Pharmacology · patient case question
What is the most appropriate next step in managing this patient?
Patient case: Alzheimer Disease and Consent for Care
Patient: 72-year-old male
Chief Complaint: Daughter: “He won’t let anyone near his mouth and I think his teeth are getting worse.”
Background: Moderate Alzheimer disease diagnosed 4 years ago. Trigeminal neuralgia on the right, managed medically. Disoriented to time and place; cannot reliably recall the purpose of today’s visit. His daughter holds a durable power of attorney for health care.
Medications: Donepezil 10 mg daily · Carbamazepine 200 mg twice daily
Vital Signs: BP 144/82 mmHg · HR 72 bpm · RR 16 · T 98.2°F
Findings: Generalized plaque accumulation, multiple root caries, and moderate periodontitis. Multiple restorations required. He is calm but does not follow multi-step instructions.
Show answer and explanation
Correct answer: A. Obtain a medical consultation from his physician before initiating treatment
- A. Correct. A medical consultation establishes the stage of his disease, his current medication regimen and interactions, his capacity, and whether any sedation is safe. It also formalizes communication with the physician managing his overall care and informs realistic treatment planning.
- B. Incorrect. This is unsafe on several counts: it is an unmonitored dose given by an untrained person outside the office, three doses of any benzodiazepine is a serious overdose risk in an elderly patient, and it invites respiratory depression with no one present to intervene.
- C. Incorrect. Treating without consent is battery. When a patient lacks capacity, consent must be obtained from the person holding legal authority — here, the daughter with durable power of attorney.
- D. Incorrect. A patient who cannot follow multi-step instructions and resists intraoral access requires a modified approach. Proceeding unchanged ignores both his safety and the likelihood of a poor outcome.