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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......

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omg, I just can't imagine putting her through that. I just had some dental surgery and I am 61 and I am still trying to recover. Escpecially if you are added dentures to the scene, they hurt for months until your body is used to them. But then again there is the other side which are infections....I am so sorry this will be a hard decision for you. I would also follow what the AL nurse and go to the consult and see what they say.
Good Luck and hang in there. You are not a bad son, this is a very hard situation we find ourselves in.
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Fruit,candy, flowers or pastries would be appropriate.
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There is nothing much worse than dental pain so it is urgent that it be taken care of no matter the age. My mother had all her teeth removed at the age of 40 and I never could understand the reason.
Removing all teeth for the heck of it is plain stupid. Any that can be fixed should be which can be done under local anesthetic and extractions done with anesthetic.
Each case is unique ut unless someone is actively dying every effort should be made to treat the problem without going overboard.
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HOW DID IT GO? I wish I had seen this earlier. We made the mistake (and so did our GP) of approving teeth removal (by oral surgeon) for 90-year old. It led to a horrible infection that may have been avoidable had someone been there constantly to see to the bleeding hole it leaves. Antibiotics alone did not work and assisted living helpers alone were not enough. Really we should have left it alone.
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I'm so glad it worked out for you and your mom! I'd put it on Yelp and write them a thank you card detailing how grateful you are. You could also send a small flower arrangement if you wanted to buy them something. I wrote my mom's dentist detailed thank you note because I was SO appreciative of what he did for my mom (in 90 minutes, he built up a "new tooth" from where an old tooth had broken off in the front of her mouth).
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What an excellent dentist!!! I don't have a great gift to recommend, but a really excellent review on Yelp would be a good thing too. You don't need to mention there being no charge (you don't want a bunch of people going to him expecting free work), but just the fact that he went out of the way to help and take care a problem.
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Update...

So many folks chimed in with advice and experiences I thought I’d put out the latest news.

I talked to mom’s old dentist last week. He the called the AL and arranged for her transport to his office today.

He called me about noon. It went very well. He easily ground off a couple jagged edges on two teeth and sent her own her way. He’s refusing to let me pay for his services. She’s been a patient of his for 40 years, it was really nothing etc........

Such a relief. So gang.....Whats a good gift to send to the dentists office? Small place. Maybe 3 people..Fruit basket? Home Depot cards?
.
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Trevor - Regarding Medicaid & dental care, it’s up to your state to make the decision to include dental services as each state manages its Medicaid programs uniquely but within overall Federal guidelines. 
Most states Medicaid dental is only within CHIP - the children’s healthcare program - and geared for prevention which can be done by other than a DDS or DMD. Usually in large mobile units - own by the state but in partnership with a children’s hospital & a dental school- which travel to schools or other community sites. CHIP has a dedicated federal coshare for prevention programs & kids dental can get paid through this so for states it’s a nobrainer to include. Kids dental is mainly visual check up, annual bite wings & paint the incoming teeth.... costs minimal as most work done by a tech but effective long term. Adult dental requires actual dentist time and usually it’s specialist work so it’s expensive plus with medication and sedation, $$$!

Dentures get recommended as those are covered by Medicare. Medicare will pay a set fee for removal & dentures. The only other way MediCARE pays for any dental - to my knowledge- is if the breakage / damage is due to a major trauma that your hospitalized for & being covered by Medicare. So like your 70 & in a major car crash with shattered jaw; the dental reconstruction can be covered by Medicare assuming you find a oral surgeon and dentist who take Original Medicare or are in your Medicare Advantage Plan that has dental providers. But other than that, dental is all private pay. For my mom, she did a huge spend down in dental the decade before entering a NH... got implants, full front bridgework, replaced vintage fillings, gum tx’s; she had the $$ and for her situation, it was $$ well spent. But if she was in a facility and already in dementia mode, like Windyridges’ mom, I wouldn’t have encouraged it.

