Oral Health, Aging, and Caregiving with Dr. Natalie Whitaker, DDS, MNutr, Whitaker Dental Associates

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[00:00:44] Welcome to the Caregiver Community.

[00:00:46] This is a place where we talk about the joys and the challenges of caring for our aging parents and loved ones,

[00:00:53] as well as caring for ourselves.

[00:00:55] I have Brantys Hall, founder and executive director of ACAP, adult children of aging parents.

[00:01:01] In this podcast we are talking about oral health, aging and caregiving.

[00:01:07] I am delighted to be joined by Dr. Natalie Whitaker, a dentist and a nutritionist.

[00:01:13] Dr. Whitaker graduated in 2004 from UNC that's University of North Carolina Chapel Hill School of Dentistry

[00:01:21] and has worked in private practice since then.

[00:01:25] Prompted by her own health issues. She also obtained a master's in nutrition degree in 2012,

[00:01:32] which propelled her into the world of all things, elder and wellness.

[00:01:37] She currently lives with her family and more into North Carolina and enjoys private practice,

[00:01:43] which allows for to engage with people in all walks of life and at all stages of life.

[00:01:48] Dr. Whitaker, thank you so much for being with us today to talk about such an important topic.

[00:01:56] Thank you.

[00:01:57] Thank you for having me.

[00:01:59] Absolutely. This is a topic that we wanted to talk about for a while.

[00:02:05] So I'm really glad that we're going to do this.

[00:02:09] There is a whole lot that we can talk about.

[00:02:14] I think that most of us really don't understand how really important oral health is and tender care is, particularly as we get older.

[00:02:26] So let me kind of start with the basics.

[00:02:29] What are some of the biggest challenges with oral health as we age?

[00:02:35] One of the biggest challenges that I see on a daily basis.

[00:02:38] And it primarily is as people age is dry mouth.

[00:02:45] And it's such a debilitating thing for people to have to experience.

[00:02:50] A lot of times it comes from just necessary medications.

[00:02:55] Like if you look at the side effects of any medication that you're taking,

[00:02:58] usually one of the top three things is dry mouth.

[00:03:01] And then if you layer three or four different kinds of medications on top of each other,

[00:03:06] it's only going to compound the issue.

[00:03:10] So that's one of the issues that I see.

[00:03:14] Also like low grade dehydration because as we age, our thirst response naturally decreases.

[00:03:22] So not only do we have a dry mouth, we don't have enough water in our system to fuel our salivary glands.

[00:03:31] And if there are already at a diminished capacity, it's just kind of a perfect storm for issues.

[00:03:37] Another thing that I see a lot of times is because of that dryness, we'll have sores like burning mouth syndrome.

[00:03:46] Sometimes there will be ulcers that creep up things like that are just painful.

[00:03:53] And they take a little bit longer to heal because of the diminished capacity to heal as we age.

[00:04:00] And that's frustrating for people in myself.

[00:04:03] I mean, I really don't want people to be in pain.

[00:04:06] Then parodonal disease is something that I see and that's where essentially the bone kind of melts away from the teeth.

[00:04:15] And then it just makes the teeth longer and longer teeth in the mouth make them more susceptible to decay.

[00:04:19] So that's another issue that we have to kind of take in consideration.

[00:04:27] Another challenge is manual dexterity.

[00:04:30] So there's decreased manual dexterity as some people age whether it's because of arthritis or what other reasons for that.

[00:04:40] And you know, when you can't properly clean your teeth with the tools that you have because your hands don't work the way that they need to.

[00:04:47] That's a that's a significant challenge.

[00:04:52] So it's something that I really understand but go back to the very first one dry mouth.

[00:04:58] These eyes just you know that being maybe sometimes uncomfortable.

[00:05:04] What is the what's the real issue with dry mouth?

[00:05:09] Well, the consequences are dry mouth.

[00:05:11] So the bacterial composition and the mouth can change and that can make you more susceptible to decay.

[00:05:19] So saliva is incredibly important for a couple of things or a couple of reasons.

[00:05:25] One, it has an enzyme in it that starts your digestive process.

