources are very limited and such a procedure is not cheap. That said - her comfort is more important than the cash - but I know she would not want me to be left “broke” when she is gone - we always had a good understanding of each other and of our financial situation…

I guess that I find it hard to prioritize…Maybe I’m not trusting God enough in this…I just don’t know.

I’m posting this to maybe get some feedback from others who can be a bit more objective than I can.

Please do not feel restricted in your replies for fear of insulting me or sounding insensitive. End of life issues sometimes require tough choices and plain talk is appreciated. So jump right in with comments - questions - ideas - experiences - insights - whatever…Who knows what might prove useful…

Oh and one other thing…It has really bugged me over the years that I have not been able to find any good “non-brushing” type solutions for teeth care in such a case. For a while years ago, I gave her sugarless gum to chew and that was very useful, but that is no longer an option.
There needs to be something that can be swabbed, or sprayed into the mouth - safe to swallow that maybe foams a bit to get in the “nooks and crannys” and can clean and is also a mild antiseptic…Maybe such a thing exists…but I’ve never found it - and I’ve looked and I’ve talked to people even a pharmacist formulator…Nothing has come up…

Anyway -
Thanks for reading this rather long vent. Posting it on Sunday of a Holiday weekend might not have been the best choice to get feedback, but oh well…

God Bless us all

Peace
James
There is a huge market for such a product…
 
This is a tough one.

Do you have a medical specialist you can run this past?
 
“I have been and will be talking to my hospice contacts - in particular our home nurse - this week.”

Whatever happens, don’t beat yourself up over any bad results. You are doing your best under very difficult circumstances.
 
James,

First please know of my prayers for you and your wife.

Life with a hospice patient is hard. So many decisions to make. And wanting to make the Right one. :hug3:

Is there a way to have the immediate, painful, potentially harmful things taken care of, and leave the rest?

I guess what I mean is do what you need to to stop the infections and pain. But don’t worry about anything that won’t harm her in the next, let’s say, year. Cavities? Leave them. Infections? Treat those.

Does she have to be put out for the more easy treatments? Or would that be for just the extractions and the like?

I have heard of patients rallying before the end. But if this has been going on for months, it sounds like something different. But I can see your worry that treatment could harm her.
 
James,

I don’t know if this would help but …

If you were your wife and in her position, what choice would you want your husband to make?

You knew your wife before she became ill and how she was before this disease hit. Which choice is the one she would likely have chosen for herself?
 
maryjk said:
James,

First please know of my prayers for you and your wife.

Life with a hospice patient is hard. So many decisions to make. And wanting to make the Right one. :hug3:
Click to expand...
Thank you for your prayers. We’ve so many prayers said for us that God must be getting tired of hearing our names…😃
But while I certainly pray for a miracle of healing and restoration (I’m greedy that way), I really only want His will and what is best for my lady.

And yes - the decisions can be tough…especially when one is right on that “cusp” or tipping point.
Is there a way to have the immediate, painful, potentially harmful things taken care of, and leave the rest?
Click to expand...
I guess what I mean is do what you need to to stop the infections and pain. But don’t worry about anything that won’t harm her in the next, let’s say, year. Cavities? Leave them. Infections? Treat those.
Click to expand...
Does she have to be put out for the more easy treatments? Or would that be for just the extractions and the like?
Click to expand...
Well - we can likely get an antibiotic to deal with the infections and certainly we can use various drugs to control pain - so that is not a big deal other than for the potential side effects of the stronger pain killers. In this sense, I wonder which is worse…heavy pain meds (should it come to that) or the sedation…See? that catch 22 keeps popping up.

As for what might be thought of as immediately necessary and what can wait…That can be tricky too. It’s sort of like - if she needs to go in and be sedated then it’s probably better to do as much as we can in that one visit / sedation.

:juggle:…:hypno:…:banghead:…:gopray2:…repeat…
I have heard of patients rallying before the end. But if this has been going on for months, it sounds like something different. But I can see your worry that treatment could harm her.
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I think that part of the problem is that I wonder - how much am I trusting God and how much am I being selfish and fearful. Maybe that is why I posted this here. You guys are the only ones I can really turn to for good feedback that includes the spiritual aspects of the issue.

It could be that I am attributing more to her than what is actually occurring and as you say it is something of a rally before the final slide.
It could be that God has granted some healing signs and that I should act upon these with confidence and trust that, if this is a healing from God, the sedation will not harm her.
It could be that I am acting selfishly and out of fear of losing the last vestiges of my dearest lady - and instead allowing her to exist in pain.
It could be that I am just to “cheap” to spend the money - which in my mind is the worst of the possibilities - even though as I stated earlier finances are very tight.
But then again - with finances - there is that matter of trusting the Lord to provide…

I just don’t know…

Peace
James
 
AnneElizabeth said:
James,

I don’t know if this would help but …

If you were your wife and in her position, what choice would you want your husband to make?

