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V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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She has moderate to late stage dementia, we really don't want to go with the Anesthesia, due to past experiences this has put her through. We are not sure she would allow or understand the Novocaine. Any advice?
Agree with Pam. Anesthesia with her dementia is not a good idea. Preferably a sedative that she has tolerated well before, possibly in a larger dose. Dr will advise not just the dentist involve her PCG
Hopefully, you are going to an oral surgeon, and not just a dentist!
My mom, with drug-induced dementia from anti-cholinergic meds, was unable to take sedatives. She also experienced significant pain due to joint problems. She'd already had an ankle fusion, both hips replaced, and one new knee. If not for it being age inappropriate, 93 at the time, she would have needed the other knee replaced as well as both shoulders. I couldn't stand to see her in even more pain and fear from worrying about AND having teeth removed. Fortunately, she'd had good experiences with oral surgery, so calm, matter of fact reminding her of that allowed what memory she had left to kick in and allay any fears.
In prior consultation with the OS, I explained her history and suggested that I dose her with her normal pain medication of acetaminophen + tramadol (she also could not take narcotics) along with her soma about 1/2 hour prior to surgery and ask if it would be acceptable that he use nitrous oxide. I asked the OS to please confer with her doctor if necessary. He felt that nitrous in addition to what she was already used to taking would work fine; that nitrous was relatively safe with virtually no side effects and, consequently, he did not feel he needed to conference with her doctor.
So, THAT is what ended up happening, and all went smoothly.
I am a dental hygienist an an educator in a dental school. There are several options. One is to take an anti anxiety medication before the appointment at home...most dentists prescribe Valium in low dose. The anesthetic injections ( they no longer use Novocaine) are perfect for extraction. and will wear off and not affect her mentally. You do not say why your concern so more info would be helpful. Is she easily frightened, combative? Nitrous oxide gas (known as laughing gas) is a wonderful sedative and the patient is awake but just sedated and the gas immediately is flushed out with 100% oxygen before she leaves. And therefore she is totally in control and no longer under any influence. I like others would advise against the general anesthetic. But I doubt that is what they would use. I would get an actual name (s) of what they would use as an anesthetic. It may be what is used for procedures like a colonoscopy. The doctor needs a full list of her medications before seeing her that day also. It would be nice if she had already met the doctor first as well.
My wife would not permit (she would push the dentist hand away) the dentist to inject novocaine. We found a dentist that used a IV sedation (using a certified anesthesiologist -not an MD). This procedure was approved by my wife's family doctor and her neurologist. We used this procedure when a tooth was removed. Also used at lesser time (15 minutes) for general cleaning every 4 months. It has worked fine without any negative results. While I would prefer the use of injected novocaine in lieu of the IV sedation, the need to keep her teeth in good condition ruled the day. Jim W.
Why put her through the trauma of a dental procedure? Unless the teeth have an absess, or they are painful, do not do anything. She has a terminal illness. Try to make her time left as pleasant as possible.
I was going to suggest Nitrous oxide gas as well. I agree with ferris1 that if the stage of dementia is advanced and pain isn't the issue it's best just to leave it alone. However, abscesses can be a problem. My mother-in-law needed surgery for that reason. They used a combination of local anesthetics and nitrous. Good luck making this decision. It's a tough one. Carol
I was concerned about a MRI on Mom's head but didn't think about the problems it would cause until the night before the procedure. Called the doc, first thing in the morning. She prescribed a very small dose of Ativan to relieve the anxiety and to just help relax my Mom. But, it was too close to her appointment time by the time it was called in to the pharmacy I was not able to pick it up. So, just decided to try the procedure without it. If there was a problem we would just try again another day. Fortunately, Mom handled it quite well and did not need to use the Ativan.
I would definitely avoid general anesthesia because of the problems it can cause and go with the nitrrous oxide. My concern would be if she would tolerate the mask.
I agree with ferris1, if her teeth are not hurting her, leave them alone. My fathers were really bad, but no pain. When we tried to explain he needed some removed he was upset for days, and I honestly don't think we could have gotten him to the office. We decided against removal, and he was fine.