[00:05:30] So you need that enzyme to properly start carbohydrate metabolism.

[00:05:34] So there's that saliva also lubricates the tissues in your mouth.

[00:05:40] So that's important.

[00:05:42] But it also buffers any kind of acidic exposure that you have.

[00:05:48] And with increased acidity, you have an increased risk of cavities.

[00:05:53] So and then we know cavities can lead to infections and then infections on and on and on.

[00:05:58] So that's why saliva is critically important adequate saliva is critically important for oral health.

[00:06:08] And saliva is directly related to water or fluid intake.

[00:06:13] Yeah, it can be I mean absolutely.

[00:06:15] I mean it's just like if you're if your lips are chapped that's or if your lips are dry that's like a secondary sign of dehydration like low grade dehydration.

[00:06:26] So it's the same thing with your skin like if your skin is dry, you know, then you need to increase your water intake.

[00:06:32] And plain water is important and we look at, you know, like flavor additives and things like that and that's okay.

[00:06:39] If that's the only way you can get water in your system.

[00:06:42] But if if you can focus on a little bit more plain water throughout the day,

[00:06:46] then that can only help increase your ability to produce saliva.

[00:06:52] Okay, so as a daughter of a mother who thought literally if she drank four ounces of water in a day that she was just like nagging it out the ball.

[00:07:05] Do you have any suggestions because a sort of a universal issue for those of us who are caring for advocating for an older dog.

[00:07:18] What are the universal issues is trying to get people to drink, trying to get our luck one to drink water particularly, you know, the thing of all I even grow up drinking water I buy.

[00:07:30] Do you have any suggestions as to how to get people to drink water in particular.

[00:07:39] That's a hard one because I've in my mind it's easy you just drink the water.

[00:07:45] So I don't know.

[00:07:47] But I hit roadblocks all the time people like well, I don't like water and in the back of my mind I'm like, how do you not like water but I get it when we're in a world of super sweet and caffeinated everything.

[00:08:00] You know, it's water is not a priority.

[00:08:02] So like I said, I'm not necessarily a proponent of those like squeeze in things that you add to water to give it flavor because they've got all these other chemicals.

[00:08:12] But if that's the only way that you can get people to drink any kind of water then by all means do that I'd rather do that than not drink anything or drink.

[00:08:23] Like caffeinated beverages like more coffee or things like that because the caffeine has decreases has a natural dehydration effect as well.

[00:08:34] So you know, instead of those kinds of things if you can't just drink plain water whatever you can put in it if it needs to be a little bit of lemon juice.

[00:08:41] You know, just to give it the flavor that you need that's great.

[00:08:45] I would just caution that it's not lemonade because they've got you know, you've got the issues with the sugar in there so and that is just counterproductive.

[00:08:57] In the whole scheme of things but yeah, I mean if you can't just do plain water and measure it because you're right for ounces somebody will drink a tiny little bottle of water and think that for ounces they have drink water all day long.

[00:09:13] Because my grandmother is one to do that.

[00:09:16] You actually kind of have to measure it and they have wonderful you know measuring bottles that like will help you track drinking it throughout the day like you should have this much done by, you know noon and this much done by one PM and that kind of thing which are wonderful tools for people.

[00:09:34] That that's a good idea to to.

[00:09:38] Let them drink out of a car borrower.

[00:09:43] I'm just going to continue that has some measurements and guidelines on it because sometimes they really don't understand I mean there is that whole thing of, oh but I don't need water I'm not thirsty I don't need to drink that much water.

[00:09:58] But to be able to you know possibly sometimes they really think that they have drunk more than they go.

[00:10:07] Yeah, well and the natural thirst response decreases with age like I said before so you're just really not as thirsty but there'll be signs like dry lips dry skin you know those kinds of things that are dry mouth that you need more fluid and honestly the more fluid that you have the more water that you have in your system.

[00:10:27] Your medications are going to work better they're going to get to the places that they need to better.

[00:10:32] You know you're going to be able to digest your food better you're going to be less likely to have things like constipation because you know that's where you use a lot of water to digest and eliminate waste from your body.

