It’s hard to gauge how much pain Dad is in and he turns uncharacteristically aggressive
Dad has a bad tooth. It’s on his lower jaw at the front and is rotten. At least they think it is. For when the dentist who visits his care home tried to look, Dad refused to cooperate and was aggressive. It’s not surprising really. Of all the myriad social interactions we undertake regularly, letting someone poke around in your mouth is one of the more unnatural. Even without dementia, it takes a brisk inner voice saying it’s for our own good to get most of us into the dentist’s chair.
Dad doesn’t have any such insight, so it’s not surprising he kicked up a fuss. But the upshot was that the dentist recommended that the tooth be removed – not at his surgery, but under general anaesthetic in hospital.
One of the nurses from the home rang to tell me and to ask what the family’s view would be.
It’s not a straightforward decision. To the rest of us, the extraction of a decayed tooth might seem a necessary inconvenience, but for someone with dementia the pros and cons need to be weighed more carefully.
Obviously we don’t want Dad to be in unnecessary pain, but the question of whether he should leave the familiarity of his care home to have what amounts to a major assault on his frail body is one that is hard to answer.
So far we’ve been desperately avoiding any hospital admissions. Even after his recent mini-stroke, when he couldn’t eat properly, we were keen to keep him in what has become his home.
Yet there are few agonies worse than toothache – and how can we know how bad it is if he can’t articulate it?
This is a dilemma that many families will face. Dental care for people with dementia is not straightforward. In the earlier stages, when there is still a measure of independence, it might be all about reminding your relative to brush their teeth. Or to try to stop them brushing them 10 times a day if they keep forgetting they’ve done it all.
As the disease progresses, there’s the issue of not being able to communicate with the person about the level of pain they are feeling and having to decide on their behalf what is best.
Oral health is such a personal responsibility – and so fundamental. There is even a suggestion that it might help you to avoid getting dementia in the first place. Last year, a study found that people who keep their teeth healthy with regular brushing may have a lower risk of dementia later in life. It’s not clear whether the association is because people who go on to develop the disease are already showing signs of looking after themselves less well, rather than a direct cause and effect. But it certainly gives pause for thought.
Dad had problems with his teeth all his life. After losing his top ones in an accident as a child, he had to wear dentures. He was extremely self-conscious about them, only removing them last thing at night when the rest of us were all in bed.
Indeed, I’d never seen him without them until recently, when his carers decided that the battle to get them in wasn’t worth it any more. His sunken cheeks and gummy smile remain a shock. For the time being, we have decided not to have the problem tooth removed. The staff have judged that the pain relief he’s already taking probably makes the toothache tolerable, and they have been feeding him with a plastic spoon to reduce discomfort as he eats. I only hope they’re right – Dad can’t tell us after all.
• Follow Rebecca on Twitter @rebeccahelenley
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