I’m long distance from folks who are in assisted living. Both have dementia, mom is really going downhill mentally and physical.
Staff took her to dentist today as she was complaining about a jagged tooth. Dentist said all her teeth but two need pulled, decay, broken etc. They will send her to oral surgeon for consult then surgery at a later date if I as POA authorize it. Then would need dentures fitted etc. Good Lord......
I talked to dental assistant and nurse at AL. Dangers are abscesses, infections etc. can’t do root canals if she would get an abscess cuz not enough of the teeth left.
At this time there are no abscesses or infections.
I didn’t see this coming. Mom’s quality of life is about .1%. I can’t imagine putting her through the horrors of all these procedures. But if I don’t, will she die of some horrible infection? Im an evil neglectful son? I’m wondering how long she has left. Should I let nature take its course or do this crazy intervention?
AL nurse, good guy who I trust, suggested going through with the consult with oral surgeon and holding him/her to absolute minimum necessary. But even that would be so traumatic for her.
Sorry this is so long, but kinda freaked out here......
Dad's teeth started breaking in 2015. At least that is when his front teeth started to break and it was noticeable, I have no idea about the back teeth. It took until 2016 to convince Dad to go to the Dentist. The dentist discovered he had a few abscesses and treated those with antibiotics before commencing treatment. Dad had to have about 10 teeth removed, mostly they had broken off at the gum and would continue to be a source of infection. Dad had 6 removed in the office by the dentist (just local anesthetic) and was scheduled to have the rest removed later. Dad refused to go back. Fast forward to 2017, Dad had yet another skin cancer removed, this time from his back. Within a week it was infected. A month later I was at a social event with him and his dentist was there, he was complaining to anyone who would listed about the post op infection, he was blaming the hospital. His dentist pointed out that he had not completed the dental work, likely had yet another abscess and that would have been the source of infection.
We cannot force dad to get the rest of the dental work done. But it has to be noted on his medical records that he needs a round of antibiotics prior to any invasive procedure to remove any potential infection ahead of time. Will the condition of his teeth continue to impact his general health? Yes, but it is his choice.
Now if he had dementia and my brother had to invoke the POAs, then I would have, in 2015, advocated for the teeth to be removed by an oral surgeon under general anesthetic.
Lastly, although Dad is missing many teeth, including noticeable front teeth, he has no interest in false teeth. He has mostly eaten soft foods for years, so chewing is not a problem.
The other issue is the I.V. sedation anesthesia problem. The dementia will get worse temporarily and she may not go back to current status. The oral surgeon may be able to give her local anesthetic alone depending on how well she can cooperate.
Minimum is best but if they see something brewing they should do that too.
Hoping it is an easy experience for her.
Another instance was my daughter's father in law who had many teeth pulled and is happy just not to wear dentures. Once the gums hardened, he could eat fine.
Our Dentist told me that any work would have to be done under anesthesia and I know that patients and anesthesia and dementia do not do well.
Not to mention that I would have to control his reaction to having open wounds in his mouth.
Trying to keep him from jabbing something into his mouth because it bothered him, or dealing with oral care after each meal would have been difficult for him as well as me. (He had a tendency to bite down on anything that came into his mouth.)
So I dealt with the broken teeth, kept the teeth he had brushed several times a day. At this point he was on pretty soft food anyway so chewing was not much of an issue.
I did not serve very cold or very hot things so temperature sensitivity was not an issue.
Personally I also noticed that pain perception or the reaction to pain changed as he declined. So it is possible that the pain of a broken tooth that would have bothered him 2 years prior did not get the same reaction later on.
Most people over 90 will begin to lose their teeth, even if they have taken good care of them, due to degeneration of the jawbone and tooth sockets. (However, dental care is definitely related to lack of dental care - either personal or professional.)
Talked to her old dentist yesterday. I though he’d retired but he’s still going. He agreed with me.....Said it was insane to put her through 10 extractions and she would never be able to deal with dentures. We are arranging for her to go see him. He will fix the jagged tooth and keep her going like he’s done in the past. I should have called him from jump street but thought it would be easier on mom to go to the clinic near the AL.