[00:10:45] You'll have less likely UTIs which are terribly devastating for older people and terribly painful so you know those are some of the other reasons that you know just trying to focus a little bit more on water intake is important.

[00:11:04] Right, yeah, yeah, as you kind of listed all those things with those check yep we did that one yet check we dealt with that one yet check.

[00:11:13] Yeah, yeah it's one of those low hanging fruit things you know it doesn't take a whole lot of effort although some people feel like it takes a lot of effort it doesn't have to take a lot of effort to do something that would have a very very important impact on a lot of facets of life.

[00:11:33] Right right but I just wanted to sort of go a little deeper into that one.

[00:11:39] Okay, so you kind of talked about the UTIs and some of the other issues that can happen from not drinking and you also says something about.

[00:11:52] Drime out can cause cavities which can cause or can become infections and all that sort of talk about oral health and how oral health can affect our overall health or vice versa.

[00:12:08] How our overall health can affect our oral health.

[00:12:12] Yeah, well, I think in medicine today we're really big on separating systems you know you have sub specialties for all different kinds of things you've got the kidney doctor you got the digestive doctor the brain dark all of this stuff but in reality it's all connected we're all connected.

[00:12:32] So taking a bigger view of that any kind of risk of infection whether it be in your mouth or whether it's your leg or anywhere you know has the that problem of rampant up the immune system.

[00:12:46] And then you know when the immune system ramps up you feel bad you can't function you can't eat you can't drink then you can't you know operate as optimally as you want to.

[00:12:57] So I mean.

[00:12:59] Infection is kind of an obvious thing as far as that goes I mean if you have dental infection the next closest organ is your brain.

[00:13:06] You know they can be deadly consequences for oral infections as well but not so much infections that's kind of an obvious one it's the underlying increase of inflammation just low great chronic inflammation from having.

[00:13:24] You know troubles with your mouth is what really impacts all the systems of the body.

[00:13:30] That inflammation can result in cardiovascular disease which you know strokes heart attacks those kinds of things it can also result in thyroid issues digestive issues even like Alzheimer's and dementia can be related to low grade inflammation.

[00:13:52] If you have infections or inflammation information and you are a diabetic they can make your blood sugars going to a tail spin and then that only leads to more inflammation.

[00:14:05] So it's a vicious cycle of inflammatory factors if you know you start out with a cavity that leads to an infection or a gingivitis that leads to inflammation or parodontal disease that leads to inflammation.

[00:14:17] And this is just the start of the whole body where it can impact everything and then like if you have autoimmune conditions they can be presented in the mouth as well with ulcers and things like that there's several different autoimmune conditions that are presented in there you can have even like viral infections like her petac infections inside the mouth like tingles inside the mouth.

[00:14:44] So like I said it's we're all connected and it can be anywhere in everywhere at any moment.

[00:14:51] I wish you all could see my face because it's like what they're couldn't say this I'm like grim as saying and just making these really awful bases thinking those sheels in the mouth but you know some of these conditions oh my heavens I have a friend who.

[00:15:05] I think I'm saying this right that her mother had an oral infection I just got obsessed to take out infected and it wound up damaging her heart because the infection.

[00:15:19] And another friend similar kind of situation but her mother wound up with really severe knee.

[00:15:28] knee issues again because of the infection that I guess sort of traveled through the body of the inflammation and it wound up permanently.

[00:15:39] The both of the mothers wound up with permanent damage because of an oral infection it has got started.

[00:15:48] Yeah and we so to speak to both of those things but there are certain heart conditions like you know maybe heart transplants or valve valve replacements and things like that where you have to pre medicate with oral antibiotics before you have dental work done.

[00:16:05] Because the bacteria in the mouth especially if you know the oral home care is not as good so that means the bacteria count as much higher they can set up in those heart valves they can set up in those artificial joints absolutely so we we do.

[00:16:24] And so pre medicate certain individuals that are more susceptible to those with antibiotics and I know the usually if we're going to do that then we get the clearance from their doctor or surgeon because antibiotic use edges gotten wildly out of control and we're breeding these super bugs and things like that but there is definitely a risk of any kind of bacteria setting up in the weakest link of your system.

