When You're Smiling...

My Mom smiles at everyone and everyone smiles back. She really brightens a lot of days.
So there's nothing I wish more than that she had better teeth.
Sadly, what should be her 'pearly whites' are more witch-like these days. I'm not being mean. She's visited the dentist quarterly for as long as I've been alive, it's absolutely not her fault.

She spent the first six years of her life in Scotland where they never used fluoride. The damage from those early years was insurmountable for any human, and any dentist. The first time I stepped up as advocate for my aging parents was with a secret call to the dentist. I told Dr. Magar I'd pay for tooth whitening and he could tell her it was covered by insurance. She is such a beautiful lady, I didn't want her to miss out on the latest technology that may help recapture a little sparkle. That saint of a dentist personally took my call and spent a good half hour explaining that although he'd be glad to take my money, no whitening on the planet would work. My pretty hip Mother, it turns out, had already requested whitening on her own and received the same answer. She suffered from a 20-some letter condition that I no longer recall, mostly a direct result of poor dental care as a child that caused premature discoloration and eventually decay.
There was no way around it. Her teeth and gums would be the first features to betray her age and beauty. Her failing brain would soon after prove too unpredictable to do anything about it.

When My Mom came to live with me, my first order of business was to get a second opinion. I was determined to help enhance her smile. Two dentists. Two opinions. Both the same. You can't cap bad teeth or you heighten chances of severe infection. Dentures, in general, don't work with dementia patients. The primary reason, they lose them. It's best to leave the teeth they have in place. They might not constitute a full set, but at least they're permanent.
Now that we mingle regularly with other Alzheimer's patients, I've accepted the dental status. I don't think much of it when I see a tooth missing here or there on our new friends and I've yet to see anyone react terribly adversely to My Mom's lackluster smile. But even though the twinkle in her eye compensates for a sparkle in her teeth, I kept holding out hope that somehow, someday, she could snag a better smile.

Well, the time has come. She's begun losing enough teeth that the only option is to pull them all -- creating a now or never time to try dentures. It's kind of a last ditch effort. Nothing to lose, except, of course, her new teeth if they're carelessly wrapped in a napkin, left on a dinner plate, or I just heard, perhaps flushed down a toilet...
Hoping she won't have the track record of my high school retainers, we thought we'd give it a shot. I expected my heart to be filled with joy at the thought of her getting a great big new smile. I thought I'd be ecstatic. I was wrong.
I'm a wreck. This is by far the toughest decision I've ever had to make as a caregiver, maybe even the toughest decision of my whole life.
We went to see the specialist today. He couldn't have been kinder, sweeter or better with My Mom. She was in a very upbeat mood, all excited about the prospect of getting a smile like mine. In the car, on the way to the appointment, I very seriously explained the situation, including that although she'd get a great new smile, they'd have to pull teeth to make it happen.
"I want a new smile," she said very confidently. Pause. "I deserve a new smile." We had lowered the vanity mirror on the passenger side for her to assess the situation. She looked side to side at her face as we discussed the topic. "Do you think he could shave a little off my nose too?"
(Note to self: It might be time to cut back on the Hollywood entertainment news shows...)
That very vanity was my selling point for convincing our primary dentist that My Mom just might keep the new teeth in her mouth. Wyn has always been concerned about looks, which makes her a better than average candidate for dentures. I felt so confident about the decision as we entered the office.
The specialist met all my expectations. He was kind, gentle and so good with My Mom. It's the most personality she's ever expressed with strangers. Then he said he'd be happy to perform the extractions himself. He went on to say he had done them a lot. In Egypt. Tons of them. My dark mind spun out of control. Where exactly had he accumulated this vast experience? In a torture chamber?
My Mom still has 19 teeth. Who am I to say 'let's yank them all out'? The whole process of replacing the teeth takes almost three months. This decision would leave her gumming-it for a minimum of 10-12 weeks.
The prospect of putting her through that kind of pain practically paralyzed me. It took all the lure of a new smile right out of the equation. Who would decide the price of beauty when it came to My Mother? Not me. I did the only thing I could think of, I deferred the decision to my sister.
She jumped in where I left off. With even more questions. How many teeth would he pull at a time? With My Mom's condition, could she alert us properly if she was in pain? What would she eat? Would she understand the gum look was temporary? That we weren't trying to torture her? Paranoia is a strong component of dementia. She might think we're selling her teeth on the black market or something.
While everyone else in the dental world seemed to only be concerned over the odds of her losing the dentures, cost didn't even factor into our concerns. We only cared about comfort.
Then we analyzed the other side. What if we left the teeth as is? The front one already cracked. Infection and choking on one were potentially serious consequences. But those side effects at least would be caused by Mother Nature. We wouldn't be to blame.
As we prepared to leave the dental office today, I turned to My Mom one more time, hoping the environment would solidify the seriousness of our decision. Honestly hoping she'd show me a remarkable moment of clarity and make the decision herself.
"You can have a new smile, but you heard the dentist. He'll have to pull all your teeth first, to make that happen. Do you still want a new smile with dentures?"
My Mom didn't hear me. She was too busy interacting with her new friends, Dr. Badr and Pam, the receptionist. She went from being the sophisticated woman gazing in the car mirror an hour earlier, to a child, amused over the toy cars, horses and stuffed animals displayed in the office. Pam gave My Mom a little stuffed bear and she lit up. The joy on her face made her current smile beam like a million bucks. "I'm naming him My Boy," she said with such joy. "Oh, I loved meeting you," she gushed. "I'll come back here a lot."
We all laughed at the irony.
"Yes you will," I answered. "If all this goes through, you'll definitely be visiting here a lot."
If only I could be convinced she'll come out of the process with the same enthusiasm.
Seeing her smile at these new people today. Knowing the joy she experiences over a good laugh. Seeing the sad state of her poor little mouth today. It seems worth a shot.