If she can handle the procedure with only novocaine, that would be good. My wife could not, so the dentist used an IV similar to that used for a colon exam. She did fine and had no problem after the procedure. Problem is fining a dentist that uses the IV method. Be sure that her doc approves the method.
I would not use IV sedation in a regular dental office you need acess to emergency care. Remember what happened to Joan Rivers. if Mom tolerates regular dental visits she propbably will come to no harm with some oral sedation before you leave home and a local anesthetic.
I agree with combination of local anesthetics and nitrous with MD's involvement. Also, I suggest making sure she is not on aspirin or insaids for about 5 days before and after as they can cause excessive bleeding.
Many many oral surgeons use IV sedation, and that is indeed safe to do in an office. Do not let that worry you. Oral surgeons go through dental school (4 years) and a 4-5 year residency to become an Oral Surgeon. That is part of their training to learn IV sedation. They also carry emergency equipment in their offices. Like all procedures there can be issues or even negligence. Which is why we all sign a informed consent form.
Someone mentioned if the teeth aren't hurting leave them alone. Did you all know that any infection in the mouth has access to the entire body via the vessels that supply and drain the tooth? Therefore that same infection can affect the heart, brain, etc. You can get a fatal infection of the heart. Infections can also raise the level of CRP (C reactive protein) in the blood which can lead to strokes. So removing infected teeth with a poor prognosis, whether hurting or not is wise. One British study showed that the same bacteria that we find in periodontal disease (used to be called pyorrhea) can be found in the brains of people with Alzheimers. Our teeth are connected to the body. Ok...off my soapbox now. (can't help it, it's the dental educator in me)
I recently had to have two of Mama's teeth extracted as well. She has advanced dementia and due to a horrid irreversible issue with anesthesia during her last surgery for an ankle fracture, we did NOT want to use anesthesia...She is 90 and actually tolerated the procedure extremely well on just novacain (sp) she had to be transported by ambulance because she it totally bedfast but we were literally home within an hour from start to finish...it went great...had the teeth not been causing a problem, one of them abcessing, we would have most likely left them alone but the abcess caused such an infection that alone was causing major issues...but the procedure went fine.
I would avoid anesthesia at all cost...I went through the same procedure personally and it involved extensive cutting and tugging but they numbed it up with novocaine alone and I was fine.
They will numb the gums before putting in the local anesthesia and I have yet to see a dentist standing over me brandishing a syringe. They are usually very discreet and put a finger in the patients cheek so they don't feet the needle comming. having a trusted caregiver in the room to hold her hand and talk to her will help a lot. As well as discontinuing any asprin type products make sure she is not recieving any kind of blood thinner
I vote for "Harpcat".. She has the professional experience rather than individual suggestions from many caregivers.
I feel that "Harpcat" has an objective view and sounds the most logical.
Sonny ............................................................................... PLEASE RE-READ THIS FROM "HARPCAT"
Harpcat Give a Hug 13 hrs ago I am a dental hygienist an an educator in a dental school. There are several options. One is to take an anti anxiety medication before the appointment at home...most dentists prescribe Valium in low dose. The anesthetic injections ( they no longer use Novocaine) are perfect for extraction. and will wear off and not affect her mentally. You do not say why your concern so more info would be helpful. Is she easily frightened, combative? Nitrous oxide gas (known as laughing gas) is a wonderful sedative and the patient is awake but just sedated and the gas immediately is flushed out with 100% oxygen before she leaves. And therefore she is totally in control and no longer under any influence. I like others would advise against the general anesthetic. But I doubt that is what they would use. I would get an actual name (s) of what they would use as an anesthetic. It may be what is used for procedures like a colonoscopy. The doctor needs a full list of her medications before seeing her that day also. It would be nice if she had already met the doctor first as well.
I agree with what someone above said..the nitrous absolutely nothing for me either...whatever they use to numb it is all that my Mama needed and it went fine.
Sonny harpcat is a certified dental hygienist and educater and i absolutely agree with her advice. However she does not say she is experienced or educated in dementia care. I can still see many problems with putting a mask over a patients face to give nitrous oxide, It is likely to be very scary. I would also poimt out that however well educated an oral sugeon is he is not triained as an anesthesiologist which is the reason one needs to be present when an anesthetic is administered. all the emergency equipment in an office will be fine but it is far better to have the knowledge and training to know how to avoid the need to use it. iI stick with the view "better safe than sorry" no offence to harpcat or sonny
Harp kitty - thanks for sharing your pro experience.