[00:16:52] Whether that's your heart your knee your brain any any part there's definitely a risk of that.

[00:16:58] But I remember again my mother had much of a whole house a heart murmur which seemed but you know they're we not can see that it since she was a child.

[00:17:09] But every time she went to the dentist and he and for just a regular cleaning she had to take an am I think it was not a biotic before they could do anything in terms of gentle work.

[00:17:21] Yeah, yeah.

[00:17:24] That is not one of the conditions they are fortunately that we're constantly as the American Journal of the Society and American Heart Association, you know the orthopedic doctors.

[00:17:36] We're constantly updating that pre medication requirements so that we don't over utilize antibiotics and and cause these other problems but yet also protect the people that need to be protected.

[00:17:50] It's such a balancing act isn't it everything is a balancing act.

[00:17:56] We just were sort of talking about teeth why are teeth important I mean you know we know a lot of people who particularly as we age lose teeth and I know dentures can be difficult to know all that sort of thing the talk about my teeth are so important.

[00:18:14] Well, I mean just eating.

[00:18:16] Eating efficiently not only is it one of the greatest pleasures of my life it's in the city for most people is being able to eat officially.

[00:18:27] So, but chewing is the start of the digestive process so you know being able to chew your food well then your stomach can do its job well then your small intestine can you know uptake the nutrients well.

[00:18:41] And then your body can utilize that more efficiently so being able to chew well is just the whole start of the digestive cascade in order to get the fuel the appropriate fuel and nutrients that you need.

[00:18:58] Another thing another reason why teeth are important is just first speaking and communicating.

[00:19:03] We use our teeth to make certain sounds and be able to speak and you know forming words and communicating is vitally important.

[00:19:11] As us being human beings.

[00:19:15] Another thing is facial shape and aesthetics so you know being able to communicate you know by maintaining your facial shape and not having in sunken in lips and things like that you know it gives you confidence to be able to communicate with other people.

[00:19:33] So we're very social creatures it's very vital for our quality of life and our longevity to be able to interact with other humans.

[00:19:40] And you know if you want to do that you want to be is happy and confident and you know look as good as you can and that way we can have those social family interactions that you won't be you know ashamed over whatever whatever you know issue that you may have to sequester yourself away from you know society.

[00:20:01] So I mean those are just some of the big reasons why teeth are important.

[00:20:08] Well I think probably all of us or some of us anyway particularly enjoy our food and would be really upset if we had difficulty eating really eating food that we like.

[00:20:25] We'll also just to speak to that you know in an ideal world you want to eat foods with different textures and you have to be able to chew them because you want to stay away from like the ultra process foods that are super easy to chew and digest because they just are essentially like a sugar bomb to your body.

[00:20:47] But without teeth those are the ones that people typically gravitate towards because they're easier to get in but you want to be and it takes more effort to boil carrots and mash them up than it is to just open up a pack of pudding.

[00:21:02] You know so it's a way to be able to get a variety of whole foods that are only going to increase nutrient intake.

[00:21:13] And particularly as we age our nutrition is so critical to healing if there is an injury.

[00:21:23] To longevity it's just really critical that we have worked or even preparing for surgeries so for example.

[00:21:34] Protein is the one of the most important macronutrients that anybody can have no matter what phase of life because protein is the building blocks of you know muscle tissue and.

[00:21:49] And you know all of these things that heal wounds and give us the ability to produce energy to live an effective life.

[00:22:02] So yeah and getting protein in you know there's protein powders and things like that but I mean who doesn't want to eat a nice juicy steak or you know get in those protein requirements that way.

[00:22:15] That chewing with adequate intention you know you can't you just can't over state the importance of that.

[00:22:25] And put those who are vegetarian or vegan.

[00:22:28] Oh exactly like if you're having to eat you know you want to eat the quote unquote ruffage like you want to be able to eat the salads and the you know all the vegetables like they're you don't want them because when you prepare them and cook them.

[00:22:44] And then you lose some of their nutrients so you know sure you can it's okay to boil potatoes and you know things like that but if you can eat the lettuce and the tomatoes and things like that with a.

