Dentist wants to pull 10 teeth on my 87 yr old, demented mom. Any suggestions?

I have not read all the responses yet. But I can tell my Dad's story. Dad does not have dementia and is now 89.

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.

Trevor--I posted a question about this several months ago and received a number of responses, some suggesting the family members have to provide this in the nursing home while others mentioned obtaining a prescription for it making it required in the NH. Unfortunately, I don't know how to find that string again, but perhaps you do or another reader does. As I recall I worded it something like "how much responsibility does a nursing home have for providing dental hygiene?" I hope this is of some help!

I'm both a RN, and a direct patient caregiver for my 86 year old father with frontal temporal dementia. I was amazed that both your mom's dentist and facility recommended dentures. For a patient with dementia, dentures are a huge choking hazard and I've seen them actually cause death due to the person swallowing them, and the airway is blocked. Your mom is likely grinding her teeth. .common with dementia ...leading to chipped, fractured, and infections of the teeth. It's our role as children to make best possible decisions for them, which is difficult from far away, and I'm sure causing additional anxiety. Think about this...how far advanced is her dementia..is she end stage? Does she has awareness and any real quality of life currently? Is she currently on a regular diet? If so, would she have sufficient teeth placement to continue a regular diet if these teeth were removed? Is she already on a soft or pureed diet? If she is, then being able to bite and grind her food would not be needed. When I took over care of my dad, I found he had neglected himself....many teeth were unsalvageable. My father has 10 remaining teeth, no dentures, eats a regular diet, including meat because he is mid stage, has 4 opposing (upper and lower teeth that meet). When patients no longer have opposing teeth, and/or dementia progresses, they would have to change their diet to soft, and sometimes to pureed...again considering # of teeth, placement of teeth, and level of dementia. It is highly likely that Mom is grinding her teeth, which can fracture and chip teeth, huge risk for infection, etc. My dad does this too...but we were able to smooth out his teeth that he damaged. Now he does not cut his tongue, inside cheeks on those jagged teeth. A night mouth guard to prevent grinding is as inappropriate as dentures for dementia patients. If a tooth is badly infected, or will not likely to hold a filling, then yes, sometimes they must go. My view as their children is to cause no harm, to maintain them the best we can, with as much quality of life, and dignity as possible. I find parents in facilities get best care, when children know all the details and are highly involved.

Hubby is a dentist and would refer a case like this to an oral surgeon for pt care and safety. Removing 10 teeth may not be as difficult as it sounds especially if teeth have been loose and/or infected already. The thing that will affect her most is her current health or blood thinners, osteoporosis meds. These are both contraindications. Blood thinners can be removed for a time and then procedure is safe. Not so with bone density drugs if there is a history of ever taking them. The pt would be at risk for osteonecrosis (bone death) of the jaw.

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.

Windyrige here is another perspective. My 87 year old Mom who has medium dementia and is in fair health was recommended by her dentist to pull her 6 remaining upper teeth. She had a partial, a huge cavity in one tooth and an abscess in another. She made the decision with my encouragement to go ahead. He measured her for an upper denture and it was made prior to pulling the teeth. The teeth pulling and the preliminary denture fitting were made the same day in two appointments 6 hours apart. I was amazed.
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.

My only comment is regarding dentures. With my mom, it got to the point where it was virtually impossible to get them in and out to clean them because of her dementia. She didn't know to open and close her mouth. She would hold her mouth tightly closed when someone tried to take them out or even try to bite us. She quit wearing them and just went on soft/pureed food. Also, she would randomly take them out before she got really bad and we'd have to look everywhere to find them, including regularly going through the garbage. Best of luck with your decision. Do what you feel is best.

Can you speak with a palliative care specialist? If your moms’s quality of life is at 1% as you say, isn’t the most important thing to keep her comfortable?

Windy, so glad you’ve gotten in touch with her dentist and gotten a sensible plan. I think the idea of what was proposed was cruel and I’m happy you’re not going down that road. BTW, if it should come to losing the teeth, one way or another, I had an aunt who lost all of hers fairly young, never adapted to dentures, and ate any and everything she wanted, steak included. We called her “gums of steel!”

Once my Husband became "non compliant" at the dentist office I made the decision not to take him any longer.
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.

I'm all for doing the least invasive method possible. But if a person has rotting teeth, they cannot be left in the person's mouth and need to be pulled. If she opts for the root canals to save some of the teeth, they can give her the nitrous oxide gas to help get her through the procedures.

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.)

Update:

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......

I have worked and taught in the dental field for 30 years. Yes dental infections can become systemic and cause heart problems for example. However I do agree that the oral surgeon should see her and come up with a treatment plan that removes the "ticking time bombs" but hopefully leaves enough teeth so she can eat. The problem with dentures is whether she can get used to them at her age. It is not easy or simple. Many refuse to wear them and go without teeth. These are the difficult decisions. If I were you I would have a private conversation with the dentist before he or she sees your mom. Tell her your thoughts on the matter and then go in during the consult.

