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After my mother had a fall with a head injury, she was complaining that her teeth hurt. So we went to a dentist, who said the upper teeth were fine, but that two lower teeth have bad decay below the gum line (I was in the room the whole exam and saw the xrays) - these are teeth supporting a bridge, and I'm sure she had food stuck in there under the bridge which caused the decay. At any rate, the plan is to remove one tooth that cannot be saved, remove the bridge, and do a root canal and crown on the other. My mother is really stressed about this, which is causing more problems with cognition. She would like to be put under for the procedure, because of a traumatic dental experience with extraction when she was 12. Then she said she wants to just leave the teeth in until she dies, because right now they are not hurting her. I told her I could not guarantee that the decay would not hit the roots before she dies, and that if she really needs sedation, I will talk with the doctor. At her age I suspect that means an oral surgeon and a hospital stay. And concerns about more adverse affects to her cognitive skills. Anyone else have any experiences with this?

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I had a similar experience with my loved one. My cousin who has severe dementia. (She doesn't remember that she is afraid of dentists. Which is good, I guess,) She was diagnosed with gum disease and needing a couple of extractions. Her bridge had to come out as well. Their office did not do this and was going to refer her out.

I got a second opinion at a place that I know the dentists better. We discussed palliative dental care. Meaning we are trying to keep her comfortable and not frighten her or cause undue stress pain and anxiety. We want to keep her ability to eat and avoid abscesses/ They came up with a plan to do the cleanings in a more moderate way over time, instead of the major work the other dentist had suggested.

She tolerated the cleaning just fine as well as the extractions. He gave her a prescription for a pill to take one hour before her appt. That really relaxed her. She almost went to sleep and was as calm as could be. They would ask her if she was okay or felt pain and she was fine. The dentist told me that if necessary they would give her gas, but that was not necessary for her.

I think I might get a second opinion, discuss sedation options and try one procedure to see how she does, before doing anything major.

Oh, a root canal is not painful, IMO. I have had two and the second one only took about 15 minutes in the chair. But, that was with a good Endodonist. They do them all the time and it really makes a difference. They are expensive though. Are you private pay?
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Thanks. Yes, we are private pay, the dentist gives a discount if you pay in advance. They were very gentle and patient during the first visit, so I don't think I need a second opinion, but I will discuss sedation options. They do nitrous oxide. She is more concerned about the extraction, because her mother had all her molars removed when she was 12 - barbaric, I know. I guess that was common 70 years ago.
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I'm with SunnyGirl on this one. You need a conservative dentist who understands how dementia works. A dentist can be very gentle and patient, but they can recommend work far beyond what may be necessary, given the dementia. I'd also get a second opinion, just to be on the safe side.

Dentists today (particularly younger ones) go to marketing and sales classes and can recommend options that are overkill given the entire situation. I've had it happen to me. This may not be the case with your mom's dentist, but I'm just saying what I've experienced.

