Dental Care for Dementia Patients

Recently, my dad went to an appointment with our family dentist without me. He's always had an easy time with dentists so I thought it would be ok to let him handle this one on his own. What could go wrong? I don't have to be there to moderate all of his appointments already, do I? Fast-forward to last night, and my phone rings. It's Dad, livid, once again.

"Well today has gone down the proverbial hole. Do you want to hear my story?", he asks. Of course I do. Dad proceeds to read me a letter sent to him by the dentist, and it goes something like this:

"A successful practice depends on mutual trust and respect between doctor and patient. In the absence of this, we regret to inform you that we can no longer treat you."

"I'm being blacklisted from the dentist and they won't tell me why!," he said. "I think it's because I declined the deep cleaning they recommended. Anyway, to heck with those people."

From my years of experience dealing with my aggressive dad, I immediately assumed that he got eighty-sixed over something he did or said, not because he declined their offer of a deep cleaning. Did he yell at somebody? Did he say something offensive (or god-forbid racist) to one of the staff? I told him I would call them in the morning to ask for more details but he said, "I already asked. They won't tell you anything. They'll just stonewall you like they did to me."

Deep Breath. Tell him he's probably right. Accept that his world and yours probably are not in alignment, and never will be.

When I called this morning, they confirmed my suspicions. Dad had acted aggressively to everybody in the office, challenging every treatment recommendation, challenging the costs of things (even though his insurance would pay for it), and he did it through clenched teeth, with a snarl in his voice, right in front of all the other patients. It's a behavior I've seen plenty of times. At the doctor's office. At the front desk of his senior living community. On the phone with his insurance company. As his dementia progresses, his ability to interpret reality loosens and he becomes confused about very straightforward things, and he jumps to the conclusion that someone must be taking advantage of him. The world becomes a scary place and unfortunately the only way he knows how to navigate it is by force. If reality doesn't match his expectations, he wants to yell at the manager. Like many people who come from privilege, he becomes the ultimate "Karen," but in his compromised state of mind he does it as a disservice to himself as well.

After apologizing profusely and telling the dentist that I completely understood, I asked for some recommendations. They recommended a geriatric dentist in our area who may be better equipped to deal with patients who suffer from dementia. Geriatric dentistry is a service I only recently discovered. Beyond just behavioral issues, patients with dementia are often no longer able to adequately care for their oral health and hygiene, and sometimes this can lead to catastrophic ends. A fellow caregiver I chatted with a few weeks ago shared the story of her care-recipient whose hygiene practices have become so bad his molars are beginning to rot. The dentist was unwilling to extract them because his poor hygiene habits ensured that the area would almost certainly become infected, and would very likely lead to serious infection or even death. The despair in her voice was palpable. It would appear that people suffering from dementia are at risk of dying from a multitude of self-care issues and I have to remind myself that my own dad's mental decline could lead to the swift onset of serious health problems, despite him being in relatively good physical shape.

Dementia is often accompanied by pronounced affective and behavioral disturbances, including depressed mood and aggressive behavior, both of which can complicate medical, including dental, treatment. In more advanced stages of dementia, patients may no longer be cognitively capable of understanding the need for medical or dental visits. In such cases, a relative, health care proxy or legal guardian must be involved, which increases the effort required for treatment and requires the scheduling of longer session times. (source)

Attending every appointment is a real burden for caregivers and if there is room in the budget for a house-call it could save you from having to take a full day off of work in order to transport your care-recipient to and from their appointment. Over 69% of providers in geriatric dentistry offer consultations in nursing homes, and 47% at the patients' homes (source). Although I'm sure this comes with a steep price tag, it may be worth considering if it will prevent catastrophic results down the road.

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For more information about dental care for people with dementia, check out this article on alz.org: https://www.alz.org/help-support/caregiving/daily-care/dental-care

and this wonderful podcast from the Alzheimers Disease Research Center, with guest Elisa Ghezzi, DDS, PhD: https://www.adrc.wisc.edu/dementia-matters/dentistry-and-dementia-importance-caring-oral-health