My MIL fell recently and knocked out a front tooth. It isn't hurting her or bothering her, and she doesn't seem bothered about it being gone, though it's hard to say for sure as she rarely says what she thinks, needs, wants, etc. It is very noticeable though, being up front. She's 85, has moderate dementia, and lives in an assisted living facility.
She needed a cleaning anyway, so we took her to the dentist and asked for options. I should add that currently it is not a problem taking her in for dental work or other doctor visits, she's easily able and willing to understand and respond to instructions from medical staff. She's not always clear on exactly why they're doing what they're doing, but she doesn't fight it.
They suggested a bridge. From an estimate I got back from Delta Dental, it looks like her portion of the cost is nearly $1,300. That's a lot of money to her; she's going to run out of money for Assisted Living in about two years and it will be time to apply for Medicaid, so that means we need to be careful with her funds, but also go ahead and get things she needs now while she has funds.
My question is: Will a bridge be a good solution for her, or are there problems that come up that require costly repairs because the bridge is in? Like if she falls and knocks out another tooth, or a tooth in the bridge had problems and needs work, will taking care of that cost more because of the bridge? Is it a good idea to go ahead and get this bridge now? If problems come up relating to the bridge later, will Medicaid pay for any of that dental work? (She currently has Medicare and a supplement, as well as Delta Dental).
Also, are there other options besides a bridge that would basically solve the problem of that hole in the front of her teeth, but cost less than a bridge?
We told her it can be hard to clean under a bridge, and she thinks she can handle it and wants it. Of course, her estimation of what she can and can't do isn't remotely rational or correct. She brushes her teeth and says she flosses, but she rarely asks me to get more floss, so I would doubt she does it on a regular basis. Now that I think of it, she doesn't ask for more toothpaste that often, either. So I honestly don't know how well she takes care of her teeth, and it's hard to get reliable information from her. If asked, she says she does.
Meanwhile, I had talked to two staff members at the dentist's office about my dilemma over the bridge, and one said she personally would not get it in this instance due to MIL's lack of dexterity in her hands (arthritis, numbness in the first two fingers on each hand and I think the thumbs as well). A second lady at the office said her grandmother lived in a care home and had teeth go bad under the bridge and lost the bridge, so she was basically advising against. A third seemed more pro doing it, and told us you can use interdental flossers and other options that can make it easier for someone with poor dexterity to floss around a bridge. But MIL would still have to remember to do it, and she gets very vague about if and when she did things sometimes.
Since she said she wants it, it looks like we'll do it. I'm not sure at all what happens if her anchor teeth under the bridge go bad after she's out of money (which will happen in about two years, and our ability to help her with money to the extent we had been is changing - I don't think we can count on being able to cover this cost for her). I guess Medicaid will pay to have them pulled, but I don't know if they'd cover any kind of bridge or denture. She could end up with a big gap there.
So now we have to try and ascertain how my MIL feels about the missing tooth, and this is the hard part. She has always wanted you to guess what she needs or wants, often causing you to go to a lot of stress and trouble and even expense for things that she may not have wanted (and she typically won't let you know clearly). And now that's worse with the dementia. So if she says it doesn't bother her much, she may mean it obviously does and wants us to take care of it. BUT she is also prone to saying yes to things just because they are offered to her when she doesn't care either way. And of course when she does care, she may shrug and say she doesn't care. So just by asking her, she may say sure, yes, go ahead and do it. But not really care and not understand the issues of cleaning. So, this won't be that easy to figure out, but we'll see what we can determine.
My son had a bonded bridge which is attached to the teeth next to it, as a teen for a genetically missing from tooth. He had it placed 30 years ago with no issues
She will take it out at the dining table and wrap it in a napkin and it will get tossed.
She will take it out in her room and put it on the night stand and it will get tossed.
She will wrap it in a tissue and put it in a drawer and she will forget that it is there.
Another resident will find it and take it. (residents "shop" in other rooms, very common)
My gut reaction is if it is not causing her any pain. Leave it alone.
I would also not bother with an implant. That would require after care for quite a while and I would not trust the staff at a facility to do the necessary care needed to allow wounds to heal and not become infected or the wound to become impacted with debris.