[00:23:03] You know with chewing as opposed to just mashing it up in your mouth and swallowing it it's going to it's going to be a more enjoyable situation anyway.

[00:23:12] Right more enjoyable and begins as you said at the beginning it begins at whole process on digestion and getting the nutrition rather than it's just sort of in and out.

[00:23:27] Yeah it's an area yeah yeah.

[00:23:32] Help us understand some things that that aging adults or caregivers about what can we do to make sure that we have a healthy oral environment.

[00:23:48] What's the even name.

[00:23:51] Well let me.

[00:23:53] So well I healthy oral environment is free of disease so if we can be free of disease then you know that's obviously the optimal health.

[00:24:06] So to promote healthy oral environment.

[00:24:10] Get regular checkups and get the films get the x-rays that are needed have a lot of pushback.

[00:24:18] On getting dental x-rays and I understand they're various factors for that you know fear of radiation I mean with the the world we live in cost you know things like that or just a lot of people are like I've had so many.

[00:24:34] I don't want to have another picture taken or anything like that totally understand where they're coming from but it's like I can't see what I can't see and those films.

[00:24:47] Give me an opportunity to see what's underneath the tissue it's underneath the bowl to look for those latent infections that may not have any symptoms.

[00:24:58] Lots of conditions have no symptoms but that doesn't mean they don't need to be addressed and that's the same thing with dental films you know getting those we can I can make a small problem very easily as opposed to reacting to a huge problem later.

[00:25:16] By being able to see with those dental films.

[00:25:21] Another simple way to increase your oral health and your oral environment is just pressure tea and I know like the recommendations or depressur teeth twice a day but I would recommend three times a day.

[00:25:37] Because the longer food particles and things can stay in there the more susceptible you are to cavities and infection and things like that so.

[00:25:48] Just adding one extra brush in the middle of the day it'll help you from having your hygienist won't have to scrape on your teeth as much because there won't be as much tartar put but this deposit it on the teeth.

[00:26:00] And it'll just decrease that bacteria count in there and then another easy way is like we've said before just minimize sugar intake you know as we age our taste change and a lot of times sweet is more enhanced so you can taste more if it's sweet and so that's why a lot of older individuals gravitate more to sweet things because it could just taste it better.

[00:26:28] And that's you know obviously not best for oral health or overall right right but yeah we live in this society that we think it has to be sweet or really super salty.

[00:26:47] You know one or the other one or the other.

[00:26:53] Well I was just going to I was just going to make a point about the you know talking about the brushing and then the sugar and stuff that you know people may not know it takes four things to form a cavity.

[00:27:04] It takes a tooth.

[00:27:06] It takes bacteria which everybody has bacteria in their mouth and some people have you know a disparity between quote unquote good and bad bacteria that can make them more susceptible to decay.

[00:27:19] But everybody has bacteria in their mouth.

[00:27:23] Then the bacteria need a food source which is typically that sugar or simple carbohydrate and then it needs time to work.

[00:27:33] So those four things, tooth, bacteria, food source and time.

[00:27:38] So if you can disrupt any one of those four things or multiple things then that's going to greatly decrease your.

[00:27:45] And that's going to be a good opportunity for a community.

[00:27:47] So like with a tooth you know teeth are in there that's one thing bacteria so that's why I recommend brushing three times a day instead of two because it gives the bacteria and your mouth less time to sit in there.

[00:28:03] Because say you get up at seven and brush your teeth and then you go to bed at ten that's a really long time in between.

[00:28:08] But those little bugs can fester in there.

[00:28:11] You're eating multiple times throughout that that's getting all kinds of food sources.

[00:28:15] So that's why three times a day is better.

[00:28:20] Then with the food source if you can decrease the amount of simple carbohydrates or sugars that the bacteria use when the bacteria use it they metabolize acid.

[00:28:29] And so that's kind of what happens the teeth essentially melts and causes that cavitation in the enamel of the tooth.

[00:28:37] So then there's where it comes in time.

[00:28:41] So I'm not saying you have to give up sugar every forever.

[00:28:44] You can still have your sugar but it takes your mouth with adequate saliva flow.