As an aside on this, when Medicare was being written into law in the 60’s, dentists were left out of any planning. It was a combo of issues as to why.... dentistry then wasn’t at all what it is now; back then loosing teeth was expected part of aging and folks just got dentures or did without teeth; & AMA wanted Medicare to be all about physicians; & AHA wanted it all about care in a hospital. The ADA didn’t present an active organized front to have dental as a part of Medicare. If an “oral surgeon” was needed, those rare guys were dentists who went onto a ENT or Head&Neck speciality residency at a Health Science center (has a medical school), so their DMD’s rather than just a storefront solo practice DDS. Most MDs never ever work with dentists, they usually do not have admitting privileges at hospitals, so got left out of the planning process.   Not to insult you dentists or dentists spouses or hygienists reading this, but back then being a DDS was way way below MD status. Dental school was the default for those who had less than great MCAT, no family/alumni connection and couldn’t do the foreign medical school grad approach to being a MD or do PH.D program. Nevertheless at least Dentures were included for coverage in Medicare planning.
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For various reasons, some individuals put off dental work. But into old age, leaving rotten teeth in the mouth is a risk of infection. Yes, I understand that dental work is expensive or the fact that some people have dentalphobia.
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Get a second opinion. If there are no infections, pain or discomfort at this time what's the point? 2 questions, can she live with the "jagged" tooth, what's the risk of surgery - i.e. discomfort, pain, infection.
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My FIL had a NH dentist request to pull 8of his teeth. He is on Medicaid and I’m sure they get something for their services, but I declined the services as I would have had to take him to the hospital to be knocked out. He has been in the NH for over a decade and I believe Medicaid covers several medical/dental procedures that are not necessary( I also declined pacemaker they said he needed 8 years ago). We declined dental work, teeth fell out or he pulled them out over a month. They convinced him he needed or wanted dentures, total waste of our/your tax dollars as he rarely wears them, he is 86.
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Windyridge et al: I follow Aging Care regularly & I was struck by how this topic is rarely addressed in information re: caring for the elderly! My parents (88 & 92) have had regular dental care over many years, so I think they're in pretty good shape. But you never know - problems can develop at any time! I'm glad you came to this site to get opinions & I'm grateful for all the responses.
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My Dad had oral surgery (at the VA) and they pulled all the bad teeth out at once. I can't remember the count, but I think it was around four. I thought it was going to be traumatic and painful for him, but it seemed to be fine. He was laughing and joking with the doctors and said he had no pain. After the drugs wore off (anesthesia) his mouth was a little sore, but no bad teeth = no more pain. I'd suggest going with the oral surgery -- the complications from not having it done are far worse, and once the teeth are out, she will not experience pain any longer. Worth it. I wouldn't wait - waiting makes it worse.
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I am curious if anyone knows what role Medicaid plays in dental care in nursing homes.
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My Mom died about 2 1/2 months ago. She was 97, almost 98, and went out with all of her own teeth! For as long as I can remember she flossed religiously. When she had to go into a NH after a bad fall and broken hip/wrist, she had to be her own advocate for her teeth - she had to insist on the opportunity and practical setup to brush her own teeth, because the NH staff never would have. About a year ago, she complained about a tooth that was sharp, and I took her to my dentist (not the Medicaid dentist) and he gave her a good deal that I could afford. She had two bad cavities in back molars, and he said if they were left, infection could set in and go to her brain or cause heart problems. We had them pulled, with local shots, and she was fine from then on. (I guess technically she went missing two teeth!) With your Mom's situation, I'd have sharp, or jagged, teeth filed or as a last resort pulled, but wouldn't opt to pull all of them. (I have total dentures and would hate to think of your Mom going through all the adjustments, both physically with the "fit", and then the trauma and "practice" to use them. Dentures aren't for sissies - especially the bottoms. And even dentures need to be cleaned regularly.)
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Thus far have only read a couple answers...but here's my nickle's worth: There are some good dental people out there...who "get it"...the trick is to find one of them and that can be a challenge for someone out of town. Call the nearest teaching hospital, dental school and ask who specializes/teaches in geriatric issues. Call the local Alzheimer's Assn. This isn't a situation that developed overnight, and she's not likely to die from it. Ask people as you go through this process who THEIR dentist is...see if the same name crops up. Call some local DDS and ask about their experience with elder or demented patients. They will, I sadly suspect, be hyper-concerned about anesthesia risk and not use much, if anything, for sedation. An oral surgeon should be regularly re-educated and trained, and if not affiliated (or getting a kick-back???) from the facility, might even give you a more rational outlook on what to do. Certainly depending on the input/advice, it might be better to not have a marathon session and do one or two at a time. IF it is necessary. And it might be, because yeah, things can go down hill and be bad and potentially effect her general health. BUT you can also keep watch, space out the procedures. In the end she has no teeth? Then what? Will she wear dentures? Will they be lost as so often happens? Will she be able to adapt? Hell, it's hard enough with hearing aids! The nurse you mention sounds rational. You might want to get hold of the records thus far, and when you find a good person, have a consult. Even more than one. It may be a worthwhile investment to check them out, get a feel for the office/staff. For instance a big practice/waiting room/lots of people may be rough on mom....a small office with no one waiting and where she has no wait may go easier. It bothers me that they already have things planned out. Don't forget that all of these "professionals" have a sort of legal obligation to forewarn you of what could happen and what is (generally) medically or dentally recommended...but that doesn't mean it is right for YOUR mom and her circumstances. EX: my mom is 95 and has dementia. DDS is a decent guy/next door neighbor. Had me come to a visit to better show me mom's issue with a FRONT tooth that he detected infection/problem with. He was obligated to let someone know. So that would (ideally) potentially involved the removal and then an implant or whatever. LOTS of visits, confusion potential etc. Person who would remove it is an oral surgeon who has become like family. Met him decades ago when I was beyond terrified of my own work needed. HIs own mom had dementia and was in a nursing home. So we're doing watch and see...mom not in pain that we know of (another issue, yes). How's your mom doing eating wise? What will that impact be? SO many questions. Maybe (haven't looked myself) you can google dementia/dental care and see what shows up. What city are you located in?
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Windyridge
DO NOT FEEL GUILTY.
Get the Dentist's diagnosis in writing along with xrays to consult with Oral Surgeon AND her doctor FIRST.