I'd question why a woman with dementia needs a crown at all. Pull the teeth and be done with it, unless that has to happen to replace the bridge. Even then, I'd question whether that's a necessary option, given your mom's situation.
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Mom is also rather vain, and the tooth that will be crowned is the canine in the front (lower). She is not happy about (as she puts it) "being a toothless hag". I'll let you all know how this goes.
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Is your mom on an anti anxiety medication? My mother is much calmer in general on a small daily dose. My mom also has dementia and as the dementia got worse her anxiety increased. I have much less trouble getting her to the doctor now. I would still investigate all of her options and see is something less drastic could be done. When I had an implant it was my front tooth. While I was waiting for my mouth to heal from the extraction I wore something called a flipper that was basically a retainer with a tooth attached so no one could tell I was missing my front tooth. I would suggest this but I'm not sure that a device would be ok for an elderly person. Also, if the issue is the bridge that is a whole other problem. Anyway, I would discuss all options with the dentist to see if there are any other options. Best!
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I also wear a flipper, but I'm not sure how well that would work with an elderly person, because you have to take them in and out. My mom (who's 96) has broken off several teeth, one near the front top, which looked awful. I took her to a dentist and he built her up a fake tooth that took 90 minutes. He's done that at least twice and maybe three times for teeth she's broken off at her gum line. Those fake teeth have worn just fine for her. It was like a miracle. I'll try to find my old post to see what it was called.
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OK, here's my answer from 2014: "OK, her dentist calls it a "Composite split bridge". It's made of composite material. He only does it on older patients. Like I said, it's worked very well for my mom. We're both thrilled with the results! I asked if another dentist would know what that meant, and his receptionist wasn't sure. So I hope you can find someone who could do that for your mom. "
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Thanks! The dentist did say we could go with a removable partial if she has trouble eating. I was a dental lab technician in a prior career for 10 years, so the concepts and lingo is easy for me. Mom has acrylic bonding on her upper front teeth to get rid of the gaps caused by the removal of her molars, and four bridges between the canines and the first bicuspid. I do need to talk to her doctor about the anxiety meds (as well as some depression going on that she is in denial about). I appreciate all the answers.
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Anxiety meds can be very helpful. My cousin takes Cymbalta and it really helps. Before that she was extremely nervous when seeing a doctor or dentist.

I would keep in mind that anything removable for a dementia patient is risky. As they progress, they may forget how to open their mouth to put something in or take it out. They may also take it out and hide the thing or throw it away. They can't recall what they did with it. That's one reason dentures are so impractical for most dementia patients.

If she has the funds and insists on the crown, then I would go with that as long as it's feasible. I believe in keeping our loves ones who have dementia happy as much as possible, when we can. My loved one has severe dementia and I do not have high expectations that her life span will be much longer. That's why we are opting for conservative care. She still eats well and is not in pain, so for us, that is successful. You can't tell she the extractions either.
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Well, this was an experience I would not wish on anyone. 3 1/2 hours in the chair, I was perched on a small stool in the corner. She did pretty well all things considered, the worst was the Novocain injections. And answering her questions between procedures. The staff was amazingly good and so was the dentist. I am upset because some of the decay is very old, and she told me she went for cleanings at least once a year before she moved down here with me, so either they let the cavities slide, or told her and she didn't remember to get them taken care of. I now suspect that the dementia started long before I had her come down here.
It was a challenge to realize that she was not totally aware of what had happened or why it happened, and to get her to comply with the after care.
I don't think we will be replacing the tooth that was removed, the space is not huge, and I am hopeful that she will not have any trouble eating.
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I'm glad it went OK...sounds like it was an ordeal for you!
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You have received excellent advice. i would add that a light anesthetic if she can tolerate it would be good and get everything done at once even if it takes a while. i would also request an anti anxiety to be taken before she leaves home.
If necessary it can all be done at a dental hospital preferably as an outpatient.
best solution is have it done in a dentist office that she is familiar with
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24 hours later, she seems to be fine. although obsessed with the gap where the tooth used to be. She wants "something" to hide it. I told her that once she is healed we can talk to the dentist about a partial, because another bridge would eventually cause her the same problems that this one did.

She is happy with the dentist at least, so that is something.
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Downsouth - well glad for you all this project is over! My mom did thousands of dollars of spend down in dental.....got rid of all her old removeable appliances & gum work done. It was on retrospect a very very good use of quite a lot of $$.