You knew your wife before she became ill and how she was before this disease hit. Which choice is the one she would likely have chosen for herself?
Click to expand...
This is a very good question and one that I have tried to take into consideration - but even has not provided a clean answer.

As just a bit of background - Neither one of us were practicing Catholics when we courted and married. In fact she was closer to agnostic while I was more of a general spiritualist type but with a firm belief in the resurrection and the Gospel message.

Very early in our relationship (we weren’t even courting yet) she said that if she were ever diagnosed with dementia she would just end her life. After we fell in love and married, this never came up again and when she was diagnosed there was no question but that we would fight for whatever (cognitive) time was left. Shortly thereafter, we were able to return to the Church and sacraments (I needed an annulment) and so our outlook shifted a bit again…hence prayers for healing.

In the more specific realm of her teeth, she was always fastidious about them - regular check-ups and cleaning and whatever else was necessary - brushed morning and night - etc. In short she took very good care of her mouth. So I’m sure that there is a sense of “honoring” that outlook that also plays a small role in my psyche as well.

Ultimately - I know that she would want me to do whatever I think is best. She has always wanted the best for me and I for her - I know that she would not fault me for whatever decision I make.

So - like with some of the other avenues I explored - so far it has just led me in a circle.

🤷

Peace
James
 
Oh, James,…

A couple things that could help… (Not sure if it could help in your case, but I know it helped me when I couldn’t afford dental bills for the moment and had a cavity.)
Code: 
Peppermint tea is good as a natural antiseptic.   It might help if you could swab that inside her mouth and especially around the area in which three is infection.   I did this for a whole year and was able to stave off infection for a while- gave me some time and relief as the peppermint helped numb the pain too.  The instructions I was given was to steep a bag of peppermint tea in some hot water then (when it cooled enough not to burn my mouth) fold the bag and place it inside my mouth where the infection/cavity is.
I had another thing to mention, but I forgot… sorry! My nephew is visiting and is wanting my help right now. If I remember I will post it later.
Hope this helps some James. God Bless you.
 
AnneElizabeth said:
Oh, James,…

A couple things that could help… (Not sure if it could help in your case, but I know it helped me when I couldn’t afford dental bills for the moment and had a cavity.)
Code: 
Peppermint tea is good as a natural antiseptic.   It might help if you could swab that inside her mouth and especially around the area in which three is infection.   I did this for a whole year and was able to stave off infection for a while- gave me some time and relief as the peppermint helped numb the pain too.  The instructions I was given was to steep a bag of peppermint tea in some hot water then (when it cooled enough not to burn my mouth) fold the bag and place it inside my mouth where the infection/cavity is.
Click to expand...
Interesting. I hadn’t heard of that.
Unfortunately in our case…she would try to eat the bag.

The swabbing idea is a good one though. Right now we are using sponge swabs. and alcohol free mouthwash (Crest Pro-Health multi protection).
I had another thing to mention, but I forgot… sorry! My nephew is visiting and is wanting my help right now. If I remember I will post it later.
Click to expand...
Code: 
 Hope this helps some James.    God Bless you.
Click to expand...
Now you sound like me…and I don’t even need a nephew to distract me…😃

Peace
James
 
I have absolutely no advice.

Do your best springs to mind… but I think what you want is the knowledge or certainty that you are doing your BEST.

However, there’s no great outcome here, and probably no miracles either.

I suppose it comes down to what is best for your dear wife, rather than what is best for you.

Is there no Alzheimer support group or someone in the parish you could talk to?

You, and your wife, have my prayers.
 
As a dentist I’ve seen a number of patients with Alzheimer’s. I haven’t seen anyone as a advanced as your wife. I would suggest that you have your dentist and her primary care physician work together to find a treatment plan that will be both safe and beneficial to her.

Unfortunately, plaque can only be removed manually. There are tooth wipes. Using them isn’t ideal, but it’s better than nothing if she’ll allow you to use them

Both of you are in my thoughts and prayers.
 
Hi JRKH,
I wonder if there is a dental school in your area which might provide charity care? Oftentimes, such schools provide services at reduced rates and work is done under the supervision of professors, or by the professors themselves as a demonstration.
Perhaps other posters will have ideas about other charities which might be able to provide funding?
May God bless you and your lady. Amen.
 
Hi.

I’m diabetic (four needles a day), and prone to gum disease – a lot of the bone where my incisors are is destroyed, the only thing holding my left upper in place is the gum and a splint to the adjoining tooth.

One of the things my dentist and my hygienist advised was swishing the area with warm salt water. It’s good for fighting infections. I’ve managed to keep infections at bay so far for three years.

I also use these tiny interdental brushes to get the goop out from between my teeth; the action also stimulates blood flow to the gums.

