Oral Care for People With Dementia
00:00:02 – 00:05:01
Welcome to fading memories, a podcast with advice, wisdom, and hope, from caregivers who have lived the experience and survived to tell the tale. Think of us as your caregiver, best friend. Now you can join important Alzheimer’s disease research from home in minutes with picnic health. Go to picnic, health, dot com slash memories to sign up and get $25. What does picnic health? Well, picnic health collects and digitizes all of your medical records into one online account. Then you can consent to share anonymized data from your records with medical researchers. By examining this real world data from medical records, researchers can find answers that can’t be found in clinical trials. There is important information in each person’s unique healthcare journey. So share your story. If you care for someone with Alzheimer’s, you can sign up on their behalf and manage their medical records in a picnic health account. Learn more at picnic health dot com slash memories and get $25 when you sign up, find the link in our show notes and on our website. Oral care for people living with dementia presents unique challenges to their care partners. Imagine arranging for a dental house call because mom’s breath is horrible. Only to discover that she has dentures. This is just one of many fascinating stories. Today’s guest, doctor joy, shares with us. We discussed many practical tips for assisting our loved ones in oral care. Dental appointments and more. There’s an old saying about the eyes being the window to the soul, but the latest medical and dental search shows that the mouth is truly a window into one’s overall health, looking out for a loved one’s health means not only keeping an eye on their nutritional intake and physical capabilities, but also on their teeth and gums. This episode is full of laughs and great information, you won’t want to miss a minute. With me today is doctor Joyce, she is a dentist and she specializes in older adults. And she’s got some excellent stories and we’re going to talk about oral care in older adults and maybe the rest of us while we’re at it. So thanks for joining me, doctor joy. It’s a pleasure to be here. Thank you so much for having me. You’re welcome. So when we were laughing because joy’s 48 hours early and we’re discussing how all of us end up playing calendar roulette. So yeah, let’s be a typical day. You know when I make House calls, you never know. I mean, there might be a situation where, you know, unfortunately, someone might have to go to the hospital, or someone, you know, someone with someone who’s suffering from dementia might just be having a bad day. You know? So I mean, you know what happened. So yeah, calendar roulette can happen in one day, let alone one week. Yeah, this is what I think of one, two. I don’t know, it was like a fourth calendar change in 48 hours, but hey, that’s okay. I was telling doctor joy sway my husband really happy and that’s all that matters, right? So why don’t you start with your background and how you got into specializing in older adults and a dentist that does House calls? That’s a thing? Yeah, so you can play in my grandmother, or I can blame my grandmother. She needed a new lower partial denture. And was suffering from sciatica. So all she could do was stay at home. And I mean, children, grandchildren, eager willing to help. But, you know, suffice to say she felt like a burden. Let me truly did. And she didn’t want to pull us away from our own schedules and our own busy lives, right? So it was my dental assistant who suggested that we make the denture. And we do all the steps for the denture in the comfort of her own living room and we called it easy to dentistry. And it was fantastic because making a denture takes 5 steps, but it’s all palliative. It’s all impressions and trying, but there’s nothing invasive about it. It doesn’t matter if someone’s on blood thinners. It doesn’t matter. If someone, you know, can enter a dental officer not as long as we can take those impressions and do the steps that denture can be made quite easily. And adjusted quite easily in the comfort of their own room. So or home. So that’s what I did. And I inserted it on a Friday, and she went to church on Sunday, that’s the one place she went with church. And I got a frantic home phone call from her daughter, my aunt saying, oh my God, joy. I’m warning you right now.