Yes, abscess are extremely bad no matter one's age, but especially your Mother's.

If these should rupture the infection will enter her blood stream and it is the heart that is effected the most.

Do you need to take penicillin before having any dental work done? If so, it's so you have a greater chance of not having an infection happen and mostly due to some type of heart issue.

I'm lucky enough that I don't have to yet, but I did end up with a rare infection caused by the hygentist accidentally getting too close to the salivary glands which is where you have lymph nodes under your tongue. Suck them dry with that suction wand. I hold it and contol now.

I ended up in the hospital immediately after I had to go to an ENT because I could not swallow and my throat was swelling to the point I would have died within the week if I had ignored it.

You're in a no win situation too.

The infection that could happen and doing the procedure at her age is also a danger due to anesthesia.

Opinions are like butt holes; we all have one. My opinion is to consult with the 3 doctors, but I would have the removal done. At her age, they may not fit her for dentures either. It may be better that she be placed on a soft food diet with supplements like Assure.
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Wow, this is a tough one....I would really have to think long and hard about putting someone through this...Just a month or so ago, I was visiting with my husband and noticed something wrong and thought maybe he had fallen and knocked out one of his next to the middle front teeth.. He is in a Memory Care Home and didn't seem to be in any pain but I made sure I got him to the dentist...After checking, he had lost a filling (looked much worse than it really was) but the dentist said, after making sure the nerve wasn't exposed, all he would do was file it smooth and not put him through any more....My husband is 87 and would not be able to tell me what to do if he had needed to have teeth removed...It's really hard making decisions when you're really not sure....My heart goes out to you......
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MaryKathleen...just read your post it my dad...we had a good laugh! 😁
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Sometimes I think Dentists, like a lot of other disciplines, want you to look perfect. They are thinking of how to make you look your absolute best. They forget your age, finances, etc. They don't understand that a lot of older people can't or won't wear dentures. I think of it this way. They have pride in their work.

I agree with a lot of other people. I would go slow and want to know why each tooth needs to be pulled right now.

Reminds me that when my mother was in her 80's she wouldn't go to the dentist. She pulled her own teeth. My mother was tough.
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Kind of a trying decision either way, but rotten teeth can be painful and result in infections. While we all dislike the idea of pulling teeth, in fact, today it can be done quickly and painlessly. The teeth of elders are also not as imbedded (attached) as when we are younger - and can be extracted quickly. I had a similar experience when taking over health care advocacy of an old friend - we both worried about the dental work that had been avoided for years. In fact, we were in the dentist office less than an hour - and he pulled 7 teeth in about that many minutes, they didn't bleed and healed quickly. Of course, each case is different - there may be crooked roots, impactions, exposed nerves, reactions to pain killers, etc. You'll just have to weigh the positive and negative factors.
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My mother-in-law, 92, advanced dementia, has one remaining tooth. The others broke off over the years. Her dentist, we were told, was able to pull one of them several years ago with the plan of making her dentures. She refused to go to the next appointment, and her son, then her caregiver, didn't force it.
When my husband gained guardianship two years ago, he took her to a dentist. The dentist said there was very mild infection, but it would be too traumatic to pull the other broken teeth, and could cause her more harm than good (risk of anesthesia at her age, infection, inability to eat). She was eating a soft diet well. He said if she complained of mouth pain, to bring her back, and only then would he consider doing something, if the benefit of treatment outweighed the risk.
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You should be very concerned about the rotten teeth turning into sepsis.That alone with kill her.
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Hi Windyridge,

Sounds like you received excellent responses! I wouldn't have my Mom's teeth pulled either.

