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He needs seven teeth extracted for new upper and lower dentures. As his wife and caregiver I do not know if he can withstand oral injections much less the amount of pain, and pain meds. Has anyone had similar situation?
I have been preparing soft food but existing denture and partial cannot be repaired. Appreciate any insight. He will need medical clearance from Primary Care and Cardiologist. However, I have found more advice and answers here.

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Thanks for the update.
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Update: The teeth have to come out because they are causing infection and are broken. Found dentist who took time to explain everything. They bill as the work is done. Over 3x the cost from the "drive thru" dentist. They were professional, took extra good care of him during initial visit. They are accustomed to working with seniors and dementia. The cardiologist is allowing laughing gas to help my honey. Still haven't gotten a refund on the $2,225 put down at the other place. Put it in dispute with credit card company. Thanks for all the help - it helped me ask right questions at our appointment. Extractions will be done third week in October. Again - thanks.
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Grandma1954 avatar
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Grandma1954 Sep 2021
Thanks for the update.
It is nice to know that there are some professionals that will do what is best for the patient.
Hope all goes well for the refund!
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Certainly the dental surgeon sounds the best route to go, and he will liaise with other medical professionals treating your husband.
I am a little concerned about the answers you have received about having multiple teeth out in one sitting. This is fine if the teeth are "solid" nicely straight, and not affecting bone and even worse putting infection into the sinuses. However if teeth are rotten the chance of extracting them in one piece is very reduced - this means the dentist/dental surgeon has to hunt around to find every tiny piece that did not come out. Also if he has had teeth which have damaged the gum and bone area this can regrow round the tooth and into any destroyed area (particularly is it is a tooth that may have had work e.g. a root canal done at some time in the past). If he has any of these problems then the extractions can take a very long time to do. There is a lot to consider with a dental surgeon in addition to the anesthesia, and after care. But as others have said infection can in itself be dangerous to the health of other organs. I think you have the right idea and the three medics concerned need to have some conversations so that you can hear all the options and decide on the way forward you think your husband will cope with best.
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LNReason, one thing I forgot, my dads procedure, 14 surgically removed teeth, took less then 45 minutes.

He used an oral surgeon and a dentist for the dentures. It was one of the best things he did for himself, his overall health improved because his teeth were rotten and causing perpetual infections. He felt sooooooo much better after the procedure.

A good oral surgeon will do his teeth in no time, with minimal trauma and they will probably do some stitches if needed to ensure no dry socket.

I am praying that you find a top quality oral surgeon and your husband is done with this likety split.

Remember, lots of ice cream the 1st week to reduce swelling and help pain. My dad got 3 milkshakes a day and sipped on those to get through the discomfort and he only took tylenol a couple of days. No additives, just creamy ice cream.
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As dentist can provide sedation and local anaesthetic I think your bigger problem is maintaining the very high level of oral hygiene that will be required following extracting 7 teeth in one go. Unless the teeth are rotten or causing problems why extract teeth to make denture - make them to fit with the teeth he has - not a repair a newly made set that cater for any oral changes. There is no way I would be agreeing to this without a second opinion and having the Xray fully explained to me for each tooth dentist suggests removing. Having personally had 3 out at the age of 64 (done in 2 lots because even then appointments were over 2 hours each) I wouldn't consider having mass dental work done that hadn't been proved to me as necessary. OK - our dentist does have a 3D Xray machine but generally UK dentistry is behind that in the US, so I would seek a second opinion.
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LNReason avatar
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LNReason Sep 2021
The teeth are rotted, bone problems and cannot be saved. I am going to seek oral surgeon and not a place where they mass produce dentures.
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I needed a broken tooth extracted and the periodontist used a high power water jet tool to release the tooth from the little ligaments that held it in place. He said it doesn’t cause the trauma of a typical extraction. The jaw was numbed first and I didn’t even know when it was out. Perhaps you could ask for a referral to a dentist who could perform that procedure on your husband.