[00:28:51] It takes your mouth a minimum of 15 to 20 minutes to buffer that acidity that's formed from a sugar exposure and bacteria being in there.

[00:29:01] So people if you have like sodas with the screw tops on there and you take a sip and you know five minutes later you take another sip.

[00:29:09] It's a constant sugar acid bath for your teeth and that's what really gets people in trouble is sugary beverages.

[00:29:17] Sipping on sugary beverages, sweet tea, lemonade, sodas, you know throughout the day that's if you can minimize those kinds of beverages to just meals.

[00:29:30] Specifically then you know water in between you're going to greatly decrease your chances of cavities.

[00:29:41] Okay so no more Starbucks for me huh.

[00:29:44] You can have it but don't sip on it all day.

[00:29:50] There you go.

[00:29:52] Oh my goodness that's really interesting I had never heard it characterized quite like that in terms of cavities need four.

[00:30:01] Or different substances to form and I'm thinking again about care care for us who are listening to this and thinking you know what are some things that they can do.

[00:30:16] For their life wise that would be really significantly helpful.

[00:30:23] I'm really, I'm really well in some cases a minimum effort and that is here's a toothbrush and toothpaste you know therefore.

[00:30:35] Yeah.

[00:30:37] Yeah caregivers it's it's it's difficult especially because each person has their own specific needs and abilities you know like with dementia patients.

[00:30:51] They may not you know they have good days and bad days they may be able to to do things by themselves they may not be able to so like with brushing the teeth may have to literally watch them do it to make sure that it's done if they have the ability to do it.

[00:31:10] If they don't have the ability to do it themselves then there are tools like electric toothbrushes are great there's actually a double headed electric toothbrush that you get more surface area in.

[00:31:23] You know that works really well for like special needs children as well as you know aging adults.

[00:31:31] But really it's monitoring them kind of looking at their sugar intake or what they're eating.

[00:31:41] Establishing routines around oral healthcare you know routines are incredibly beneficial for any human but especially either dementia or I mean any human.

[00:31:55] And then you know really it's just you try to do the best you can do I know that sounds so cliche but it's like you just do the best you can do as long as it's in your mind that it needs to happen.

[00:32:09] And whatever capacity that it can happen brushing the teeth monitoring that then it's going to be good whatever capacity can be done in.

[00:32:17] And I really appreciate that affirmation that caregivers are doing the best they can do it so many difficult difficult situations.

[00:32:27] So I want to give a shout out specifically to those who may be listening to this who are caring for someone regardless of what the situation is or what the circumstances are.

[00:32:44] So let me ask you this.

[00:32:47] And I know someone who had C.O.P.D. and could just a part failure.

[00:32:54] The person was in their 90s and she literally did not have the strength to brush her teeth although this is something who was diligent or in prior life.

[00:33:10] Okay so what about if the person is not able to brush and they're not willing for someone to brush for them or for them.

[00:33:24] What about using the listening or some mouthwash kind of substance?

[00:33:34] Does that helpful at all?

[00:33:37] Well I mean it has limited benefits because of the limited amount of time that it's an exposure with the oral cavity.

[00:33:48] So um, listerine is if that's the only thing that you can use use it or if that's the only thing that's tolerated do it.

[00:33:56] It's listerine is a little bit harsh because of the alcohol content however they do have some that don't have that alcohol in it and it does kill bacteria.

[00:34:09] So absolutely it's beneficial probably more so I would recommend a floor i-drants because that's going to buffer some of the acidity in the mouth and then help re mineralize any kind of cavities that may be starting.

[00:34:26] So there's the big brand name of fluoride rants is act but I know like they have a quite like Walmart brands and offerings like that so you don't have to pay for the brand name.

[00:34:37] But I would probably more recommend a fluoride rants because it's not so harsh on the tissue.

[00:34:45] Then then the like the listerine.

[00:34:50] Good to know thank you.

[00:34:53] You taught a minute ago about people with dementia.

[00:34:58] And that is such such a difficult journey and such challenge for some for so many adults and caregivers family members and loved ones.

[00:35:10] Are there some do you some particulars suggestions as to how to or live a loved one with dementia?

[00:35:19] How can we best share with them relative to oral care?