For my mom, she did a thousands in spend down on dental and worth every penny. In addition to the health issues harpcat mentioned, I'd like to add what the nursing staff @ mom SNF told me: their being able to fork or hold food, to bite, chew, grind, swallow is central to their cognitive ability. There is a whole set of brain synapses at work in eating. You need healthy teeth & gums to do this.
For NH, staff quite frankly doesn't have the time to monitor or help with each residents brushing & flossing. They need to enter the NH with their teeth as tippy top good in shape as possible & as proactive in ability to brush daily on thier own too. NH dental care usually means those pink sponge tip disposable dental swabs at best.
Yes it's costly but an investment in your future good health.
I'm having the same issue, SIL on hospice, but she's better right now, her teeth have been an ongoing problem, she needs all of them removed, causing her extreme pain. Several appts to get them removed have had to be missed because she was hospitazed. She already has paid and has a whole set of dentures waiting. At this point unsure of WHAT to do about this
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
My mom, with drug-induced dementia from anti-cholinergic meds, was unable to take sedatives. She also experienced significant pain due to joint problems. She'd already had an ankle fusion, both hips replaced, and one new knee. If not for it being age inappropriate, 93 at the time, she would have needed the other knee replaced as well as both shoulders. I couldn't stand to see her in even more pain and fear from worrying about AND having teeth removed. Fortunately, she'd had good experiences with oral surgery, so calm, matter of fact reminding her of that allowed what memory she had left to kick in and allay any fears.
In prior consultation with the OS, I explained her history and suggested that I dose her with her normal pain medication of acetaminophen + tramadol (she also could not take narcotics) along with her soma about 1/2 hour prior to surgery and ask if it would be acceptable that he use nitrous oxide. I asked the OS to please confer with her doctor if necessary. He felt that nitrous in addition to what she was already used to taking would work fine; that nitrous was relatively safe with virtually no side effects and, consequently, he did not feel he needed to conference with her doctor.
So, THAT is what ended up happening, and all went smoothly.
While I would prefer the use of injected novocaine in lieu of the IV sedation, the need to keep her teeth in good condition ruled the day.
Jim W.
Carol
I would definitely avoid general anesthesia because of the problems it can cause and go with the nitrrous oxide. My concern would be if she would tolerate the mask.
I feel that "Harpcat" has an objective view and sounds the most logical.
Sonny
...............................................................................
PLEASE RE-READ THIS FROM "HARPCAT"
Harpcat
Give a Hug
13 hrs ago
I am a dental hygienist an an educator in a dental school. There are several options. One is to take an anti anxiety medication before the appointment at home...most dentists prescribe Valium in low dose. The anesthetic injections ( they no longer use Novocaine) are perfect for extraction. and will wear off and not affect her mentally. You do not say why your concern so more info would be helpful. Is she easily frightened, combative? Nitrous oxide gas (known as laughing gas) is a wonderful sedative and the patient is awake but just sedated and the gas immediately is flushed out with 100% oxygen before she leaves. And therefore she is totally in control and no longer under any influence. I like others would advise against the general anesthetic. But I doubt that is what they would use. I would get an actual name (s) of what they would use as an anesthetic. It may be what is used for procedures like a colonoscopy. The doctor needs a full list of her medications before seeing her that day also. It would be nice if she had already met the doctor first as well.
For my mom, she did a thousands in spend down on dental and worth every penny. In addition to the health issues harpcat mentioned, I'd like to add what the nursing staff @ mom SNF told me: their being able to fork or hold food, to bite, chew, grind, swallow is central to their cognitive ability. There is a whole set of brain synapses at work in eating. You need healthy teeth & gums to do this.
For NH, staff quite frankly doesn't have the time to monitor or help with each residents brushing & flossing. They need to enter the NH with their teeth as tippy top good in shape as possible & as proactive in ability to brush daily on thier own too. NH dental care usually means those pink sponge tip disposable dental swabs at best.
Yes it's costly but an investment in your future good health.