My mother had a heart murmur and her doctor always prescribed her antibiotics before any kind of dental work, even teeth cleaning.
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LNReason: Imho, perhaps he will not require anesthesia for the procedure. His cardiologist will no doubt require him to take medication before the procedure as standard practice for a cardiac patient. If he goes ahead with the procedure, he must be very careful that he doesn't get a dry socket(s). Perhaps he can tolerate pain medication.
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Get an opinion from his doctors for each particular procedure. Cardiologist work with dentists on a regular basis as tooth infections can cause serious problems with the heart. The strain of the extractions could also affect his heart. Doctors often think only of the organs in their specialty and forget about the other organs. As one of my Dad’s doctors said: “We tend to root for our own organs and forget about the rest.” This is why the primary care doctor is so important as they look at the whole patient, not just the specific organs, and they look at the mental well-being of the patient.
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It was the general anesthesia that provoked my husband into dementia according to his cardiologist. The dentist who removed his teeth for upper dentures did not supply antibiotics. Little did I know then. That was a couple of months before his heart attack.
So when he needed teeth removed last week, he got antibiotics, antibiotic rinse and ibuprofen (also hydrocodone, but that is another story). So far so good.
The local injection of novocaine or whatever it is, is not a general anesthesia, so no dementia worries there.
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I had 11 teeth pulled in one sitting without anesthesia; with just novocaine, in the dentist's chair, without issue. But, if your DH has dementia/Alzheimer's, I'm sure he would not sit still in the chair for such a procedure.

If it's absolutely required that these teeth be pulled, I'd look into having it done under twilight sleep sedation vs. full-on anesthesia. See what his doctors have to say about that sort of medication, and go from there. Be aware, however, that new dentures take A LOT of getting used to. And, a person with dementia may not be compliant with such a thing. There's also quite a few 'adjustments' necessary for a proper fit with new dentures, where DH will have to tell the assistant where it hurts, where the filing down needs to happen, etc. I don't know how advanced his dementia is, but some level of cooperation and cognizance will be required on his part for a successful end result.

BEST OF LUCK!!!
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LNReason avatar
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LNReason Sep 2021
He's losing his ability to communicate. I don't see how he can live with rotted teeth. I married him in 1984 and he just had his dental work done and again in 1987 - he had a horrible time adjusting then when he was younger. I feel bad I didn't know enough about dental that's why I'm asking for help.
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What about the laughing gas?
I had that after an implant failed and I needed it removed.
Can he tolerate that?
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Check out (POCD) from anesthesia
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Plus he can’t take all that pressure in one setting.
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It’s true u can have the teeth removed but not all at once.
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lealonnie1 avatar
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lealonnie1 Sep 2021
That's incorrect advice.
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Please be careful. That’s a lot going on. My uncle was in his late 70s and went to the doc and they pulled out to many teeth at one time and he caught an infection and unfortunately passed away. He was going to get implants. Just get a whole set of false teeth and eat soup chew slowly sometimes we make things to be worse
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if he has rotted teeth........get with the doctors and get them removed asap. an infection in the gum area can lead directly to the heart (as I was told by my dentist and doctor)............plus the bad teeth will put that poison thru out the rest of his body.
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find out from the dentist what they will be using for numbing and then speak with the heart doctor to see if okay. and normally for only 7 teeth he would not have to be put under, just the numbing stuff. can they do 3 one time, then wait a week then do the other 4? each place might be different, but run it past the doctors to see what is best and keep after them until you get an answer as they are the professionals, which none of us are. wishing you and hubby luck.
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I would do what his doctors recommend. I think the procedure would be too much for your husband and he does not want it. Good oral mouth care with a gentle mouthwash after meals, perhaps a water pic might be beneficial. Good he is on a soft diet. He should have a consultation with an oral surgeon to see what he/she thinks is best for your dad and have them discuss it with his doctors. Tough decision but the infection can progress and cause serious health issues and a lot of discomfort.
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Hapcat has the best answers.

You, as his wife, know what he can or can't tolerate as far as pain, and I completely understand your reluctance to put him under anesthesia, given his medical history. You also have to think about the long recovery period as Hapcat outlines.

Can you get a 2nd opinion from another dentist on whether or not they can make partial dentures, bridges or any workaround without extracting his existing teeth? A skilled dentist may be able to find alternate ways to circumvent these issues rather than go the traditional, easier way. Push them to try.

Keep us posted!
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Pretty clear here, New Chompers won't do hubby any good if he's dead.

Follow Dr's suggestion and don't have him get any anesthesia!

If you were told that regarding yourself, would you go ahead and chance a heart attack or death verses some shots?

Have you called around to see if anyone can make new dentures just using his old ones as a model instead of his mouth.

