My mom has been diagnosed with Dementia and Alzheimer's as of November 2015 and all the testing results per her neurologist say the damage to her brain showing she has been having non symptom strokes for some 50 years, lots of damage.
About 2.75 years ago she had a root canal and has repeatedly complained of pain with that tooth. The dentist who performed the procedure has x-rayed numerous times = no problem. A 6 hour stay at an ER Christmas morning shortly afterwards worth the same complaint showed no problems. She sees the dentist quarterly due to bad dental hygiene (normal for Dementia patients), new dentist at current facility doesn't find any issues with root canal area.
Almost 2 weeks ago she spent days between ER and hospital observation for the same complaint and same result = no problems. I visited her yesterday and her reactions to "the pain" is so extreme the staff are telling me about it plus my witness of her reactions, I am at a loss. Everything leads me to the Dementia is distorting and escalating her reaction. Any thoughts out there? Anyone else experience this? My mom's history is that her situation needs addressing and anyone else's similar situation she lowers its importance. I am the sole person overseeing her care, my brother shows empathy but that's about it, I want to do right by her but with Dr's saying nothing is wrong has me at a loss. I appreciate any thoughts...
(edit)I've been doing a little bit of reading on line - it is possible that a problem with the root canal may not be obvious in an x-ray, if the pain is intractable I'd be inclined to look into redoing the root canal or even consider an extraction.
Also my MIL has a nerve in her face that gives her constant pain. Keep exploring options although it is entirely possible she is obsessing on a phantom pain due to dementia or for attention.
Two weeks ago, it's bad enough to get herself taken to the ER and admitted for observation.
And in between? Did it settle down? If it "grumbles" without flaring up so badly, does anything help to relieve the pain?
What does strike me is that the dentist and doctor aren't saying there's nothing wrong, they're saying they can't find it. And it wouldn't be so unusual for a troublesome nerve to be very, very difficult to get to grips with. I certainly think you should try to hide (even if you can't quite drop) your suspicion that she's making this up for attention.
What is her main doctor suggesting now as a treatment strategy?
You don't say how old mom is but it sounds as if she has had D/A for a while. It may be best to be without the tooth. I am mid-age and don't have dementia, but I had a root canal several years ago and I can tell you that I have had "flair-ups" where the tooth is sensitive bordering painful--then returns to normal. It seems that D/A symptoms can include hyper-sensitivity, so these combined sensitivities may be the problem. If your mom can live without the tooth, you may consider that alternative. Just be sure the extraction is done by an oral surgeon. However, she may then miss the tooth.... Good luck with whatever you decide. So difficult to know the "right" thing to do.
Is there an immediate reaction when someone comes into the room. Does she look as though she is in pain? Is she touching the area or screwing up her face, or very restless. Is she able to sleep. What happens when she eats?
I had the same experience with a tiny abscess under a tooth. Nothing showed up so nothing could be done. Finally another dentist did a root canal and sure enough there was pus. That all cleared up but for years I could press on my face over the area and it was still sore.
Have they done blood tests to see if she shows signs of infection.
An extraction is a good idea but if she needs anesthetic that is another risk.
I think I would ask the Dr if a course of a suitable antibiotic would help. That's always a good idea prior to what could be the extraction of an infected tooth.
Agree any extraction must be done by an oral surgeon. It is a simple matter but carries great risks. Also in a facility that has fully trained staff and life saving equipment, that is assuming she is not a DNA.
Is she getting adequate pain relief medication. A couple of Tylenol won't touch that kind of pain.
Take your time and observe her carefully before making any decisions.
Make sure she has adequate ORAL care--doctors never look at the teeth..and tooth pain is an all too common source of discomfort. I supervise my mom brushing her teeth and she can still use a water-pick which has helped prevent gum disease..and I still take her to her dentist every 6 months. If she is diabetic like mine they are the most prone to gum disease.
I had an abscess and root canal was done. One year later I was back at the specialist who couldn't understand a new abscess on the same tooth. It was decided to extract the tooth and they discovered the root had cracked. This will NOT show up on an X-Ray, not even the circular kind that the specialist uses. Needless to say, the specialist was horrified and felt terrible that I was again in so much pain. He apologized profusely and explained how a cracked root doesn't necessarily show up on an X-Ray.
Tooth pain is totally debilitating and she might need an extraction. I had no more pain after the extraction, other than to my wallet, lol.
In my mother’s case I am quite sure that there is no pain. It took 50 years to put the pieces together, but I am 100% certain that my mother has narcissistic personality disorder. She presents herself as a covert example. Fortunately for me this complicated mess is in the capable hands of a nursing staff 2000 miles away. Overseeing her health is all I can handle.
I am hopeful that this is not your situation, but if she’s controlling and uses people it may be worth further reading. I wish you and your mother much luck with this mystery.
If he has dementia or Alzheimer's, you are allowed to lie. If he doesn't remember, tell him he saw the Dr yesterday or day before. That he can't go back until next month. Give him an ice bag to hold against his cheek, that the dentist told you to do this if the pain comes back. Get Dr to give RX for placebos for the pain...remember it's all in his head. Treat him like it's real.
I care for my wife with advanced ALZ and I wouldn’t hesitate to at least try this approach.
Its safe and harmless and you can learn to do it yourself. Often works when nothing else does.
It is a great stress therapy for you also.
I once had a patient of 50-ish, whose 91-year-old mother constantly complained of pain - to the extent where the daughter demanded that the mother be placed on hospice care so that a morphine drip could be started to ease her pain and stop her complaining! The daughter said that the mother was driving her crazy complaining of pain all day long.
But the issue was that the mother was not terminal - she was only very old with the normal chronic aches & pains of an aging body.
So, it's possible that it could be an attention-getting technique.
If her pain disappears then it is phantom pain if it doesn't then she is truly in pain but you will have more information about the situation because of this try than before
If the caregivers are having trouble identifying what to do, because they cannot identify the source of the discomfort, it might be useful to weigh out risk/benefit of various options as you work to find a solution.
For example, if it seems reasonable to guesstimate that the tooth extraction is a likely root cause, is it likely that any pain rt to this is neuropathic? If that is a reasonable conjecture, what are the risks/benefits of various approaches to controlling neuropathic pain?
Clove oil is helpful for superficial nerve endings on the gums. Systemic nerves generally need systemic meds. It is also possible,that a routine anti inflammatory may help, or, acupuncture . which things to try are about relative risk and likely benefit.
See if her dentist has a "most likely" hypothesis. Then brain storm from there.