Between the two, I’ve actually seen some recovery of my receding gums – which is cool, since I would have considered a stalemate to be in the “win” column.

Major prayers for you, too.

Hope some of this helps.
 
It is very difficult and I can only offer my prayers and suggest to keep praying as I do for my mother. I don’t believe God ever tires of hearing our prayers. Remember that because you love and cherish your wife, any decision you make is made from love. As God is love, you will not be making your decision alone.

God bless you both.
 
triumphguy said:
I have absolutely no advice.

Do your best springs to mind… but I think what you want is the knowledge or certainty that you are doing your BEST.

However, there’s no great outcome here, and probably no miracles either.

I suppose it comes down to what is best for your dear wife, rather than what is best for you.

Is there no Alzheimer support group or someone in the parish you could talk to?

You, and your wife, have my prayers.
Click to expand...
TG,
In truth, I do not lack for people to talk to. Our hospice care is excellent with a nurse and a case worker, an in patient unit for acute or respite care, as well as home care aides etc. I also have family I can talk with (my dad died of Alzheimer’s in 2006). Then, of course, there is my CAF family…

You are of course right what is best for her is what is best.
maltmom said:
As a dentist I’ve seen a number of patients with Alzheimer’s. I haven’t seen anyone as a advanced as your wife. I would suggest that you have your dentist and her primary care physician work together to find a treatment plan that will be both safe and beneficial to her.

Unfortunately, plaque can only be removed manually. There are tooth wipes. Using them isn’t ideal, but it’s better than nothing if she’ll allow you to use them

Both of you are in my thoughts and prayers.
Click to expand...
Maltmom,
Thanks for posting - it’s certainly nice to have the (name removed by moderator)ut of someone in the field.
Indeed the DDS and PC will have to coordinate (with hospice) since it would be necessary to sedate my lady for any procedures - including a good cleaning and evaluation. Our Dentist is one of the few in the area to offer the IV sedation option (Advertized mainly for people who are afraid of dentists) and thankfully this is the same dentist she had been seeing all along so he is very familiar with her and her mouth.
As you can imagine, x rays are pretty much out of the question at this point. 😉 So I count this familiarity (and records etc) as a real blessing.

I’ve not heard of the"tooth wipes"…sounds like an interesting idea - if I can keep from getting bit. 😃
jeannetherese said:
Hi JRKH,
I wonder if there is a dental school in your area which might provide charity care? Oftentimes, such schools provide services at reduced rates and work is done under the supervision of professors, or by the professors themselves as a demonstration.
Perhaps other posters will have ideas about other charities which might be able to provide funding?
May God bless you and your lady. Amen.
Click to expand...
Jean - such a option would be a good one under circumstances of normal health but I think it unlikely that such a place would be willing to cater to our special needs at this time.
I do appreciate teh (name removed by moderator)ut though…

Peace
James
 
John_Lazarus said:
Hi.

I’m diabetic (four needles a day), and prone to gum disease – a lot of the bone where my incisors are is destroyed, the only thing holding my left upper in place is the gum and a splint to the adjoining tooth.

One of the things my dentist and my hygienist advised was swishing the area with warm salt water. It’s good for fighting infections. I’ve managed to keep infections at bay so far for three years.

I also use these tiny interdental brushes to get the goop out from between my teeth; the action also stimulates blood flow to the gums.

Between the two, I’ve actually seen some recovery of my receding gums – which is cool, since I would have considered a stalemate to be in the “win” column.

Major prayers for you, too.

Hope some of this helps.
Click to expand...
Of course “swishing” is simply not something we do…Anything going into the mouth is swallowed. 🤷
The “tiny brushes” sounds interesting…but there again - the issue of her allowing me to do the work comes in.

Thankfully when I swabbed her teeth this AM there was no blood and her gums look much improved.

Peace
James
 
JRKH said:
Maltmom,
Thanks for posting - it’s certainly nice to have the (name removed by moderator)ut of someone in the field.
Indeed the DDS and PC will have to coordinate (with hospice) since it would be necessary to sedate my lady for any procedures - including a good cleaning and evaluation. Our Dentist is one of the few in the area to offer the IV sedation option (Advertized mainly for people who are afraid of dentists) and thankfully this is the same dentist she had been seeing all along so he is very familiar with her and her mouth.
As you can imagine, x rays are pretty much out of the question at this point. 😉 So I count this familiarity (and records etc) as a real blessing.

I’ve not heard of the"tooth wipes"…sounds like an interesting idea - if I can keep from getting bit. 😃
Click to expand...
You’re welcome! I’m going to send a private message to you about the tooth wipes.
 