Juse curious, what are your husband's thoughts?

Prayers
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LNReason avatar
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LNReason Sep 2021
Top dentures can be done - but bottom partial cannot be repaired as the teeth are all rotted. Have apts set up with cardiologist and primary care. He does not want the procedure. I need to get him to a regular dentist (oral surgeon) not a dentist super center - with no personalized care or effort to answer questions.
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Commenting on HarpCat's excellent advice, as to temporary blood thinner as opposed to something like Warfarin, it's been my experience that doctors recommend and use Lovenox, which is fast acting and doesn't remain in the body as long as the usual blood thinners.   My father's had Lovenox on more than a few occasions, with no side effects.   

It was administered by a shot in the upper abdomen close to the waist.  I couldn't do it though; I just can't put a needle in my parent.  It might be that the dentist or whoever monitors your husband's PT/INR could see him before the procedure and administer the shot, but going to 2 doctors in one day might be a bit difficult and unsettling.
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My hubby is 81, with A-fib, CHF, pulmonary hypertension, and dementia. Last year he had 14 teeth pulled to fit a lower denture. He had no problems, either with the novacaine or Tylenol.
We went to a geriatric dentist, who required a comprehensive medical history, and a clearance from his PCP and his cardiologist. It might serve you well to find a geriatric dentist in your area to evaluate your husband. Hugs.

Edited: The geriatric dentist made a "healing" lower denture which my hubby wore out of the office after the extractions. He ate soft foods for a week until he went back for a follow up appointment to check healing. He had to rinse his mouth and denture with warm salt water after every meal. After one week, he could eat whatever he wanted. He wore the "healing" denture for 9 months, with monthly checkups, until he got his permanent denture. He has had no problems after a couple minor adjustments.
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You are right to be very careful about this. His doctors instructions are clear. Talk to the oral surgeon and tell them what his doctors advise.
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Talk to an oral surgeon. They can do "conscious sedation" where he is awake but groggy. Usually, he receives anti-anxiety medications so he relaxes through the entire procedure. There is oral (surface) medications to numb the gums so that he won't feel oral injections to locally anesthetize the areas of surgery. Afterwards, he can be given liquid pain medication and will need a liquid diet until the surgeon says he can have firmer foods. Conscious sedation shouldn't be a problem for his heart or other health issues.
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Can the dentist/oral surgeon administer gas?
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Does he have current infections?
Are his intact teeth painful?
Can he eat without the current dentures?
If he has no infections, If his teeth are not painful and he can eat I would not put him through a protracted dental procedure.

The problems with anesthesia are one thing. Difficult to recover from, may not return to baseline cognition
The problems with dealing with open wounds in the mouth that he will try to pick at, having him comply with oral care after surgery. And the potential for infection, dry socket after. THEN getting him to sit still or having to undergo anesthesia again for them to put that "goop" in your mouth in order to make the mold.
I would not put him through a procedure like that.
As the disease progresses he will go from soft food to pureed food just as a result of disease progression. You may put him through all this and in a few months he may not be able to eat anything but pureed foods anyway.

I may be biased but I, as the wife, caregiver, guardian for my Husband elected NOT to do any dental work as long as he was not in pain nor had any infections.
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Harpcat’s response is right on. Many dentists will not deal with a patient who suffers from dementia and behavioral problems. Also many seniors will not tolerate the procedures and follow-ups for dental work and dentures. My only additional comment is that you need to determine if is it worthwhile to extract the remaining teeth or wait until they fall out, and then let dad eat with just his remaining teeth.
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I am a retired dental hygienist and have also taught in the dental program at the university. Have worked in the field for 35 years.
people on here are right that dental infections are serious. The same circulatory system runs through our tooth and gum blood supply that goes through our heart. That bacteria can cause lots of problems in the heart, liver etc. if he has infected teeth or they are loose due to periodontal (gum) disease they need to come out. Since he sees a cardiologist, he may be on a blood thinner which would be stopped for a short time to cut down on surgical bleeding so he will clot after as well. An oral surgeon would be the best person to extract. They can provide either just local anesthesia which given by an expert after using topical numbing gel is hardly felt. Sometimes they can use a mild sedative like Valium. I would not let them give him Versed which is IV sedation, because in older adults it can cause cognitive issues after and affect memory.