00:05:01 – 00:10:01
She’s telling everyone you make House calls. And I’m like, oh my God. This was like a one off. But Merry Christmas Graham. You know, happy birthday, happy grandparents day. I love you so much. Wouldn’t you know it? I got a phone call the next day from a propel parishioner of hers. And it was a granddaughter and her grandmother had suffered a stroke two years prior. And was nonverbal. And she was a very formal woman. And always wanted to have her hair done and her makeup. And so they were continuing to do this for her, which I thought was so lovely. And one of the things they were continuing to do was brush your teeth. Except all of a sudden they started noticing a smell. And so they’re like Jack, if you could come over, well, I don’t know what to bring. I mean, this is literally the next day. So I brought what I thought was appropriate and it totally was because I didn’t need to clean anything because she didn’t have any teeth. She had dentures. And I have the daughter, the granddaughter and the rest of the family around this, and I told this story so many times, but it’s just suffice to say I mean this is the acme of what I deal with at a regular basis. I have the entire family surrounding this bed because this is a major arc of the family. And they’re beside themselves because they’ve been trying so hard to keep the quality of life as the way it used to be for her when she was before the stroke. Correct? And so I take a look at her, and I lift up her upper lip. And I see that it is her. It’s a denture. And so they couldn’t believe it. Take the dentures out. The smell was a little ripe. Unfortunately, had to prescribe an antifungal medication because she did suffer from denture stomatitis. And the family was beside themselves. Absolutely beside themselves. And after I showed them what to do and they were able to come up with a really good game plan for her to make sure that her oral environment, the mouth was healthy and on a daily basis and what to do with the dentures and all that stuff. I started thinking about this. This was not neglect. This is a situation where people are just not being educated on proper oral care. And, you know, the person was in a hospital, right? If they noticed at all that she was and the granite, these were gorgeous centuries. They were beautiful. She paid premo dollar for these dentures. They were very realistic. I mean, that was what she wanted, obviously. But the hospital never said anything. And we can’t expect the hospital to say things, right? So yes, number one. So, okay, fine. They didn’t say anything. They’re trying to get her stable. They want to get her home, right? That’s the hospital’s job, right? But it was a home healthcare agency that I wasn’t even in the business yet, and I had recognized the name. Never they never looked at the person’s mouth. Like how is this, how is this even possible? So that’s when I realized we don’t know what we don’t know. We have to take it upon ourselves to be advocates for our loved ones. And the residents in for those that work in nursing homes and assisted care facilities and skilled nursing facilities in rehab. And memory care facilities, we have to take it upon ourselves. Because there is no education when it comes to oral care. And so that’s why it’s so important that we know what’s going on in our loved one’s mouths. Ahead of time. While we can still communicate with them at early pre early stage, because when it gets to the point when they can no longer communicate with us, we don’t know if there is a problem or not until potentially, you know, it can become an abscess or swelling or something that really can be, well, and abscess can lead to sepsis. We’ll just leave it at that. It could become serious. It could become a medical problem. A dental issue that can be completely reversible can become a medical problem. So there you go. Also, the short takeaway would be. Don’t be so vain that you don’t tell people you have to tell your family that you have dead. That’s my Friends. ’cause I’m thinking, I mean, I could just imagine the gobsmack expression on their faces. Dentures? Just like. They didn’t believe me. Until I flipped them, it took them out of her mouth. You know, they did not. She said, no, they no, no, no, no, impossible, that’s impossible. And I went and I took them out and they were, I mean, beside themselves. But also, they felt so bad. They felt so bad that they felt that they had let their grandmother or their mother down, you know? She was a widow, so the husband was no longer around to say, no, this is what she has. So in the daughter was a medical POA, right? So she’s making all the medical decisions. Still had no idea what was going on in her mom’s mouth. It is there a way. I always took my mom to the dentist. That was fun. ’cause they got my parents had one of those postcards remind you of your dental upcoming dental appointment. This is back in March, 2017 and I had to call the dentist’s office and say, well, only mom will be coming because dad has passed away.
00:10:02 – 00:15:02
Yeah. And then I had to tell them this past year, 2020. So almost a little more than a past year. That we wouldn’t be accepting the April appointment because she passed away March 31st. It’s like, man, I’m always telling the dentist, my family member. Right? But ’cause I was also the medical POA. So I knew what was going on with mom. She didn’t have any dentures or any of that. She had crappy teeth, very chalky. She had to be kind of careful what she ate because you know those you know we’re recording this before Halloween. Those sugar daddies and those sticky candies, man. Those things popped her teeth out. Just so well. Cracked teeth. Yeah, she had. She had problems. But no dentures, but how would I as the POA have communicated learned what she had and communicated that properly? Because that sounds like a great question that I guess I didn’t have to deal with. Yeah, no, that’s absolutely fantastic. Find out who the dentist was. Impossible. Have a conversation, especially if they are the emergency contact. A lot of times, the