One of the staff at the NH mom eventually went into told me that the whole process of actually having to actively dine -the sit at a tablet, cut /fork /spoon food, place in mouth & chew, reach to get things -keeps their cognitive abilities & independence going longer.
Your lucky you found a dentist who worked with your mom in all this too. My mom just slipped under the wire in pulling those impressions for her last posts done.
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I am so glad I came upon this topic. My mom has 2 bad teeth. She's in later stages of Alzheimer's. She knows the teeth bother her, but she doesn't not-eat anything. The local dentist has grandiose plans to restore the teeth. I got quite a look when I suggested they just pull them. Long story short, after MUCH searching, I found an office situated in an AL facility that has partnered with the University's Dentistry School that has a geriatric dentistry program. I hope for the sake of all the people we care for that more dentists will become savvy to true "palliative" dentistry. BTW, in my area (MN) I found when looking for this, palliative dentistry is considered going to the Emergency Room when you have a severe toothache & they pull the tooth. Really? That's palliative dental care?
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Fix the teeth, put her under with anesthetic, and do not listen to what she has to say at this point. She has dementia. My husband changes his mind within two minutes. Do what is best for the remaining time she has left. She must be able to eat, and having just gone through this with my husband, she will thank you afterwards. Since this is going to be costly, check into an interest-free credit card "CareCredit" (by Synchrony) which will allow you to make payments without interest (as long as you pay within the 1--1 1/2 yrs.
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For what it's worth, in our situation, I don't agree with fixing my mom's 2 teeth. Her memory care MD didn't think that made any sense either. It's 2 upper teeth on opposite sides - one toward the back and one toward the front. She can surely function perfectly well without 2 teeth. (And we can be vigilant about maintaining the remaining teeth.) We have plenty of other things those funds can go toward. The cost of fixing 2 bad teeth would be better spent on time spent at a day program and/or installing some safety features. Sometimes having to weigh what you have to work with might seem barbaric, but we have to consider the greater good.
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My DIL is a dental anesthesiologist (also a board certified anesthesiologist, so she's kind of "overkill" in her job right now--super overqualified, but that's another story.

General anesthesia can be administered in varying doses. Your mom can be "lightly sedated" which has fewer long term complications and will make working with her (for the dentist) a TON easier.

The vanity issue is something you just need to address if she's adamant about it. My mother took $10K of dad's life insurance policy and had all her teeth veneered at age 76. It was a waste of money, IMHO, but she felt better about herself and it was her call.

Your mom needs to be able to eat confortably, and letting teeth rot in the mouth is dangerous and can have long term very bad effects...the mouth is a gateway to the rest of the body and bacteria from the mouth can enter the bloodstream and cause a myriad of problems. Deal with the decay and good luck with the rest.

Also, using an electric toothbrush is far more effective in elderly patients who cannot or will not brush.
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I am taking my mother to a dental college. She is totally immobile . They refuse to lift her to put her in a dental chair. I have no one else to help me unless they take off a day of work. They will only clean her teeth and not fill the cavities she has because they say of risk. She only has four teeth but has more cavities than that. I brush her teeth every day but with her condition she needs several small meals a day and takes meds that need to be crushed with food. I can't brush her teeth all day. I would like to find a dentist with accommodations for a wheelchair but have not been successful. She obviously has gum disease and dental problems her entire life. This one problem could cause her death with all the medical problems she has. Any suggestions???
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denimrock, I have heard that many patients with disabilities in my state of NC are referred to the UNC School of Dentistry. I suppose that they handle patients who are in wheelchairs.

My cousin saw two different private dentists and she is wheelchair bound, however, she is able to transfer to their office chair. If she couldn't transfer to their chair, then I"m not sure how they would handle it. Probably, they would refer them to the dental school. I suppose the dental college that you are referring to may be something similar.

I think I might talk with your mother's doctor about her medical condition in making decisions about her dental plans. Is she likely to stay totally immobile? What heath conditions does she have? Is she on Hospice? Is she receiving Palliative care from her medical doctors? What is her general health? There are many things to consider.

Even if she were to have extractions, I have been told that some patients eat just fine that way, even without dentures. Of course, they can't chew hard or tough food, but most things they handle fine. I'd discuss that with the dentists and see what the options are. Is she private pay or Medicaid? I think that will limit your options further.
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