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Welcome to CareNotes. In this special section we will feature a reader's letter and provide an opportunity for an interactive exchange that will help find some answers and possible solutions to concerns. If you wish to respond to this letter, simple follow the link provided at the end of the letter and add your comments and thoughts to our CareNotes Board.

This Week's Carenote - 06/28/11

Hi Gary,
I get the FCG newsletter and really enjoy it.  Thanks for making available such an outstanding resource for caregivers.  Momma is almost 90 and has Alzheimer’s.  She'd brush her teeth and rinse out with mouthwash for a while.  Then she'd allow us to do it.  Now, she just bites down on the toothbrush and swallows the toothpaste and mouthwash.  We give her lots of liquids and fruit like apples and pears to crunch down on.  She still is eating well for the time being.  However, food is lodged in her teeth.  She needs a good cleaning.  She sometimes holds water/liquid in her mouth.  I believe she's trying to swish the liquid in her mouth to clean it.  I know it must be very uncomfortable for her.
I called her long-time dentist to find out if there was a special procedure for treating such patients.  He has no clue.  Her doctor didn't have a solution either; just trying to clean her teeth while she's medicated.  What does one do?  Can she be sedated and then have her teeth cleaned?  Is there is a specialty dentist out there that deals with this problem?  I'm sure it must be pretty common.  I can't believe we're the only ones going through this.
Any help would be most appreciated.

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Name: Kathleen
Location: Wisconsin
Date: 07/02/2011
Time: 07:24 PM


Forgot one thing, there is a dental society called Special Care Dentistry who can probably refer you to a dentist in your area. google Special Care Dentistry to get to their website.

Date: 06/28/2011
Time: 03:11 PM


We bought a water pik to help get the food out of mother's teeth when she stopped brushing anything but the front. Some times I'm soaked but she seems to enjoy the "squirt gun battle" Her dentist gave us those color tablets one uses for little kids to show them where they haven't brushed and she doesn't like purple or red spots on her teeth so letting me help her remove them works wonders. Good luck.

Name: Diana
Location: Alabama
Date: 06/28/2011
Time: 11:04 AM


Try this: Stand behind or beside your mother with toothbrush in your hand. Gently put her hand on top of yours and slowly brush teeth up and down. YOU will be brushing her teeth, but it will feel like and she will think she is doing it. This is a technique from Teepa Snow, dementia expert.

Name: Jennifer
Location: North Carolina
Date: 06/28/2011
Time: 10:20 AM


You might want to try Toothette Oral Swabs with Dentifrice - Mint Flavored - they might be a little easier to get in her mouth and you should be able to clean out a lot of the particles that are still in her mouth. Here are some other suggestions: Dental health care for Alzheimer’s patients Dental health problems in Alzheimer’s patients can lead to pain, unmanageable behavior and extensive dental treatment. Yet, the dental needs of Alzheimer’s patients are often overlooked, usually for very understandable reasons: the patient’s forgetfulness results in unintentional dental neglect; medications may cause chronic “dry mouth” (reduction in the healthy flow of saliva) that can lead to tooth decay; patients and their families lose contact with their dentist because they are focused on other health issues. Good dental health can make eating and digesting food easier for an Alzheimer’s patient, improving the overall quality of life. If you are a caregiver for someone suffering from Alzheimer’s, here are some tips and techniques from the Alzheimer’s Association to assist your loved one in maintaining good oral health. 1.Brush teeth twice a day. •To make teeth cleaning less of a chore, find a toothbrush that the patient can manage and that is also easy for you or other caregivers to use, if the person needs assistance. A powered toothbrush may be a good choice, if the patient can tolerate the vibrating sensation. (For more details about selecting a toothbrush, click here.) •If toothpaste makes the process more difficult, omit it. •Ask your dentist if the patient can use a fluoride gel or rinse to keep tooth enamel strong. 2.Floss teeth once a day. •A floss holder can make flossing easier for those who do not have good finger dexterity. Special picks and sticks make a good alternative if the patient clenches his or her teeth. •Ask your dentist about using an anti-microbial solution to protect the gums. 3.Clean mouth and dentures after every meal. •Some patients with Alzheimer’s do not swallow well. Clear the patient’s mouth of any remaining food and rinse after every meal. •Remove the patient’s dentures for cleaning after every meal. •Using a toothbrush with soft bristles, very gently brush the gums and roof of the patient’s mouth. 4.Visually inspect the patient’s teeth and gums once a month. •Ask the patient’s dentist about any trouble spots you should watch. •If gums bleed or appear swollen or red, the patient may have gum disease and will need to visit a dentist. 5.Schedule regular dentist visits (beginning with an Alzheimer’s diagnosis). •Maintain a current list of the patient’s medications for your dentist and all health care workers. •See a dentist as soon as possible if the patient has difficulty or pain while chewing or has bad breath. Source: Information courtesy of the Alzheimer’s Association, Northern California Chapter and David Blende, DDS, special needs dentist..

Name: Sonia Morrison
Location: Santa Cruz
Date: 06/28/2011
Time: 09:10 AM


Hi M, My first thoughts to assist you in your Alzheimer mother's mouth care are to use toxic free products and the other is to let her bite one toothbrush (or a tongue depressor) while using a second brush to clean her teeth. Hope this helps. The Heart of Caregiving author

Name: Michelle
Location: Fairfax VA
Date: 06/28/2011
Time: 07:03 AM


Hi,the holding food/ water in her mouth might be addressed by a speech therapist. They specialize in swallowing issues. To find a special needs dentist, try contacting a local nursing facility, they likely have a comsulting dentist who may know how to handle your mothers dental issues. Even if you don't use that dentist, he/she may be able to advise you on how Mom's dentist can approach her care most effectively.

Name: Kathy
Location: NH
Date: 06/28/2011
Time: 06:32 AM


You've probably tried this already. The only thing that helped with my Dad was to stand beside him in the bathroom with a tooth brush myself and pretent to brush my teeth and tell him to do what I was doing and it helped a little. There were other times when I gave him a facecloth with warm water and showed him to wash his teeth and that helped a few times.

Name: gail
Location: midwest
Date: 06/28/2011
Time: 05:57 AM


You're not the only one going thru this. call 1-800-dentist and ask for a referral to a dentist who might be able to handle it. Our dentist has a way of dealing with it, and gets the job done 3x a year. Also give her foods that cleanse the teeth, like fresh apple, carrots, etc. it's better than no attempt. Good luck. fyi- another challenge is getting eye exams for people like this. What we did was just get a new pair of glasses with the same prescription.



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