[00:35:27] Yeah, it's very I'm learning how to do or help a service dementia patients now.

[00:35:36] So I mean you have to meet them where they are and their good days and their bad days and if it's a bad day.

[00:35:43] There's just it's okay. It's okay to skip the day if you, you know oral healthcare is important but you know quality of relationship is more important.

[00:35:55] So it's okay to take a break if you have to take a break that day.

[00:36:00] One thing is if they repeatedly complain about something that hurts or a sharpness or something like that like it's a repeated thing then we need to see it.

[00:36:12] You need to check it out to see if there's something that we can do to manage that discomfort.

[00:36:18] Because usually if it's over and over and over stated then there's a real problem there that we could possibly help alleviate.

[00:36:27] But then other than that it's just okay if they'll let you brush do it, if they do it on their own great you're just going to have to monitor it.

[00:36:35] It's just like any other kind of bodily maintenance thing. Like you may have to help bathe them if they can't bathe themselves or make sure that they bathe themselves adequately.

[00:36:47] You know same thing with brushing teeth with all those tools.

[00:36:52] I think an electric toothbrush if they can tolerate it is great because it'll do all the work for you and it's timed it's some of them sing to you it can be a great experience.

[00:37:02] You know having a if you can get that routine established where they'll use that and they know they can know that that's coming.

[00:37:12] And it's something that we do every day after lunch or whatever that can help minimize confusion and you know like agitation as best as possible but really it's just if you can do it do it if you can't that's okay to.

[00:37:31] It's going to be okay.

[00:37:34] I remember you're saying that you're talking about someone to mention how they preset.

[00:37:42] I remember going to a seminar one time and they were talking about dementia people with dementia and I remember that she was talking about the prisoner was talking about woman that she had encountered.

[00:37:57] That kept kind of patting her cheek and laughing and just laughing mysteriously and it took them this is someone who I believe what I can't remember she was at home or in a retirement community.

[00:38:16] Or now I care for somebody but I remember that she was talking about that it took them the longest time to understand.

[00:38:25] That the laughter that she didn't that she could not communicate the her to just pain but her padding her cheek was really to clue that they finally figured out.

[00:38:37] Whether something going on and I would definitely remember that a really awful infection was really infected so so yeah there's all this whole dementia is so difficult such a difficult journey.

[00:38:53] Oh it's so difficult for the people the caregivers the family I mean it is so very difficult.

[00:39:04] And you talked about which it truly some some days are good and some days are not good.

[00:39:12] If somebody has a a dental appointment scheduled and it is really not a good day or the for the patient the person with dementia.

[00:39:26] How would you recommend they deal with that.

[00:39:31] Is that is that a is at a time that it would be appropriate to call the dentist's office and say it's just not going to happen let's reschedule or kind of conversely is there a way that dental offices can kind of scoop someone in.

[00:39:53] When there is dementia and when it's a you know a good day and they need to have dental work.

[00:40:02] Well all I can speak for is my office so if if your loved one is having a very bad day then absolutely don't bring them into the office for their sake.

[00:40:16] I mean it's only going to compound confusion and irritation and possibly anger or you know upset we don't want people to you know be upset at all so for my office.

[00:40:30] I have zero problems at all if your caregiver your loved one is having a bad day you need to cancel that appointment no problem.

[00:40:38] And certainly we'll try to reschedule you for you know and hopefully have a better day as far as.

[00:40:48] With with our office like if you know that there's a situation like that and you're like okay dad's having a great day today is there anything available.

[00:40:57] We certainly welcome people to call you know first thing that morning and then we can try to work that in the schedule I mean we we have a schedule for a reason but things change and certainly we want to see people that are having issues or problems or concerns or infections or anything.

[00:41:18] And we have built in kind of emergency times in there so if you know miss the regular appointment having a good day I welcome people to call my office to and I would think most.

[00:41:32] Officers would do that to say hey you know we're having a great day is there any way we can get in there and you know.

[00:41:41] And just accommodate as best you can.

[00:41:44] Thank you because I know for people who are caring for someone with dementia that it can be day to day and sometimes.