My dad w mild dementia had to have 2 teeth pulled in the last year, 2 different appointments. One was in an office and the other appointment was in his room (!)
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.

If she has an infection (abscess) then yes, I would say have it pulled. They can be nasty. Not to mention very painful.

My mom has dementia. About 3 years ago she was complaining about a toothache. I took her to a dentist and they took x-rays (or tried to). It was a difficult process. My mom won’t let them. The dentist suggested an extraction and deep cleaning. The explained the procedure to me and that she would need a dental surgeon. I thought about the disconfort, pain and troubles this would cause her. I spoke to another dentist and her doctor. I decided not to put her through this ordeal. I kept a close eye on her for signs of discomfort. The pain went away. It’s more than three years ago and I am glad I did not put her through that. It’s tough choices we must make and you know what would be best for her.

I agree with BarbBrooklyn.

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 mother is in her 90s in a nh. I have been worrying about the issue of dental problems for some time, not because the dentist has reported something but because I don't think the nh is very thorough in examining. I don't know what I'd do if I had your problem, certainly only the absolute essential. Very worrying issue. I'd be interested in reader comments on nh dental care and any preventive advice.

Put her on hospice care (comfort care only--fixing to die) if you don't want rotting teeth removed. An abscessed tooth is really a medical emergency.  But I understand how it's like someone with end-stage Alzheimer's to get them to brush well--especially they are fighting you. They also pocket food in their mouth so brushing alone does not always work well. What works best for me is to have her brush AND use a water pic twice a day. IMMEDIATELY after eating. Have a regular feeding and oral care schedule. Once you establish this as a routine it gets easier. But yes it is a losing battle..brushing combined with a water pic really helps a lot and also put some Listerine mouthwash in the water pic. that really helps a lot too.

I completely understand you. My mom is so, so fed up with everything failing, it is heartbreaking. Right now she’s struggling with her teeth and gums, they hurt terribly, yet she keeps postponing the dentist visit. She already lost her two bottom front teeth and she doesn’t wear anything to cover up the gap unless she goes out, which is infrequent.
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.

Hey Windy, you can call the vet and he/she'll file her tooth down just like they do the horses! (lol)

Then you have your answer, Windy. And you can deal with any issues as they arise. Hope her old dentist has some wisdom.

Windy, I would get a second opinion, though, I know that is easier said than done. The reason I suggest that is that I got VERY different recommendations from dentists for my LO. One wanted her to undergo deep cleaning under anesthesa, referred her to the dental school that was hours away. That was not feasible, to me, so I got a second opinion from a dentist that I knew and he treats patients with dementia. He was able to come up with a plan of regular cleaning in office, a few extractions and good oral hygiene regimen at the MC. (Prescribed brushing and oral rinse twice a day. If prescribed, they have to do it for her.) She did fine with the office cleaning a few extractions and is doing fine.

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.

Do you have anyone who can go with Mom. Don't think staff go with residents. Me, I am leary of dentists and eye doctors associated with NHs. With no family member to ask questions they can say anything and Medicaid pays. I would ask to have dentists report sent to you. Then take it to your dentist and ask him to look at it and what are his recommendations for a woman her age. If front teeth are OK why remove? Me, I would only worry about the decayed teeth if no infection is evident. They can file down broken ones. I would also check with a doctor to see how a procedure like this could effect Mom. I had an Aunt with ALZ in her mid 80s and the dentist wanted to cap 4 teeth. My cousin said no. Now...gum disease is a different thing. It can cause health problems.

A good dentist could just file down that jagged edge and be done with it. My personal dentist recommended a dentist who was good with seniors. That's where I took mom and he was outstanding. Maybe ask her old dentist for a recommendation or ask his advice when he calls you back.

You know, WIndy, I didn't see that it was YOU when I typed my response.

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.

You guys are great. Thanks for all the thoughtful comments and experiences.

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 $$$$$

We faced this with my mom about 18 months ago. Facility dentist recommended pulling all mom's teeth and making dentures. We just said no. Two of mom's lower teeth broke off. About 3 months before she died, dentist said all of her teeth had cavities. I thanked him. There was just no way I was going to put my mom through the trauma of dental surgery.

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.

My mom's teeth at about 95 started to just break off or fall out. They got very brittle. They looked awful where they broke off - all blackened at the root. I went over one time and she had put two of them that broke off together (and were still stuck together) on her side table, like a little shrine for the tooth fairy, LOL. I think I still have those two little teeth.

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!

I was thinking the same as Golden. I know she isn't feeling to kindly disposed to you right now but maybe there is someone there who can sit with her to go over the options and ask her thoughts.

Have you asked her what she wants, Windy, or does that not make sense? An abcess is pretty painful and can lead to worsening dementia symptoms as with any infection.