My 88-year-old diabetic Mom has 7 damaged teeth left in her mouth, in addition to 2 undamaged implants. Although the 7 teeth have chips in them, she still can chew with them. Eventually, she will complain that she has pain in one of the teeth, and then we will have that infected tooth extracted. Two dentists have advised that it's best to remove all 7 damaged teeth before infection sets in, since my Mom is a diabetic and infection in a diabetic is particularly dangerous. One oral surgeon has advised me that dentists will often suggest that all teeth be removed as soon as possible because they are "covering their butt". Although he is aware of my Mom's diabetes, this oral surgeon is more concerned that if we remove all of remaining teeth at once, it will be difficult for my Mom to chew. (My Mom has advised she is "not putting up with dentures"). My Mom is against having any teeth removed before it's completely necessary -- i.e., before she has pain because the tooth has become infected. She is also in the very beginning stages of dementia, and feels that the dentists are "in league" to remove all of her teeth. I am torn between removing all of her teeth now, or putting my Mom at risk by waiting for an infection to set in before removal. What further complicates things is that my Mom is becoming increasingly confused and physically weak from the natural aging process. I am concerned that if I don't remove all 7 teeth now, her developing confusion and weakness will make postponed extractions all the more difficult for her when we do eventually extract them. She doesn't do well "in the chair" and with time, that experience will only be more difficult for her. However, she is extremely agitated at the prospect of all her remaining teeth being removed, and I am earnestly trying to do the "right thing" by her. Does anyone have any opinions on this matter? If so, I would greatly appreciate hearing them, as I am truly torn. Many, many thanks!
I have had several root canals and a couple of oral surgeries to save a tooth (that eventually failed), two extractions other than wisdom teeth and implants. What I have learned is a damaged tooth does not always become painful or infected. A damaged tooth becomes painful when there is some decay into the tooth's central nerve. In some people that central pulp or nerve is quiet high in the tooth and sometimes even shallow fillings come near the nerve, causing pain (which can be treated with root canal or extraction) and if left untreated infection and abscess. In other people, the nerve is deeper within the tooth and not as easily impacted by fillings or other damages.
I would want to view x-rays showing the nerve depth and how close any damages are to the nerve. How long have the teeth been damaged? Can composite filling or sealer material be used to treat/cover the damages and extend the tooth life? My father had this treatment for several teeth opposite of crowns where the harder crowns ground down the softer natural teeth; applying a sealer every 6 months kept the teeth from abscessing during the last 2 years of his life.
In general, I would probably try to keep her teeth unless x-rays show the damage is near the nerve and likely to have problems in the next year or so. I doubt I would even consider getting all 7 removed at one time. The big complication with dementia is your mother may not be able to tell you about early small pain from decay into the tooth nerve so you would need to repeat the dental x-rays periodically; at some point in the cognitive decline she may no longer be able to brush her teeth effectively. I would also encourage the use of a dental rinse to strengthen the tooth enamel and reduce the decay rate.
Getting him to the dentist was a 3 person move--and then he had to be put in the dental chair--it was an all day operation. His dentist took a very gentle approach and pulled a couple of the teeth--but did root canals on others. He did see the dentist twice a year, always, and they really tried to stay on top of them so nothing got out of control.
Dentures were out of the question--he couldn't have stood the time in the chair. Just trying to stay one step ahead was the best. Fluoride rinse and helping him brush was about all we could do.
I do know he clenched his teeth really hard as the Parkinson's got worse and a bite guard was discussed and dismissed. For some people, that would be a helpful device. I've worn out 2.
I know at her age it’s hard to maintain oral health but she has to be diligent. Abscess’ are very painful & sometimes the Novocain won’t even work with a bad abscess. After 9 shots of Novocain I was sent home & had to go to an oral surgeon the next day to have it extracted under anesthesia. Best wishes to you both!
control, dietary needs. Next, will she stop recognizing you? I feel the dentist did you a serious favor by recommending removing the remaining few teeth. A very
soft diet can be easily "gummed" and delicious. This back and forth, trying to figure how bad is the situation , need for pain anesthesia = 100% removal. Then
start collecting favorite Mac 'n Cheese recipes.
It is important to keep teeth and mouth healthy as an infection can end up in the brain. My mother-in-law had that happen...they found it in the hospital.
Sis teeth are getting worse at facility. they are not helping to keep her teeth clean-decay is worse since 6 months ago. She can not remember to do for herself or if staff help every day or not. She is not allowed to keep toiletries in her room-thinking residents will be confused and think mouthwash is juice or spill or something else.
Both sis and dad had teeth pulled in the last 6 months-seemed to do okay, but not sure how it will go the next time-they both need to re-do fillings, dad needs two more teeth pulled. Neither one is going to get the daily assistance with brushing or rinsing to keep things from getting worse.
Sorry I don't have an answer for you as to a sure way how to get the job done, I wish I did. Maybe her doctor would prescribe a mild-temporary medication to help mom be able to sit in the chair and get some work done might be worth a try.
So. For me, I fully believe in palliative care at this stage of life. My mother is 93 and has more issues than Newsweek. I handle them as they come up, and refuse to borrow trouble. I believe in taking the most minimal treatment option available, no matter what issue she's facing.
Sure, in your mom's case she 'may' develop issues from these bad teeth that can cause even MORE issues. But guess what? Having all those teeth removed is an issue, too! So, pick your battles, like we said when our kids were little. If it were me, I'd let the teeth become a problem and then have them removed IMMEDIATELY, one at a time. Plus, she's against having them pulled in one sitting anyway, so there's little decision to be made here. It's her right to choose how she wants to proceed.
Wishing you the best of luck in a Catch-22 situation. If it's not one thing, it's another, isn't it?
This post helped me weigh the good and expected and the unknown. I wish I had some advice to give you. I'm sorry I don't.
By the way, I had all of my teeth removed and got dentures long ago. It was no picnic. Liquid or soft foods only for months. Dentures just do not chew like real teeth, so lots of digestive issues since then.
Both the teeth and dentures were a problem once mom was in the nursing home - she had bleeding gums because nobody bothered to brush regularly, and cleaning the dentures was hit and miss, some days when I went at lunch she wasn't even wearing them. Of course by this time she was on a pureed diet and she didn't need to chew BUT I knew that when she had her wits about her she would never allow anyone to see her without her teeth!
You could also inquire about the "sealer' that TNtechie suggested. That might be a better solution.
IF the damage is enough that decay might begin, I would honor mom's request to only take those that cannot be saved. Would she sit for "repairs", if it is possible to drill/fill any cavities? If she is only in the beginning stages of dementia, that might be a better way to deal with it as well. If a tooth would be better removed (repair too extensive?), I would recommend local anesthetic (novacaine) vs any anesthesia, if possible.
My mother was in early stages when I started taking her for cleanings (she hadn't been to anyone for a while.) Each time she would say they poked around, etc but didn't clean her teeth! This was a dentist I had been going to for decades, so I know they would clean them! They identified one tooth with a crown that had decay under it and had to talk with me (between her bad hearing and minimal dementia, she wasn't really understanding.) I basically approved the work for her. The crown had to be removed to repair the cavity and then have a new crown made. She tolerated this okay. She was still getting bills, etc at that point and was seriously questioning the charge she got for this as she had no clue what work was done!