emergency contact is a spouse. And a lot of times to the emergency contact is not updated. So it’s crucial for HIPAA purposes that you that the POA me I’m the medical POA as well, power of attorney that I am made the emergency contact and that way communication can be had and we don’t have to worry about HIPAA. We’re not breaching any legalities there. So even if so an early stage, you know, someone might be offended, right? But in this particular situation, you will be a breast made a breast of the situation of what’s going on in the mouth with the findings are what the current routine treatment is like, are they going every three months? Are they going every four months every 6 months? That is a great conversation to have with their current dentist. And if someone has been moved, you know, so now they’re closer to a loved one. It’s still relatively easy to find out. That being says something that you can do on your own accord is by having someone there with you to, you know, take a look in the mouth, you know, lift up that upper lip. Lower the lower left. Take a look and see what’s going on. If it’s getting to the point where they no longer can really say, I don’t really know. And it’s really important to be looking for things like a clasp to a partial denture that they might not have taken out in a while because it just feels so comfortable and it’s a part of them, but not really part of them, you know? So yeah, so yeah, so the situation like that to take a look around and have that conversation with them. Because it’s really important to make sure that they continue with good care regardless if they’re early mid stage, you know, end stage hospice, no matter what’s going on, you could continue good quality care. So would you advocate for a little bit of medical detectives? Like maybe go in the bathroom and see if there’s container for dentures. That’s okay. I’m like, not really sure what I’d be looking for, but I think I would know I mean I had braces in a retainer when I was a kid, so I kind of have an idea what I’d be looking for. Absolutely. If you’re the healthcare power of attorney, then you definitely need to make sure that you’re in contact with their dentist. So that’s a that was just a natural thing for me, but maybe that’s not, you know? Maybe we just gave somebody the oh duh, I need to take care of one more thing moment, which I’m sorry for adding to the list. Yeah, I apologize right now. But still, now aren’t you glad you know because now you don’t have to have that situation that joy told us about in the beginning ’cause seriously seriously. Glad we’re not recording this before meals. For sure. But yeah, absolutely looking into looking in the bathroom. It was a brilliant idea. You know, take a look around. Are they using a manual or an electric toothbrush? An electric toothbrush is something that they’re used to doing. You want to continue that until they potentially say no. But I’ve got some patients that are they welcome it. Do you know what I mean? And are you surprised? Let’s just put it this way. You’re surprised that they would. But it’s something they’ve been used to for the past 20 years. And so they have that memory that feeling of having an electric toothbrush in the mouth. Also looking at super kind of toothpaste to use, but kind of mouthwash they like. You know, that’s really important too. You want to continue to buy the same products. That’s what they’re used to. That’s what they like. That’s what they’ve chosen to have when they brush their teeth and clean our mouths. Continue to get it for them. That’s what they like. Also too, yeah, you want to be looking for those cases. It could be a little case like this. It could be really small like a retainer case, really thin. It depends. You can be looking in the drawers or the medicine cabinet, whatever to be looking for a case like that.
00:15:02 – 00:20:06
That is a really good sign that there is something there. And don’t be surprised if you shake it and there’s something in there. It might be also something that they just stopped wearing that they’ve chosen not to wear anymore. And you know what? I’m a firm believer in less is more. If they are eating okay if they are happy as a clam and you had no idea they had, let’s say, a lower partial denture, it’s not a big deal if they don’t wanna wear it anymore. I promise you, no dentist is gonna be like, you have to wear it. No. If they no longer want to wear it, that’s fine with me. Yeah, what about seriously? Let it go. Yeah. Well, you don’t want to be fighting with somebody with their mouth because you’re probably going to get bitten. You’ve probably experienced that. You know, actually, there are ways not to. And that’s one of the things I do educate this staff with in different facilities is how not to, because it’s really simple on how not to get bit. And there’s really easy ways that depending on the situation. So to show that, you know, even if the person is clenching, and if all we can do is brush the front of their teeth, that’s still a win. You know what I mean? We’re brushing 50% of these teeth. Do you know what I mean? Are we going to try to force this mouth open? Absolutely not. But if they’re clenching and they’re like, oh, go for it. There’s a lot of tooth here I can run. You know what I mean? Yeah, let’s get in there. Also, too, we want to be checking for hoarding, you know? We want to make sure they’re not holding any food on either side of their mouth. That’s also something that we can be looking for when we’re going side to side. And my hand is over here and their teeth are over there. And I’m not going to I’m not going to get hurt. But yeah, there were some really easy ways of the really easy techniques to be able to clean the teeth, clean the mouth and not get that. But that’s the number one fear that the most DNA have and caregivers have, for sure. Well, it’s not an unreasonable fear. No, absolutely not. Absolutely. The one thing that I’ve seen like demonstrated is to brush teeth together so that you’re doing your teeth and they can kind of mimic you. Yes. That’s probably better for early