That is a challenging question. When an elder has a sore tooth, he may be yelling or lashing out at his caregivers. In a situation like this, it’s only human to want to give the patient whatever’s necessary to help relieve their pain and anxiety, not to mention their behavior! It may seem completely impossible for the elder to sit quietly in a dental chair for a filling, or God forbid, something more involved like an extraction or a root canal.
Normally, I am very resistant to giving patients tranquilizers of the “benzodiazepine” class (Ativan, Xanax, Klonopin, Valium, Tessalon). I find that these medications often cause more problems than they solve. They may make a patient less inhibited, creating behavioral problems. They’re very addictive. Approximately 70 percent of patients who stop taking these drugs will experience a “rebound” effect, that is, they may feel a resurgence of anxiety, insomnia or depression. These problems don’t last forever, but they may be worse than the issue that led to the prescription in the first place.
I would try other things first, before reaching for a benzodiazepine: You could use Tylenol. You might ask your doctor to prescribe a little Gabapentin, 50 to 100 milligrams. If none of these work, then
in an emergency like this, a small amount of a drug like Ativan may help. I would suggest 0.5 milligrams of Ativan, just enough to allow the dentist to provide the needed care. Don’t forget that if you give a tranquilizer like this, someone should stay with the elder until the drug wears off.
In the best of all worlds, an elder with dementia should avoid involved dental visits by maintaining proper dental hygiene. With all the other problems cause by dementia, dental health often gets forgotten. For instance, if an elder has been in the hospital on a respirator for any period of time, remember that his teeth have not been brushed. After an episode like that, schedule a dental cleaning as soon as possible. And don’t forget to make sure the elder brushes and flosses regularly! Consistent care will avoid rotten teeth, pain, infection and complicated dental procedures.
Elizabeth (Dr Liz) has over twenty years of experience in providing medical care to the elders. She is board-certified in Internal Medicine, Geriatric Medicine and Palliative Care Medicine. Dr Landsverk founded ElderConsult Geriatric Medicine, a house calls practice, to address the challenging medical and behavioral issues often facing older patients and their families.