Physical and Cognitive Health Collide:  Dentistry the New Tractor in Ralph’s Life



shutterstock_Untitled design.jpg


Last Wednesday, the day after I congratulated Ralph and me on our comfortable status quo, I received a reminder from the gods—Never get too comfortable!

First thing that morning, Ralph fell down the stairs. He made it to the bottom step before he tripped so it was not a long or serious fall. But it was the second time he had fallen on that same bottom step in less than a month. Just before Christmas he had tripped and fallen, hard enough to dent the wall with his head. On both occasions he did not appear to hurt himself, although he has been complaining of some back soreness this time. But twice in a month! The possibility that he is no longer sure-footed, that he is fragile and at risk has freaked us both out.

Then that same afternoon, I took Ralph for his regular dental cleaning and check up. The dentist solemnly announced that she had found gum disease. Also a tooth that needed pulling. And another tooth that needed a crown. These are not big health issues in the large scheme of things, but to Ralph they became major crises. All the way home and throughout the evening he kept repeating, “This is a very bad day.” And I couldn’t help thinking he looked like the little boy in Judith Viorst’s classic Alexander and the Terrible, Horrible, No Good, Very Bad Day.

By Thursday when we returned to the dentist for the tooth-pulling, Ralph was a wreck. He didn’t understand why he needed to have a tooth pulled if it didn’t hurt, and he was convinced that having a tooth pulled was a major medical event. He also understood that he would have to see a different dentist, a periodontist, for the gum disease, and he swam into a state of anxious confusion over where he had to be treated (as if it matters, since I drive him there anyway)— the fact that we might have to drive to another town got lodged in his memory although he couldn’t remember why we were going there. But then he charmed everyone the way only he can, singing Dylan lyrics as they were about to inject him with Novocain.

It was afterwards that the real crisis sunk in. The dentist casually mentioned that Ralph couldn’t drink through a straw or smoke for 72 hours without risking a painful “Dry Socket.” I had her write on a sheet of paper in large letters THE DOCTOR SAYS NO SMOKING UNTIL SUNDAY AFTERNOON. Fat good it did.

As someone who has never smoked I realize that 72 hours would be a long time for any smoker to go cold turkey, but cognitive impairment compounded the problem for Ralph and made the next three days a Groundhog Day-like comedy. We enacted the same scene over and over. Picture Ralph walking in from the bedroom (where he’s been half napping most of the day) wearing a heavy jacket and a hat with ear flaps.

“Where are you going Ralph?” I say putting down my book and looking up from the living room chair I’ve chosen because it gives me a good view of both in the porch where Ralph usually goes to smoke and his car parked just outside.

“To have a cigarette.”

“You can’t smoke, remember.”

“Why not?”

You had a tooth pulled.”

“I did? Well it doesn’t hurt so it must be fine.”

“No, it needs more time to heal or you will have terrible pain.”

“How do you know?”

“The Dentist told us.”

“She did? Why did I have a tooth pulled?”

“It was creating a problem for your other teeth.”

“So I’m fine now.”

“Just one more day.”

“Then I’m done?”

“Well, no, you have gum disease. We have to go to the periodontist.”

“What will they do?”

“I don’t know.”

With a defeated shrug Ralph heads back to take another nap. Ten minutes later I catch him about to light an e-cigarette he’s found in some pocket or drawer.


For months Ralph’s memory has been holding steady. But now he was confronting a specific demand to remember. What concerned me was not just his inability to remember that he couldn’t smoke. Or why he couldn’t smoke. Or that he’d had a tooth pulled in the first place. (“What did I have done to my ear,” he asked more than once.). But a more general cognitive melt down. He became foggy about everything. Hang dog depressed and beaten down.

I hid all the cigarette and e-cigs I could find. I also hid his car keys—if he could drive he would head up the driveway to his “office” in the barn to smoke. (Given his lethargy and the cold weather he wouldn’t walk even for a cigarette.) Sure enough while I was on the phone, he headed out to his car. And a moment later came back wild eyed.