I had 8 teeth pulled for a denture a couple of years ago and I used a product called Nature's Answer PerioBrite Cleanse which helped heal my gums and prevented infection. I don't know if your Mom would rinse with this but I just wanted to mention it because it helped me.

Jenna
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Mom's dentist chose to polish down root tips and make a temporary partial (a softer material) to protect the 4 teeth left on her upper palate. The decision was to basically leave them alone unless a problem like infection became evident.
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Thanks all for sharing your experiences. I’m good here.....NO TEETH PULLING

The AL is arranging to take mom to her old dentist. I talked to him yesterday. He’s going to grind off the rough edges. Done......
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The dentist wanted to pull DH's (96 yr old)  front 3 teeth and crown the 4th. He already has a partial and there were no plans on the dentist's part to add teeth to the partial.

As luck would have it, they forced my hand when they made me leave him alone in the waiting room to pay $103. He was supposed to return in 3 days for the work. I totally freaked. After 28 years with them, they couldn't trust me 3 days for $103.

Went across the highway and found another dentist that rebuilt 2 of the teeth - pulled nothing - for 1/3 the cost.

Get your 2nd opinion.
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I would definitely get another opinion to start....maybe from her old dentist, the one you trust. I, myself, had a situation with a dentist when I was in my 30's. Went in for a cleaning and was told my teeth were in terrible shape, I was going to get gum disease and lose all my teeth, and was accused of not even brushing daily! They put me on prescription mouthwash and everything! Eventually I went to another dentist, who basically laughed when I told him what the other dentist said! Today, at 52, I have had no issues, get 2 cleanings a year, never use prescription mouth wash, and am no longer scared to death of the dentist! He said I do have a higher plaque buildup than most people, and periodically I will add an "extra" cleaning in the cycle....but that is due to my body producing more acidic saliva (or whatever they call it) and it is nothing I can control, even with proper brushing and flossing. So my point is, don't trust the first opinion, esp. of a dentist you don't know. I'm betting there are better options available other than pulling 10 teeth! Even just taking care of each problem as it occurs seems to be a better option than putting mom through that trauma this dentist is suggesting.

P.S. The dentist who told me I would lose my teeth is out of business, or I would have taken him to court!
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I worry about this too. Dad's dentist was his high school friend. He went only when he had a problem. But when the friend/dentist retired that was that. So about 5 years ago I took dad to one of those "dentures only" places. They took xrays and said dad's bones were very dense and it would be an effort to get his teeth pulled. And like others have said, dad didn't even want to spend the $80 to get the eval so he certainly was NOT going to pay thousands for dentures when "he didn't hurt". Fast forward, his teeth are worn to the gums, front teeth broken, etc. He doesn't brush at all unless I tell him to and I'm not there every day (he lives in his own home). So, I just let it go. I ask him if he has any pain and he says no so I guess if he ever has pain I'll get him to a dentist. And yet I worry. Ugh.
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Hi Windy... I’m in agreement with most folks on this one. We just went through the rotted off broken tooth thing a month ago. It was only one tooth that broke off and left a jagged mess at gum line. She also had cavities and some other issues. Dentist pulled it and filled cavities and wanted to do a partial denture or implant. I’m like really? No way. Aside from the need for a multitude of visits and after care, I weighed the options. Spoke with 2 other dentists. Both agreed if no active infection, go on as needed basis from this point on. Leave the pulled tooth alone and don’t worry about asthetics. My mom forgot about the missing tooth the day after the jagged mess was removed. Until it got pulled, it was all she could focus on and played with the area with her tongue non stop. Although there’s a big space where the molar was, she has no pain. We don’t have to worry about dentures. I now make sure we brush and floss together and pray no more teeth fall out. My mom has a dead black tooth too that we left alone because it still was functioning. Dentists basically said if no pain and no infection, leave alone and address on tooth by tooth case. So difficult to make decisions for someone incapable. Best to you...
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