and maybe not early since but mid stages for sure. You know, it’s really good with that too. If I may interrupt. It’s really good to us now. You can also be watching them to see how well they brush. Can they find the toothbrush? Are they putting the toothpaste on the toothbrush? How much toothpaste? Are they putting on the toothbrush? Are they bringing it to their mouths? Or are they just running it underwater? I mean, it happens. You know, okay, so now they probably trigger them as are they really brushing, you know, maybe they’re only really brushing the right side. They never really make it to the left side now they’re done, right? So you can see what their technique is like. And then you can do a little tell show do. What do I mean by that? You know? I think that you didn’t brush your left side of your mouth. You know, let me show you how to brush the left side of your mouth. I’m gonna brush the upper left for you right now, and it could be hand over hand while you’re doing it with them. And you could be behind them to do it if you know if they’re in a wheelchair. You can be behind them and doing it. And you touch the outside and you show them what you’re going to be doing and then you do it. And then you touch the lower left and say, hey, and now I’m going to brush the lower left. Once again, hands out here, right? Can’t be hurting you. Brush down stairs over here and you’re Tapping the outside so you can let them know where you’re going to be going next. That is a really good way of helping them making sure that they’re brushing all their teeth. Not just in modeling or not just following what you’re doing, but also to make sure that they’re doing everything they should be doing in order to make sure all teeth are brushed. All areas are covered for sure. And if you’re standing behind and to the side of them, especially in later stage Alzheimer’s or dementia, they’re monocular vision sort of takes over and they don’t really see you. So if your hand is underneath their hand, guiding theirs, they might think they’re doing it. Yes. So that’s one thing I learned a few years ago from tip of snow and the hand underhand technique is really the most beneficial thing I think people could learn. Because you know, and I think it would be helpful with toddlers too because they’re at the same developmental stage. The kids are getting better, unfortunately, I loved ones are getting worse. And at some point, their developmental age is about the same. And so I think a very least you might as well try it with toddlers, right? And I will say to for caregivers out there and they’re just trying this out. Another thing that I’ve learned over the years is by being at eye level with them. So once again, if someone’s in a wheelchair, I’m kneeling down next to them so that we because we’re equal. We are still equals. And I want to be eye level with them. And also, once again, you know, if I’m doing with the hand over hand, either mine over there or there is over mine, or if I’m doing it for them, we are at the same level.
00:20:06 – 00:23:19
And I have found that to be so helpful and make it amazing results that way. Because and I’m able to I feel like I’m engaged with them. We have accomplished something. And it might be have to do it again the next day and again the next day. But you get to the, you know, you are achieving something that has not been achieved in the past. So that is huge. And you’re doing it in a positive way. And after a few attempts or not necessarily attempts. But for a few days, you will remember that that you’re at okay person. Yeah. And that’s what I tell the caregivers, too. Yep. I have a perfect example of that. My mom was in late stage, Alzheimer’s, my listeners know that we’d go to the park or wherever we’d go, we’d go kids. And we’d go watch children, which makes us sound creepy, but we weren’t creepy. And this one particular day, it happened to me, my wedding anniversary and we had come home from Colorado. Anybody that’s flown through Denver should know that you’re never going to get where you think you’re going to get when they say you will because Denver likes to screw that up. So kind of like that calendar we let we were talking about. So I got home later than normal. And I knew I was a little tired and I know I had known from experience that if I had to fuss with her to get her in and out of the car and from point a to point B it would be hard to keep my energy level up. So I preemptively decided we were just gonna bring our nice snack and I brought my wedding album that she had a lot of involvement in putting together. And when I showed up, she goes, oh, hi. Where are we going today? And I was like, oh, it’s freaking figure. So I’m like, seriously, you don’t even remember that I am your daughter. You think I’m your best friend, but you remember we go out all the time. It was just like, I was like, really? I mean, I felt good that she thought of me in such a positive way. I’m like, wow, see that as we go out all the time, but crap, why do you have to remember that today? Because they were not leafy. But that was, you know, that’s how I made her feel was like I was the fun friend that came and took her places to watch kids. And so if after, so that was September of 2019. So after, you know, two and a half years took a little while. You know, and they weren’t always positive experiences. So we’ll take two and a half years for them to understand something that you do daily. But yeah, if you, if you make sure to keep it positive, then they’ll be easier to do and yeah, so getting my mom tune from the dentist wasn’t too bad. She was actually pretty cooperative. The car ride was always a pain in the butt because she always wanted to know why her husband was not taking her. And one day it was so funny. She’s grumbling all the way from the care home to the dentist office. And she blah, blah, blah, complain complain complain. Her husband was just a lazy SOB, yada yada, and I’m like, no, he’s not. He’s gone, but I didn’t remind her of that. She looked at me and she goes, now he’s paying you to do this. Like, really, I wish