She is 89, has dementia and poor hygiene.

Re dry socket possibility, I remembered that it happened more either in the upper jaw or in the lower jaw. I checked, and it's rare in the upper jaw; usually, it's in the lower jaw--and dry socket is actually very rare overall. So if it's an upper wisdom tooth, the possibility of your mother's having a dry socket would be much less. While there are many other issues, whether it's an upper or lower wisdom tooth could be a factor in your decision. I actually had a dry socket myself after an adult wisdom tooth extraction (lower jaw) because I didn't understand/know that I shouldn't drink with a straw right away. Obviously, for your mother that factor could be controlled.
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Reply to caroli1

My mother is 94+ with advanced dementia living in memory care the past 2+ years. I call the mobile dentist to come see her only when it's absolutely 100% necessary. When mother is in pain, in other words. Then there's no question and the tooth has to be pulled. Of course anesthesia has to be used because if it isn't, the pain would be excruciating and nobody could sit thru it! But it's local anesthetic, Novocaine that's used. The mobile dentist comes to mom's room and does the surgical procedure in her recliner to minimize the trauma, and it is definitely traumatic for an elder with dementia to have dental work done. Which is why I limit it to emergencies only. If doing so shortens her life, so be it; if anesthesia is adding to her dementia, so be it as well. Dementia ruins her quality of life ANYWAY, who's kidding who, so doing anything to prolong it is cruel, that's my outlook.

Don't apply the same rules you use for yourself to someone who's 89 and suffering from dementia, that's my advice. Of course you're going to treat your own general health differently at 50 or 60 than you would at 90 with dementia wreaking havoc on it.

My goal is to keep my mother as anxiety free as possible.....and dentists wielding needles, drills and other sharp and hurtful objects is not the way to accomplish that goal. Palliative care means she gets the least invasive and bothersome medical treatments possible at this stage of her already very long life.

Best of luck.
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Reply to lealonnie1

Ask oral surgeon who pulls teeth beside regular dentist if possible. My 94 year old mother with dementia had a few teeth pulled a couple years ago because they were bad & infected so they had to come out. She also had a half molar …the top broke off & oral surgeon said if it doesn’t bother her, leave it alone. That one would need general anesthesia instead of the local anesthetic for the others. So it’s still in …but if were rotting & infected..I’d decide with oral surgeon what to do. Hugs 🤗
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Reply to CaregiverL

My DH, a liver transplant patient, has to pre-dose with antibiotics before ANY dental procedure, even a simple cleaning.

I know a woman who let a tooth rot out of her head and the ensuing bacterial infection went into her kidneys and she went into kidney failure. She lived about 5 more years, but that was the base cause of her death.

Seems crazy, right? But I worked as a dental assistant and I saw things that scared me into making sure my family knew the importance of good dental health.

Talk to the anesthesiologist first. My DIL is an anes. dr and does primarily dental cases. She will not do cases that she deems too dangerous--but then, rotting teeth are in and of themselves a huge health concern.

She can do 'light' anesthesia or 'complete'--depends on the case.

The lack of pain in itself is not significant. Daddy would have a huge abcess that signaled a dying tooth and he couldn't feel a thing.

The KIND of bacteria that come from the mouth are very dangerous and not to be downplayed.
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Reply to Midkid58

Teeth are the gateway to health. If someone needs surgery and the anesthesiologist sees rotten teeth, surgery is canceled until extractions are done. Passing a breathing tube through a rotten mouth is a very high risk for pneumonia and death
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Reply to MACinCT

I hope this might help you. I would consult dentist and follow the dentist's advice for the individual concerned.
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Reply to AlvaDeer

there is a great risk with giving anesthesia to someone with dementia.
It takes a long time for it to clear the system and there may be a decline after the procedure.
Now for the actual surgery. (pulling teeth would be considered surgery)
If the oral hygiene is poor now how will it be done after the procedure? There will be open wounds in the mouth that will be painful. will be swollen, possibly sutures, there is the slight possibility of a dry socket that will cause more pain. And if oral care is poor a higher rate of infection is a possibility.
If the wisdom tooth is not giving her any pain I would not have it pulled. If there is mild pain that might be resolved with topical products that are used for teething or for people with sore gums. Tylenol can also be used if it is not contraindicated with any other medications.
I had all these same questions when I cared for my Husband, his oral hygiene was pretty good, he did well himself and allowed me to brush his teeth when he no longer could. I elected not to have dental work done on him for the very reasons I gave above.
He had no pain when eating and eventually transitioned to a soft then pureed diet anyway.
There will always be the questions in the back of your mind ..Am I making the right decision.... Make the best decision you can based on the information you have. that is all anyone can ask of another person.
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Reply to Grandma1954

Not hurting is one issue, but:

"studies have shown...Poor dental health increases the risk of a bacterial infection in the blood stream, which can affect the heart valves. Oral health may be particularly important if you have artificial heart valves."


I have a cousin with a phobia of going to the dentist. In his 50's he was pulling out his own teeth with his fingers as they rotted and became loose. He is a smoker, but today has had no negative impact from how he handled his oral health and now has dentures.

Then you must consider if your LO is on Medicaid. There aren't many dentists where I live who accept Medicaid or are even willing to work on a patient with dementia. They would most likely use only local anesthesia or your LO can be given a mild sedative prior (if she isn't already on many other meds). Also she will probably need to be off any blood thinners for about 2 weeks and take antibiotics for a while afterwards. Would she be cooperative with post-op care from whomever is responsible for her? Dry sockets from pulled wisdom and other teeth? etc...
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Reply to Geaton777

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