“I’ve lost my keys.” His tone was frantic. I realized that hiding his keys might have been a mistake, one more sense of failure for him to face. So I pretended to find them. But an hour later I came out of the bathroom and had to rush outside out to stop him from taking off in the car.

“Where are you going?”

“I’m out of cigarettes.”

“You can’t smoke.” …And so the scene repeated and repeated every few hours.

We made it to Sunday at 4 pm. when restrictions lifted. I was/am exhausted. He was/is still groggy. Tired. A little more confused than he seemed a week ago.

Physical and mental health are so wound up in each other, I don’t know if there’s been a real slide or if this is a temporary glitch. By the time I figure it out, we’ll probably have moved on to the next stage anyway.

6 thoughts on “Physical and Cognitive Health Collide:  Dentistry the New Tractor in Ralph’s Life

  1. Oh, what a time you’ve been having! Jabberwocky’s suggestion is excellent. It may be that Ralph need not have any other procedures immediately and can recover his equilibrium.
    As a former smoker I know how terribly difficult those 72 hours must have been for him. On the other hand, my sister suffered a dry socket and I had to take her for emergency treatment on a Sunday when she was climbing the walls in agony.
    I took Dad to the dentist when I discovered he hadn’t been for years (he was older than Ralph and at a later stage in dementia) and really didn’t know how he would react. In fact, he was fine and seemed to recognise at once what was expected of him – getting into the chair, opening his mouth, etc. There were a number of problems with is teeth – dentures, which didn’t fit well any more and his gums showed signs of disease. He had no toothache and the dentist said she wouldn’t do anything unless we insisted because she felt he wouldn’t cope with new dentures and all it entailed to have them fitted. She offered to do a house visit if he ever did have toothache – at no cost! And then she went off to do a course on dentistry in dementia because she realised she was going to see more patients like dad. I love her!

    Liked by 1 person

    1. Of course Ralph has no memory of struggling through last weekend. The gift of living in the moment is that when bad moments pass, they’re gone. Will take this whole dental thing one day at a time. A dentist connected to the practice is deeply involved in Alzheimer’s issues–she and I have had many discussions–so I feel pretty comfortable moving forward. Of course, I am not mentioning to Ralph that we are heading back to the dentist until the morning of our appointment. Thanks so much for your input. I love when my readers/friends are spurred to give advice from your own experiences. Makes me feel a real sense of community.

      Liked by 1 person

  2. I find the constant need to repeat and explain exhausting,too. But forgetting also can be a good thing when dealing with medical things. Ned has squaumous cell cancer on his head (discovered because of the skin checks required for the research he and Ralph are in) and will have Moh’s surgery to remove it this month. It’s not a serious diagnosis, easily treated and rarely spreads after the treatment, but it probably would worry him if he could remember.

    Liked by 1 person

    1. Yes, that forgetting is often helpful. Ralph has forgotten the weekend travails. And that he has more appointments coming. And I am not reminding him. As for the skin checks…Ralph really enjoyed those because he had a little crush on the dermatologist who was particularly lovely and kind.


  3. Hi Alice – just a suggestion, from similar experience. Not all health professionals “get” what dementia does to patients, and hence to caregivers, and so you might make further private inquiries about the absolute need to see a periodontist right away. Find out exactly what the prognosis and timeline is, what the possible alternatives are, etc. (oral antibiotics can pinch hit, for instance, etc). What is a reasonable referral for a cognitiely-intact individual can be just way too much for a person with dementia. The gains may be outweighed by the stress and strain, repeated over and over, for both you and him, leading up to, during, and following up on any procedures.
    Take care!

    Liked by 1 person

    1. Thanks so much for this advice. I did discuss his cognitive condition a bit with the dentist, but I think what you suggest makes a lot of sense. We go back to the dentist in a week and I will discuss in more depth with her then..I am genuinely grateful that you took the time to respond.

      Liked by 1 person

Leave a Reply to Mary Smith Cancel reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s