[00:41:53] Oh absolutely yeah yeah but but that understanding really really would be very helpful.

[00:42:02] Dr. Pitaker we have talked about so many different things is there anything else that you feel like we really need to be sure to talk about.

[00:42:14] I think really if you just focus on the big doll movers and that's what we've talked about throughout the whole time is you know consistent home care consistent routine home care is a big doll mover that super important.

[00:42:31] You know minimizing that sugar and processed food and then getting the regular checkups if you can you know try to just make it a priority if it's not every six months if it's every eight months whatever it's just so that we can hit big things off before I mean hit small things off before they become big things that's always super helpful now that doesn't mean that will always be able to fix them.

[00:42:59] I mean I have several olderly patients dementia or not that just don't have the capacity to sit in the chair and get things fixed.

[00:43:10] So we have to kind of triage what needs to be done and sure it's essentially watching things deteriorate but it's kind of a controlled the demolition as opposed to you know putting them through a bunch of hard things that if they can maintain for

[00:43:29] several years and then we hit the things that are truly detrimental to their health and prioritize those and then just leave the rest of it you know.

[00:43:42] So as it comes that works to you just you have to kind of meet people where they are and and honestly individualize each plan for each person but really just focusing on the big things focusing on.

[00:43:59] You know cleaning cleaning the teeth if it when you can and not eating the junk that will that's 80% of the battle.

[00:44:09] So a lot of it that we can do without intense intervention don't enter.

[00:44:17] You know when you're talking about some of your patients that really have difficulty but you need to work with whatever they can do.

[00:44:28] I mean even thinking you know arthritis can make it very uncomfortable to be in that chair or in that position.

[00:44:36] Crank back people who have had been lost and lost teeth and now have dentures you know that's a whole nother.

[00:44:48] Yeah, dentures are like prosthetic limbs they work but they're not the same as what you had.

[00:44:59] So dentures are extremely difficult to.

[00:45:05] One initially get and get used to an adapt to but then the older you get if you have dentures didn't there's so difficult to utilize in any kind of efficient manner.

[00:45:19] So if we keep keep keep them.

[00:45:24] And when you're saying dentures I'm thinking even implants.

[00:45:28] I have a friend who's mother like clicks for teeth and that's phenomenal.

[00:45:34] Particularly because she's 91 92.

[00:45:39] Yeah, that is a phenomenal option if you have one if your bone and health can support the implant placement procedure.

[00:45:47] All that is like life changing for people that have dentures and you know, partials and things like that that implants are amazing and life changing for sure.

[00:45:58] Right right right.

[00:46:00] This has been excellent thank you so very much for for all the inside all the tips all the oh yes this be sure to do one two and three.

[00:46:14] Thank you all of this.

[00:46:18] And thank you thanks also for helping us understand the key role that dentists can play in our overall health not just our overall health that are hope in general.

[00:46:32] So thank you for that.

[00:46:34] Well, thanks for having me absolutely.

[00:46:36] Thank you also to you our listeners we hope this information will be helpful to you to you and to your loved ones throughout your caregiver journey.

[00:46:48] We definitely want to thank pace at home and big renewal of Carolina.

[00:46:52] They are the funds about all of our caregiver community podcast and we are in deemed grateful for their support.

[00:46:59] This caregiver community podcast is part of the mesh network of online shows and podcasts.

[00:47:05] We record one new ACAP podcast each month addressing many other topics related to caregiving and advocating for an older adult you will find all the podcast on any platform for you listen to podcasts as well as on our website.

[00:47:23] www.acapcommunity.org.

[00:47:26] While you're on our side we hope you will take a few minutes to learn more about ACAP, our educational programs and our local chapters.

[00:47:35] And if there are other topics you would like for us to address as a podcast please do let us know.

[00:47:40] Again that website is www.acapcommunity.org and that's ACAP like adult children of aging parents.

[00:47:52] ACAPcommunity.org.

[00:47:55] Thank you so much Dr. Whitaker for being with us.

[00:47:58] Thank you to you our listeners and to to pace at home for sponsoring this.

[00:48:04] Stay well everyone.

[00:48:07] Bye for now.