once he heals and the tissues shrink he can then have the dentures made. These will be made by either a general dentist or you could have them made by a specialist called a Prosthodontist. For me, I would see the specialist. Well made dentures are not cheap…usually running around $3-5000. Do not go to a place like Aspen Dental which are usually run by recent graduates. Mind you this will take several visits and after he gets them he will need further adjustments. Getting used to new dentures is not easy and will rub sore spots on the tissues until they develop a "callous". So the dentist will grind away some of the acrylic where the denture is placing undue pressure.
Having teeth for appearance and for function such as eating and talking is important for social as well as health. However, only you know if your dad can tolerate the visits required. My dad had full dentures for over 60 years. He was in the NH and had lost so much weight they wouldn’t stay in. I did take him to get a new set and he could not adjust. With his dementia he was also an awful patient. Finally he wore his old set until they tossed away his upper in a napkin on his tray. After that he just would eat a soft diet.
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LNReason avatar
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LNReason Sep 2021
I'm going to try to print your response to take to both doctors. My husband
does have periodontal disease, all teeth are rotted and not even in his mouth straight. He's on antibiotic but the x ray also showed sinus infection. Waiting for appointments. I went to dentist "doc in a box" - wasn't impressed at all. I have to get my $2300 prepaid money back.
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When my mom needed several teeth extracted (she had avoided the dentist for 20 years!) her dentist referred her to a dental surgeon to have them removed under sedation and that concerned me because at the time she was just beginning to show signs of some mental and physical decline due to several TIAs. I called around for second opinions and found a dentist who had worked extensively in nursing homes and was well aware of the problems older people face. He he advised saving 4 lower front teeth because a partial lower denture was much more stable, and he was able to remove mom's teeth with a local - sorry I can't remember if he did that in more than one appointment. Mom healed well and was able to adapt to the partial.
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ckrestaurant1 avatar
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ckrestaurant1 Sep 2021
Seems that having multiple visits rather than doing all the extractions in one visit however given the undesirable ability to transport these elder patients I can understand the hesitation...pulling one tooth at a visit certainly should lessen the impact...my Uncle had his daughter take him to the dentist or oral surgeon I believe and extracted multiple teeth perhaps at the urging of the doc or herself wanting to finnish with the task of preparing for dentures but my Uncle had a fatal heart attack weeks after the prodecure. So a conscienous dentist or not wanting multiple visits perhpaps exacerbated the trauma to the body. Teeth are an immensely diificult geriatric problem...checking on a seniors teeth earlier is paramount..NH regularly misplaces dentures and from my experience do not like the job of placing the dentures in the mouth everyday....this is true as one day I asked about it for my father because i was so preoccupied with observing everything else that was going on like bathing,changingsheets,transfers for eating,feeding at the bed by someone and I found the NH does its best but think of all the jobs that need to be done by multiple workers for the declining patients....degree of their dissability...as it worsens..in my case I did not know that dementia patients should be in a different part of the NH requiring much more attentivness....I mean its hard to feed someone three times a day yes?..and you are better off with a pureed diet...or health drinks with vegetables and fruit...
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LNReason, I was on a soft diet for about 2 months recovering from a fractured jaw (in 2 places) after a negative encounter with a tree that didn't want to be cut down.   Six teeth were knocked loose; nerves of 3 teeth were almost severed, and a titanium plate inserted in my jaw.    All I could eat was soft or pureed foods.   I was sedated for the surgery, but there were no other medical issues, so I'm sharing the post-surgical issues for what they're worth.

I don't specifically recall the type of dentist who handled the surgery but I believe it was a periodontist and performed in a hospital, with an overnight stay.  He did prescribe a special mouthwash as I couldn't brush my teeth either. especially with the entire lower level wired.

You're definitely on the right track with soft food.  

When my father needed dental work in his 90's, our regular dentist recommended a Endodentist.   It was quite an experience, very tailored, considerate and compassionate.   I don't recall what anesthesia or meds were administered, but Dad had no issues other than just sitting in the chair for so long.

The anesthesia did not knock him out though; he was conscious throughout.

I also don't believe he had to get clearance from any other doctor, but of course his situation was different.

I mention these only as potential alternatives to anesthesia which could be more compromising for your husband.  

Do stick with the soft foods though; a dysphagia diet could offer some suggestions as to how to make food tasty and presentable.

Good luck, and I hope everything works out well for you and your husband.
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