Going to the dentist can be highly stressful for anyone. For someone with dementia, it can be terrifying. There is a lot of worry-inducing, unfamiliar equipment, surgical-style implements, an antiseptic atmosphere, people in lab coats and masks: it is all very disconcerting, especially if one tends to have some paranoia. When deciding how, or whether to proceed with dental work, you will have to analyze what is possible, and whether it is viable.
Your own attitude affects the outcome too. If you have anxiety or discomfort about dentists, they can influence your loved one — many people have no fear about this whatsoever, but they will be strongly affected if they sense that you’re worried. People with Lewy Body Dementia can be remarkably aware of, and sensitive to facial expressions, body language, fidgeting, and other unspoken cues, in addition to what’s actually said. Make the experience as good as it can be by being as positive, light and calm as you can.
Dentists: Assess, Analyze and Advise Them In Advance
You may be able to find a great dental professional by contacting your local Alzheimer’s chapter, or a seniors group or a nursing home in your area. Hospitals frequently have well-equipped dental divisions that can handle almost anything, but for someone with mild LBD issues, it may provoke much more worry since hospital units often look like war-zone operating rooms with an intimidating array of surgical implements and devices.
Choose the dentist or dental surgeon very carefully and rigorously. You and your loved one have to be comfortable and confident with the experience. This can be affected by many elements:
- familiarity of dealing with cognitive and behavioural issues
- appearance and attitudes of the staff and specialist
- authenticity of their friendliness and smiles
- the appearance of the suite and comfort of the chair
- noise level of equipment and office
- degree of local accent and ease of understanding their voice
- volume of activity and passersby; location and distance
- familiarity or commonalities
- music and waiting room environment, etc.
All are valid points for analysis of whether you’ll be comfortable, and whether you’re likely to have a successful experience. Ensure that they are aware of all medications that are being administered in advance. For example, typical blood thinners can cause excessive or prolonged bleeding which can be very problematic, especially if there are swallowing problems.
If you have a specialist you’re already comfortable with and have been using for some time, contact them in advance and let them know that their client has developed Lewy Body Dementia, and give them information on what they should expect, and how they should prepare and behave.
Is The Dental Work Beneficial? Actually Required? Enquire Assertively.
Dentists often have planned frequencies for cleaning, filling replacement, whitening, etc. Be careful about what you decide to proceed with. Critically analyze if this is merely something that is recommended — but actually unnecessary — or vital. Much that is typically suggested is merely cosmetic, or because it would be done under normal circumstances. Often things are promoted only because they are highly profitable for the clinic. Only that which is vital should be acted upon. Be assertive, and question every recommendation on the basis of whether it is needed, and whether it will actually prevent or cure a serious problem.
Hygiene to prevent infections is vital. Cleaning and cavity repair is also necessary. Anything else should be investigated: ask what the benefits actually are, and what would happen if the work was not done, and when it might become a bigger issue.
Be conservative in your approach to dental surgery, extraction and procedures; be realistic about your expectations of success with dental appliances; only use a pre-screened specialist you’re comfortable with; and be rigorous in pursuit of regular dental exams and cleanings for both yourself, and anyone with dementia.
Provide Staff with Full Disclosure about Lewy Body Dementia
Tell the staff that your loved one has Lewy Body Dementia, and that they may behave unexpectedly. Here are some things you might want to advise them about.
The dental patient with LBD may:
- misuse words, leading to inappropriate responses
- imply, or act like they understand, when they do not
- be unresponsive to requests and commands from incomprehension
- have difficulty swallowing or spitting on command
- be stiff and have difficulty sitting up or directing spit to a basin
- react strongly to loud sounds, pokes and prodding
- need extra reassurance
- benefit from proximity to their loved one
- may need figurative, or literal hand holding, and
- have other unusual behaviours that may be unique to your particular situation.
What to Do Before and During Dental Work
When you’ve chosen your dentist, make sure they know what to expect, and what you expect.
There are many considerations, including the following:
- Decide whether you should let your loved one know an appointment is upcoming based on compassionate analysis. It may be better to say nothing, and then use a “fiblet” to diminish anxiety about an upcoming procedure.
- You should be able to be easily seen and in view of your loved one during the entire process, to add reassurance as needed. Remembering how to “spit” and being able to position themselves may be an unrealistic expectation.
- Extra care for suction to remove saliva and dental solutions will likely be needed to avoid swallowing/choking issues.
- The patient’s position may have to be more upright to avoid swallowing problems, which can be significant if they are reclined.
- Have the specialist clearly describe what they are doing — before they do it — throughout the appointment to make sure the patient is comfortable with what is going to happen.
- Advise the staff to be as calm as possible, and to use short, simple, easy to follow commands.
- Request more frequent breaks in the process than may normally be typical.
- Get tinted glasses so the work light does not blind them, but so they can still see if they want to (instead of using a blackout mask).
- Ask if they can play music during the process, and ask that any staff members outside the room be especially quiet and stop talking.
- Have them close the door if possible so that other voices are not distracting or upsetting
- Avoid all general anaesthetics if possible, but ensure enough local numbing is used.
- Ensure that any expected pain is provided for and able to be managed afterwards.
- Make sure that anything left in the mouth is accounted for: sometimes they will leave gauze in which can be a choking hazard.
Follow-up Care: Ask Questions And Avoid Post-procedure Problems
After a normal appointment, once the work is complete, dentists will normally just send you on your way with only a reminder to book your next appointment. This is unacceptable in many instances with LBD. Get specific information, and write it down to make sure you understand and remember it. Ask about any issues that may crop up such as pain, and what to do if it begins. If there is a new dental appliance such as a bridge, make sure they let you know whether this is temporary or permanent, when the permanent one will be available, and if there is any risk that it could come loose and be swallowed or choked upon. There are countless possibilities, so ensure that you impart to the dental staff that your case is unusual and you need full disclosure of potential complications to prevent other, greater complications.
Some people forget their anxiety about dental work when their memory is compromised, even people who were afraid of dentists all their life. And a great many dentists are highly caring, compassionate people who only want to do what’s best, and are very warm and reassuring — you might even find that your loved one enjoys the experience.
Our family has personally had some surprisingly good interactions with dental specialists. While having two teeth removed, two more ground to the gum line, and a bridge fitted, my mother enjoyed the many smiling faces of the hygienists and specialists and even fell asleep — and the entire event went very well, including the after-care. This was primarily because of the preparation and coaching we did in advance. The same can potentially be true for you. It’s worth a try!