Different Strokes For Different Folks: Treatment Options For Those Living With One Of The Dementias
Submitted by Dr. Joy Poskozim DDS, FSCD, CDP
Founder of Joyful Dental Care – House Calls, Advocate, & Presenter
Geriatric House Call Dentist for over 15 years, Dr. Joy Poskozim speaks to Long-term Care Facility Administrators, Nursing Staff, Caregivers, and loved ones on the importance of oral health care as we age. Her goal is to share as much dental information as possible, thereby making it easier to communicate to traveling dentists on what oral health problems residents may have.
Having provided oral care for the geriatric community for over fifteen years, Joy understands medical conditions – and the subsequent issues revolving around them – supersede oral care.
Treating Those Living With Dementia Requires Individual Assessments
Same day, but look at the different needs for these people: one requires no blanket; one has a blanket down past their feet; and the third only has the blanket resting on their lap. Treating those living with the different types of dementia also have sub-categories as well. Here I will try to provide broad examples of who I work with in memory care and how I can help them – and their caregivers – achieve the best in oral health as possible.
My wanderers are a definite challenge when it comes to having them walk to their rooms to brush their teeth. These residents, I try to see right after lunch while they are still sitting, so I can guide them to their bathrooms. One action immediately followed by another action keeps everyone focused, let alone those in memory care.
Those who have become nonverbal are, of course, the hardest to communicate with. They require a lot of time and patience. I have found that asking them questions confuses them as they do not have the means anymore to respond, so talking to them, discussing “with” them, generally engages them to brush their teeth. This doesn’t mean they don’t know where their toothbrush is! I will still bring them into their bathroom and ask them to give me their toothbrush. If they reach for it, I will then ask for their toothpaste.
If they apply the toothpaste onto the toothbrush, it’s a win! If not, I will tell them what I am doing, show them, then do it for them, handing them the toothbrush.
If they brush their own teeth, most times I will brush their teeth after, or place my hand over theirs to continue the brushing of teeth.
Typically, Who Wants To Stay In Their Room and Why?
Generally speaking, those who prefer to stay in their rooms vs joining the others in activities are the ones who feel they need to maintain their independence. Some simply like to watch their daily TV programs they are used to. Others prefer the quiet. I tend to spend the most time with these residents, engaging in conversation. I truly want them to feel as comfortable with me as possible.
One time I spent about 20 minutes watching an old Cary Grant movie on TCM. What fun! It was a movie I had never seen before, but I am a true fan. I thoroughly enjoyed watching Arsenic and Old Lace while bringing the toothbrush to them, having them brush their teeth in front of the TV, etc. Achieving and feeling that connection allows for a better dental appointment, and I was able to see everything I needed to see in order to properly diagnose and treatment plan.
The social ones are usually so busy there is no time for me – even if they know I am coming! Another reason to see them immediately after breakfast or lunch, before they get into their morning/afternoon fun.
One particular resident would only allow me to remove her partial dentures to clean her mouth if we played a game of checkers first! A spouse of one of her floor mates had made her a better checkerboard table, so it was even more special to play with her. Gotta admit, in the beginning of our relationship, she usually won!
Having A Loved One Present During A Dental Exam Could Be A Plus Or A Minus
Having a loved one present can be good or bad, depending on the relationship between the patient and the family member. One resident, I got better results with in making her a new lower partial denture when her son was NOT there. Her son was a lovely, well-meaning man, but when he was in the room with us, my patient would always make a big fuss.
Having had a lower partial denture before, I delivered her new one while she was with her floor mates, watching I Love Lucy. She bit down and swallowed with it as if it had never left her mouth. Success! The Activities Director gave me a cookie for her to eat, and she had no problems doing so. I then let her son know when I left that he would see her at dinner with her lower partial denture in place.
Sometimes having a loved one present makes life so much easier for me. No matter how long I try to engage a resident’s trust in me, it is to no avail. A spouse, child or even a friend can make all the difference in the world, and we make sure to arrange a convenient time for both them and myself for a great dental appointment.
For those living with Alzheimer’s, I like the time between 10 am – 2 pm for their dental appointments. We all know for most, their Circadian rhythm is off, so taking care of them earlier in the day presents the best results in being able to achieve a full comprehensive exam, brushing teeth, and then following up with a cleaning.
Moving From Assisted Living To Memory Care
Having a resident move from AL to Memory Care sometimes feels like I am starting all over again in gaining trust and re-establishing a doctor-patient relationship. Most of the time they feel lost, confused, frustrated, overwhelmed, and defeated. Apathy for those living with Alzheimer’s begins to set in, along with the lack of desire for self-care, which includes oral health activities.
There is nothing worse for me than to have created a decent relationship with a resident only to find six months later that they have progressed into another stage of Alzheimer’s. For the staff, they have been seeing the daily struggle all along, but for me it is always harsh and hard to deal with. A new routine/regimen needs to be established, along with new staff. New Physician’s Orders need to be put into place, along with making sure my meds are still being ordered; 
fluoride toothpaste, for example. Of course I am NOT asking them if they remember me; I make the usually correct assumption that they don’t know me and so I introduce myself as if we have never met. Hard for me, great for them, and that is all that matters at the end of the day.
Most of my residents have some type of dementia, including Parkinson’s and vascular (stroke victims). Regardless of how my patients have gotten a form of dementia, the importance of their smiles reigns supreme.
Questions/comments? Never hesitate to reach out!
Submitted by Dr. Joy Poskozim DDS, FSCD, CDP
Founder of Joyful Dental Care – House Calls, Advocate, & Presenter
Geriatric House Call Dentist for over 15 years, Dr. Joy Poskozim speaks to Long-term Care Facility Administrators, Nursing Staff, Caregivers, and loved ones on the importance of oral health care as we age. Her goal is to share as much dental information as possible, thereby making it easier to communicate to traveling dentists on what oral health problems residents may have.
