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Husband moved to memory care 3 months ago. At the original assessment and subsequent and numerous meetings, discussions and phone calls I indicated he needed one-on-one cueing for showering and brushing his teeth. I even wrote out instructions for the caregivers on how to walk him through the brushing process. In 3 months his dental health has declined such that he now needs an intensive periodontal cleaning which is very expensive. He has never needed any periodontal work prior to his move to AL. The last dental exam shows that he is only doing the front teeth — my instructions show them the process for getting him to move the brush around the entire mouth. It is obvious to me that they are not following the procedure nor are they cueing him to do a complete job. The AL Director and social worker indicate that they are limited in how much they can do. I want to avoid further damage to his teeth. What options do I have and how should I proceed?

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My mother's dental hygienist told me that nursing homes never take care of their teeth. She used to visit her mother daily to help her clean her teeth and also helped her roommate. Mom loves clean teeth, but needs the mental prompt to remind her, just as your father does. Between my siblings and myself, Mom has a visitor daily to do so. However, not everyone can do that. I also printed an image of a chimp with a wide grin and added the text BRUSH YOUR TEETH at the top and I taped it to the corner of her mirror.
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Judy79 Dec 2019
I like the picture idea! Something for me to think about IF she isn't doing it at the new place...
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The RN at mom's nursing home tried to tell me that bleeding gums are normal 🙄.

It isn't realistic to expect staff to perform anything but the most cursory dental care, the reality is that they have many more people to look after than there is time allowed for. I went to mom's dentist and got a prescription mouthwash - because it was prescribed they had to comply - but after that things went back to the status quo. I then brought in a peroxide mouth wash (colgate I think) and cleaned mom's teeth whenever I was there, I figured once a day was better than nothing.
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I had the same problem with my mother, but she is 96 years old and has advanced dementia. She's now on soft foods, and needs to be fed. She is in hospice-type care, which means we do only things to keep her comfortable. She bites people if she doesn't like what they are doing, including tooth brushing. It wasn't worth fighting with her. We decided just to let it go. Every day I lower the bar...
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againx100 Dec 2019
That is sad but it makes sense that it is not worth fighting over many things when your mom is on hospice. Just keeping her comfortable is the key and at that point her oral health doesn't seem to rise to the highest level of priority any longer.
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They need to take over the job of brushing his teeth.
I suggest an electric toothbrush.
Discuss this with the care team possibly with the director at the next meeting you have. Do they have any options that would help facilitate proper oral care? How often do you visit? Is it possible that you could brush his teeth during your visits? I know it is not the way you want to spend your time when you visit. At least that way you will know it is being done that often.
I had the same "problem" when my Husband was in rehab, I brushed his teeth each morning I was there as well as shaving him.


Side note.
Your husband will at some point become non compliant at the dentist and an exam will be difficult.
Even at this point he may have to be given a light sedation for the periodontal cleaning. Most dementia patients do not do well with sedation. It takes a long time to get back to baseline "normal" for them if they get back. And as he declines even for a simple exam he may have to be sedated. It can be a vicious circle. When dental work is done it can hurt either from just a cleaning or if it comes to it extractions and trying to deal with open wounds in the mouth in a normal situation can be difficult but when a person has dementia the care of the open wounds can be more difficult. (and I bet the facility would not comply with what needs to be done so you are looking at the very good possibility of infections) I guess what I am saying is at some point you have to let go of "normal expectations" and while oral care is important it will not be at the top of the list as other things decline. (and as he eats softer food and pockets more it will get more difficult to brush the teeth, the focus will be getting the food out of the mouth to prevent aspiration not brushing the teeth)

By the way switch to a toothpaste that has no fluoride in it in case he swallows it. And if he is using a mouthwash switch to one that has no alcohol.
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againx100 Dec 2019
Excellent point re not fluoride in the toothpaste. There are many good ones out there.

I also agree with using an electric toothbrush.

And that you can not expect the staff to do a good cleaning of his teeth on a regular basis. Typically they seem to be understaffed and very busy.

Does anyone go visit him that can do it? Or hire an aide to come in and do it once a week?
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It could be he is not complying with aid instructions. Does the facility have a dentist that has rounds there?
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They can’t force him to brush his teeth the way you want him to. Have you tried helping him brush his teeth since he entered memory care? Perhaps he has declined and cannot brush his teeth. If that’s the case then I think the facility needs to change his care plan & use a diffferebr approach to cleaning his teeth!
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Does he use a good anti-plaque mouthwash? It might be easier to have them hand him the mouthwash in a small cup then cue him to rinse his mouth than to get him to brush his mouth properly. Might be less expensive (than the periodontal cleaning) to schedule an extra tooth cleaning(?)
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oskibear Dec 2019
He was using a mouthwash successfully for awhile, but began swallowing it so we stopped using it.
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It's difficult to ensure the quality of someone's teeth brushing, but, I had my LO's dentist write a prescription for her to brush her teeth daily AND to rinse twice a day with a plaque fighting mouth rinse. I taped the prescription over her nightstand, so, the attendants didn't forget to do it. This was to keep her from further decay and extractions, which has worked so far. I take the toothpaste and rinse to the MC, but, now that she is end stage, I don't think she has the ability to rinse anymore, even with assistance.
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I'm no dentist however seems kind of odd that his gums would deteriorate that quickly, usually takes years for this to happen.

I would talk to the director about this, perhaps they can change his care needs.
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superstring Dec 2019
Maybe not. My husband's dental care degenerated between two 6-month appointments with his hygienist, from "you are doing a great job" to "Oh, this is terrible" (from a hygienist with no bedside manner, obviously--we changed hygienists!) that's when we changed his appointment frequency to every 4 months and his caregivers took over at first helping him and now they do all his oral care.
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When you’re there can you make sure he brushes his teeth properly? This would at least give him regular good cleanings.
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