JRKH said:
…Teeth. a few months ago her one bridge came loose and I got her to the dentist and he was able to remove it. Now it looks as though she is having problems (with pain) on the other side of her mouth and I’m thinking that I might need to take her in again…but here’s the rub.
If I do this it will need to be for a cleaning, an evaluation and possibly one or two fillings or extractions - I just don’t know…and this will require an IV sedation (something her dentist does regularly). There is just no other way.
The problem is that elderly and dementia patients often do not recover well from such sedation. So - I’m presented with something of a "catch-22’…

If I don’t take her to the dentist, we’ll likely need to use some antibiotics for gum infections and pain-killers while her teeth slowly rot…but maybe she has a few more good months (or dare I say, years?) of lucidity - depending of course on the strength of the pain killers…
If I do take her to the dentist, We can get some things under control (fixed) so that she is much more comfortable for her time left…but the anesthesia might destroy the potential for “good months” and leave her completely “out of it”…and even send her spiraling down to her earthly end…
Click to expand...
Just as I wouldn’t diagnose all the options for medical care on my own, I wouldn’t assume to know everything that might be done in a dental situation. Having said that, the likelihood is that dental problems themselves could speed her mental decline, and not just make her uncomfortable. As you know, too, just having constant pain can do a number on anyone’s mental status. You don’t think as clearly when constant irritation or pain has you mentally exhausted.

Contact your local chapter of the Alzheimer’s Association. They may have a list of local dentists that special in the care of geriatric and dementia patients, such as this one for the St. Louis area.
alz.org/stl/documents/stlreportdentist.pdf

(What does her geriatric doc say?)
 
JRKH said:
May I vent, crab, bend your ear for a bit??
This may get long…

Some of you know that my dear wife has been battling Alzheimer’s dementia for some time now. She is, in an advanced stage of the disease and is, for all intents and purposes, bed bound though I am able to move her from bed to chair - living room to bedroom etc.
Interestingly - over the last few weeks / months she has shown some improvement in eating, level of activity, trying to talk etc. She reaches for things, smiles more, even gives me hugs and just seems to display an awareness that I hadn’t seen in some time. Naturally I’ve encouraged these things (especially hugs ;)).
I even entertain the idea that these things might be part of God’s plan - could he be granting us a healing? Most likely not…but one never knows does one. 🤷
I just try to trust Him and move forward…

Anyway - A new issue has come up…Teeth. a few months ago her one bridge came loose and I got her to the dentist and he was able to remove it. Now it looks as though she is having problems (with pain) on the other side of her mouth and I’m thinking that I might need to take her in again…but here’s the rub.
If I do this it will need to be for a cleaning, an evaluation and possibly one or two fillings or extractions - I just don’t know…and this will require an IV sedation (something her dentist does regularly). There is just no other way.
The problem is that elderly and dementia patients often do not recover well from such sedation. So - I’m presented with something of a "catch-22’…

If I don’t take her to the dentist, we’ll likely need to use some antibiotics for gum infections and pain-killers while her teeth slowly rot…but maybe she has a few more good months (or dare I say, years?) of lucidity - depending of course on the strength of the pain killers…
If I do take her to the dentist, We can get some things under control (fixed) so that she is much more comfortable for her time left…but the anesthesia might destroy the potential for “good months” and leave her completely “out of it”…and even send her spiraling down to her earthly end.

I want so much to do what is best…

Then there is the matter of the expense. I HATE that this is a factor, but it is. Our resources are very limited and such a procedure is not cheap. That said - her comfort is more important than the cash - but I know she would not want me to be left “broke” when she is gone - we always had a good understanding of each other and of our financial situation…

I guess that I find it hard to prioritize…Maybe I’m not trusting God enough in this…I just don’t know.

I’m posting this to maybe get some feedback from others who can be a bit more objective than I can.

Please do not feel restricted in your replies for fear of insulting me or sounding insensitive. End of life issues sometimes require tough choices and plain talk is appreciated. So jump right in with comments - questions - ideas - experiences - insights - whatever…Who knows what might prove useful…

Oh and one other thing…It has really bugged me over the years that I have not been able to find any good “non-brushing” type solutions for teeth care in such a case. For a while years ago, I gave her sugarless gum to chew and that was very useful, but that is no longer an option.
There needs to be something that can be swabbed, or sprayed into the mouth - safe to swallow that maybe foams a bit to get in the “nooks and crannys” and can clean and is also a mild antiseptic…Maybe such a thing exists…but I’ve never found it - and I’ve looked and I’ve talked to people even a pharmacist formulator…Nothing has come up…

Anyway -
Thanks for reading this rather long vent. Posting it on Sunday of a Holiday weekend might not have been the best choice to get feedback, but oh well…

God Bless us all

Peace
James
There is a huge market for such a product…
Click to expand...
In his own last days my Dad was using Crest non-alcoholic mouthwash (comes in a pink bottle). Do you have that available to you? I think it’s non-toxic … I mean obviously you don’t want her drinking it in large cupfuls, but small amounts at a time could be helpful?
 
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