Keep in mind this poor lady will be lucid one moment then look at me and say WHERE DID WINDY GO? She just scored 6 out of 30 on the SLUMS test. That’s pretty serious dementia. Gonna cut out 10 teeth on this lady? No F........ Way......
We talked about it, and he just went with it.
Both times it was smooth. Dad fell asleep afterward.
It is really toxic to have bad teeth in your mouth (infection starts at the root, not the gum line), yet weigh whether it's worth it or not.
The small cavities I'm not worried about yet bad teeth! It can cause major infection in the body down the road, in addition to making it hard to eat, which is extremely important. Truly, my dad's last pleasure.
Can you talk to your mom about it?
If you end doing it, do it at a time when she is most clear. It was mornings for my dad.
OR maybe they can just file it down so she's not bothered by it anymore? That would be least invasive.
Both oral surgeons had lots of experience with elders. There was no waiting, and communication and compassion throughout the experience. I was quite impressed really, and my dad was put at ease with all the little jokes at the beginning and then the quickness of everything else. The nurses held his hands....
Anyway, follow YOUR intuition about it, surely that will the clear answer.
Also. if possible, may be the sharp tooth can be gently filed down. With a smooth diamond nail file. Confession, I have done this to myself.
Good luck
My mom has always been a top to bottom all put together kind of person. But at this point in life it is all way too much for her.
So I don’t envy your predicament as it is mine too, but I second Golden, can you ask her own opinion? Whichever the case, I’d most definitely NOT pull all those teeth. That seems just a really bad decision from many points of view. Like many others recommend do the bare minimum, and if the doctor tells you “she’ll end up loosing all of them anyway, there could be a risk of...etc, etc”, remind him/her that you are aware everything is possible, everything is a risk at this point in life. It seems to be non stop with all the health problems that come up! But all you can do is take care of each problem one day at a time, one issue at the time. Getting ahead of the curve isn’t always advisable. You put off a fire when and where you see flames!
God bless you and your mom and helps,you make the best decision possible.
Dentists opinions vary greatly based on what I have observed. Maybe, her old dentist will understand the situation.
I wanted to avoid dentures at all cost. It's just not feasible for people with severe dementia, but, I have been told that they can eat pretty well, even if they have few teeth. As long as it's soft food.
I woulda said "H$LL no".
When mom was in the NH, the dentist would visit every 6 months. I could NEVER get the guy to call me back to tell me WHY he thought all of mom's teeth needed to be pulled and dentures made. I didn't pass the smell test.
I’ve pretty much decided I’m not going to put her through any extractions. What would she say if asked? HELL NO. I AINT HAVING ALL MY TEETH PULLED!
I called her old dentist office. Didn’t know he was still around as he is pretty old. The office is going to call me back tomorrow. He bailed her out about 3 years ago on a broken tooth deal.
That’s what started this whole mess. She had complained about a jagged tooth hurting her tongue. Not jaw pain, tooth ache, abscess ........I think the place they took her is a chain/dental mill....Rack up the procedures $$$$$
I think, as you get closer to the end, there are just an array of bad choices. Our job is to pick the least bad ones.
Twice, when they were in a very noticeable spot (next to the front), her wonderful dentist made her a fake tooth that he built up in 90 minutes. My mom had dementia and forgot about seeing him two days later. But she liked looking good and having a big gap in the front would have really embarrassed her.
She finally said "NO MORE DENTISTS". I also worried about infections and pain. But mom didn't suffer. She died at 97.5 and went out pretty well. If it was me, I'd do the least amount possible to ease her suffering and pain and just keep an eye on it. I don't think that most medical professionals understand the ramifications of what they're recommending for the super-elderly. Having ten teeth pulled with dementia is a big undertaking. I'd try not to do it, or do it over a very long period of time, with very small treatments each time to see how they go. {{{Hugs}}} None of this is easy!