You’ve probably been there a few times, although given the emotional nature of the thing, it’s likely that you weren’t taking notes. Hospice workers, on the other hand, do take notes, so here are some things you might want to know, and if anything makes the next time even a little easier, that’ll be good:

Last stages

Here are the discussed signs of the “active dying” phase:

• Increasing unconsciousness:
  • The person will be mostly unresponsive most of the time.
  • Eyes may be open or partially open but not making eye contact.
  • Mouth will likely remain open due to muscle relaxation.
• Cessation of food and water intake
  • The person will likely not eat or drink for several days.
  • This is a natural process and does not cause suffering per se (e.g. thirst, hunger).
  • Dryness of mouth, however, can be treated with a little moistening, for comfort.
• Changes in breathing
  • Breathing patterns will change and may be irregular.
  • This is a natural metabolic response, and is not a sign of distress.
  • Terminal secretions (“death rattle”) may occur:
    • A gurgling sound caused by saliva buildup due to loss of swallowing reflex.
    • Not painful or distressing for the person.
    • Can be managed by repositioning or using medication to dry secretions.
• Skin color changes / mottling:
  • First appears on fingers and toes (purple or gray discoloration).
  • May spread to knees, nose, or other extremities.
• Temperature fluctuations:
  • The body loses its ability to regulate temperature.
  • Person may feel hot but be cold (or vice versa).
  • Fevers are common—cooling measures and/or Tylenol can help.

A person in discomfort may appear restless, have a furrowed brow, or show physical agitation. If on the other hand they appear peaceful and unresponsive, they are almost certainly not in distress. At such times, it’s best to focus on just keeping them clean and comfortable.

For more on all of these, see:

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Want to learn more?

You might also like to read:

Managing Mortality: When Planning Is a Matter of Life and Death

Take care!

One of the problems with the human form is that our teeth evolved to last us for the whole of our life, with plenty of room to spare before our eventual death at the ripe old age of about 35 on average. Dr. Ellie Phillips advises those of us who might be a bit older than that, on how we can avoid becoming “too long in the tooth”—in other words, how to keep our gums, and thus our teeth, in place and healthy.

Getting to the root of the problem

The single biggest cause of gum recession is an acidic environment in the mouth, which harms teeth and gums alike. This acidic environment is produced not merely by consuming acid foods or drinks, but also (and much more often, and more problematically) by sugary foods and drinks, which are not necessarily themselves acidic, but they feed bacteria that release acids as a by-product of their metabolism. If we consume an acidic food or drink, it’s there for a moment, but if we then salivate and/or take a drink of water, it’s pretty much gone in a few seconds. But those bacteria when we feed them sugar? They are there to stay unless we do something more about them than just drink some water.

Other contributing factors to gum recession include teeth grinding, and (ironically) certain oral care products, especially many artificial teeth whiteners.

In case you were wondering: no, brushing will not* generally cause or even worsen gum recession, but flossing can exacerbate it if it’s already underway.

*unless, of course, you are using one of the whiteners we mentioned above

What to do about it: Dr. Phillips recommends:

• use a moderately firm toothbrush to massage gums and promote blood flow
• avoid acidic oral products and homemade remedies even if they’re not acidic but can be caustic, such as baking soda
• rebuild your gums’ and teeth’s protective biofilm (yes, there are “good bacteria” that are supposed to be there) with proper brushing
• avoid cleanings that are more intensive than brushing—skip flossing until your gums have recovered, too
• adjust your diet to avoid acids and (especially) sugars

10almonds note: she also recommends the use of xylitol to promote a healthy oral environment; we don’t recommend that, as while it may be great for the teeth, studies have found it to be bad for the heart.

For more on all of her advices and a bit more of the science of it, enjoy:

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Want to learn more?

You might also like to read:

• Toothpastes & Mouthwashes: Which Help And Which Harm?
• Flossing Without Flossing?
• Less Common Oral Hygiene Options ← including the miswak “chewing stick”, which even outperformed toothbrushes in clinical trials, by biochemically altering the composition of the saliva while gently cleaning like a toothbrush.
• Fluoride Toothpaste vs Non-Fluoride Toothpaste – Which is Healthier?
• Non-Alcohol Mouthwash vs Alcohol Mouthwash – Which is Healthier?
• Xylitol vs Erythritol – Which is Healthier?

Take care!