I’ve never met someone who lives with dementia who hasn’t got a horror story or two about teeth or toenails. These small, but potentially troublesome bits of body can be a veritable nightmare when you’re caring for someone with dementia and they are usually the bits that the health and care systems don’t want to touch with a bargepole. If anything exemplifies the need for health and social care integration and a focus on prevention it has to be teeth and toenails. If you’re eating your breakfast, look away now. No I won’t use photos but the mental images are just as bad.
Teeth. The very thought of teeth and dementia makes my jaws clench. A lifetime of 6 monthly dental visits, hygienists and daily brushing and flossing counted for nought when dementia set in. Mum not only forgot to brush her teeth, but the 15 minute care slots in the morning and bedtime were just not long enough to even begin to tackle teeth, how could they be? Over a period of 3 or 4 years, those chocolate biscuits and the excessive amount of cake older people are fed all the time took their toll (see a future rant about cake and older years!).
By the time Mum got into the care home and a daily dental regime was put in place, the damage was well and truly done. Mum has had more fillings in these last few years than her whole life and then teeth started to fall out. She would be heart broken if she knew, she always brought us up to take care of our teeth. If we ever got to the stage of her needing all her teeth out (God forbid) false teeth are likely to be a problem – what if Mum can’t remember that she’s got false teeth and takes them out or gets a fright with them in?
It’s not vanity. An infection is a nightmare. It may get missed because people assume it’s just the dementia; if you’re living independently at home with dementia taking antibiotics correctly is unworkable (even with carer visits). You have to watch carefully for signs of pain whilst your loved one is eating – not conducive to a relaxing meal. All too easily a minor bit of tooth decay becomes something serious with a hospital visit looming at the end of it.
Our local dentists are great and know well how to support Mum, they really do epitomise person centred care. They explain what’s going to happen and explain what they’re doing as they do it. They are calm and very very patient. But what if something hurts and Mum asks them to stop mid treatment and won’t let them continue? As I’ve got power of attorney I’d have to decide about restraint, of my Mum. It doesn’t feel right. Luckily Mum knows exactly what to do when she gets in the dentist’s chair and she’s very good at doing what she’s told – it’s become one of our family jokes. What’s it going to be like for my and future generations when dentists are dealing with complicated things like implants, root canals and bridges.
A lot of carers I speak to have found their own dental health suffers along with everything else, creating a whole new generation of problems now and for our older years. I too have had more tooth problems as a carer than all through the rest of my life.
Toenails are another bugbear. They’re not physically or psychologically like finger nails. They’re often quite hard to cut, hard to reach and are tucked away from sight in socks and shoes. Folk are often embarrassed about their feet and a bit wary of who gets close to them (sometimes with good reason!). Toenails are fiddly and feet can be sore or tickle, toenail cutting becomes a skilled job. Unnoticed toenails can grow and start causing all sorts of problems from falls to cellulitis – both of which happened to Mum more than once. Yet again, A&E looms with all it brings with it.
Luckily Mum and I have survived another dental nightmare, thank goodness. Fingers crossed that’s it for now.