Edited to add: I just realized, when you say implant, is that part of a permanent bridge? The dentist recommended a permanent bridge, and did not mention after care. These are the kinds of things it's good for me to know to ask about, I'll go to the dentists office later this week to go over the estimate from insurance and can ask questions then.
Otherwise, though, we've been very happy with her current supplement, which is United Healthcare via AARP. Anything that is something medicare approves, they will pay the full amount of the co-pay or deductible that Medicare doesn't pay. Meaning if it's a treatment or doctor medicare says is not covered, then the supplement won't cover it either. It also has great flexibility in finding our own doctors ourselves. We looked at an advantage plan before that assigned her a primary doctor that's was probably 2-3 hrs away, said we could only change him by writing in a request to change, and that whoever the primary was would be the one to coordinate and schedule specialists, etc. It would've been much worse for us, so I'm a little nervous about switching her away from this plan.
Though one problem with my MIL's insurance is that it really only fully covers cleaning/xrays - when she needs other work it adds up quite a bit. I'm not sure if it's the best plan or not, really, it's what she had before we started helping her. She had actually already done a good job of picking her medicare supplement, so we decided to stay with her choice for dental as well. But I may need to look into that - we're already paid up thru early next yr on the dental insurance, though.
Most bridges are removable and I can tell you this doesn't always work with those in care with some memory loss. They are removable for cleaning and removal of food, but once out they tend to end in the facility's kitchen disposal. Sadly they are easily lost. There are some few permanent solutions, but they don't work well for elders, and if food gets behind them they can lead to pockets of infection, infection of the bone, even sepsis.
My brother fractured his front tooth and had a bridge, but he was capable of caring for it.
I will tell you the truth; he looked kinda cute with that front tooth out. A cute and goofy grin. If she isn't bothered and you don't think there is likely to be any senior bullying about this I would tend not to do anything, myself. I say this from a health and safety standpoint. A dentist will tell you that there is danger of movement of other teeth in the gum, of loss of other teeth, and etc. But at her age I think that may not be a major concern.
This is a decision, again, to discuss with the dentist and make the best choice you can.
I myself would try nothing for a while. Gives it time to heal well before work, as well. See how it goes. They don't serve a whole lot of corn on the cob at these facilities.
This is so hard to decide for even more reasons than I thought! I feel bad for her when I see that missing tooth, I guess because I know I'd feel embarrassed about missing a front tooth. There wouldn't be much comment about it from other seniors though, as she won't leave her room at the care home (except when we come take her off-site). We didn't expect that, we were sure she'd settle in and end up glad of all the activities she could do. She steadfastly refuses, won't clearly admit why, but it seems like some mental issues around how she looks at living there, and that other residents were somehow all told "lies" about her having dementia. Of course they don't know what her diagnoses is, and many of them have cognitive issues, too, some much worse than her from what I've seen. But she has proven to be unwilling to go out for any activity, and she's been there since the summer.
With dementia at play and dwindling funds, you just have to pick your priorities and apply for Medicaid if and when the time comes. That was my attitude with mom in Memory Care Assisted Living. She wound up passing about 6 months or less before I had to apply for Medicaid.
One day at a time is the best approach.
Once we understand it better and what we want to recommend to her, we'll go over it with her to make sure she understands. I'm sure the dentist's recommendation is the bridge, as that's the only option he priced out for us. After all that, it's not impossible she'll say nah, leave it as is! In which case, we'll just leave the missing tooth and hope that later when she's out of money she doesn't turn to us and say hey, when am I getting this tooth fixed?
My Mom got a "flipper" tooth as a cosmetic solution. It's a tooth attached to a retainer-like plate. Fits snuggly in place, looks like a real tooth. Cost was $700. But my Mom is fairly independent and knows how to care for it (and uses Poligrip to keep it very snug so she can eat anything with it in).
I think bridge work means grinding down the good teeth next to the missing tooth, might not be the way you want to go
For the bridge, she already has a missing tooth one over from the front one that got knocked out (located on the side of her mouth where you can't really see it). She'd had an implant there, her last dentist chipped that while doing other work on her teeth, and very long story short, he ended up pulling it and not replacing it. So I think it might just be one tooth ground down? I'm now realizing I need to read up more on how they do bridges, and check out some photos as well.