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My 88-year-old diabetic Mom has 7 damaged teeth left in her mouth, in addition to 2 undamaged implants. Although the 7 teeth have chips in them, she still can chew with them. Eventually, she will complain that she has pain in one of the teeth, and then we will have that infected tooth extracted. Two dentists have advised that it's best to remove all 7 damaged teeth before infection sets in, since my Mom is a diabetic and infection in a diabetic is particularly dangerous. One oral surgeon has advised me that dentists will often suggest that all teeth be removed as soon as possible because they are "covering their butt". Although he is aware of my Mom's diabetes, this oral surgeon is more concerned that if we remove all of remaining teeth at once, it will be difficult for my Mom to chew. (My Mom has advised she is "not putting up with dentures"). My Mom is against having any teeth removed before it's completely necessary -- i.e., before she has pain because the tooth has become infected. She is also in the very beginning stages of dementia, and feels that the dentists are "in league" to remove all of her teeth. I am torn between removing all of her teeth now, or putting my Mom at risk by waiting for an infection to set in before removal. What further complicates things is that my Mom is becoming increasingly confused and physically weak from the natural aging process. I am concerned that if I don't remove all 7 teeth now, her developing confusion and weakness will make postponed extractions all the more difficult for her when we do eventually extract them. She doesn't do well "in the chair" and with time, that experience will only be more difficult for her. However, she is extremely agitated at the prospect of all her remaining teeth being removed, and I am earnestly trying to do the "right thing" by her. Does anyone have any opinions on this matter? If so, I would greatly appreciate hearing them, as I am truly torn. Many, many thanks!

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Having 7 teeth pulled out at once is traumatic, there is no softer way to say it. Acclimating to a full denture is absolutely a nightmare..........there's no softer way to say that, either. A partial plate is doable, certainly, but a full denture is a horse of another color, so I don't blame your mom for not wanting to put up with such a thing.

So. For me, I fully believe in palliative care at this stage of life. My mother is 93 and has more issues than Newsweek. I handle them as they come up, and refuse to borrow trouble. I believe in taking the most minimal treatment option available, no matter what issue she's facing.

Sure, in your mom's case she 'may' develop issues from these bad teeth that can cause even MORE issues. But guess what? Having all those teeth removed is an issue, too! So, pick your battles, like we said when our kids were little. If it were me, I'd let the teeth become a problem and then have them removed IMMEDIATELY, one at a time. Plus, she's against having them pulled in one sitting anyway, so there's little decision to be made here. It's her right to choose how she wants to proceed.

Wishing you the best of luck in a Catch-22 situation. If it's not one thing, it's another, isn't it?
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gdaughter Mar 4, 2020
More issues than newsweek... Thanks...I needed the laugh.
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Thank you so very, very much for such an incredibly informative answer! I didn't want to make my question terribly lengthy, but, yes, I did get an opinion from an additional oral surgeon. She said the seven teeth were so severely damaged that they could not be saved. While she said they all had to come out, she did say this did not have to happen all at one time. It was her opinion, however, that sooner rather than later was better. I am going to follow up with everything you have suggested: conference with PCP; discuss nerve depth and sealer options with oral surgeon who conservatively favored waiting; implement periodic x-ray; and stress importance of daily dental rinse. I can't verbalize how very much I appreciate your response. Thank you, thank you, thank you, and thank you, again!!
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TNtechie Feb 26, 2020
Remember your mother's "save the tooth" time frame is probably shorter than what an oral surgeon or dentist is accustomed to using. My father was "living on borrowed time" from CHF for the last 4 years of his life with a higher risk of healing problems from extractions so I found a dentist who agreed to try sealers to stabilize the tooth deterioration. Sounds like you have found a dentist who's adaptive already. My father also needed a soft food diet shortly after we started with the sealers, so there was less impact on his teeth which help extend their viability too. Your mother is 88 so "saving" the tooth for 8-10 years is a reasonable goal.
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Please understand there are risks with removing the teeth too. Dry socket, infections, and difficultly healing from the removal in addition to losing the ability to chew her food. Being able to eat well has a big impact on elderly health. The anesthesia and/or sedation can also cause problems for a senior with cognitive issues, advancing her cognitive decline by a couple of stages overnight. You state two dentists are advising for and an oral surgeon against. I suggest you have another option from an oral surgeon who will actually be looking at the risks of the extractions. I would also have a discussion with her PCP about her general health and how much difficulty he would expect from sedation and in her healing from the extractions.

I have had several root canals and a couple of oral surgeries to save a tooth (that eventually failed), two extractions other than wisdom teeth and implants. What I have learned is a damaged tooth does not always become painful or infected. A damaged tooth becomes painful when there is some decay into the tooth's central nerve. In some people that central pulp or nerve is quiet high in the tooth and sometimes even shallow fillings come near the nerve, causing pain (which can be treated with root canal or extraction) and if left untreated infection and abscess. In other people, the nerve is deeper within the tooth and not as easily impacted by fillings or other damages.

I would want to view x-rays showing the nerve depth and how close any damages are to the nerve. How long have the teeth been damaged? Can composite filling or sealer material be used to treat/cover the damages and extend the tooth life? My father had this treatment for several teeth opposite of crowns where the harder crowns ground down the softer natural teeth; applying a sealer every 6 months kept the teeth from abscessing during the last 2 years of his life.

In general, I would probably try to keep her teeth unless x-rays show the damage is near the nerve and likely to have problems in the next year or so. I doubt I would even consider getting all 7 removed at one time. The big complication with dementia is your mother may not be able to tell you about early small pain from decay into the tooth nerve so you would need to repeat the dental x-rays periodically; at some point in the cognitive decline she may no longer be able to brush her teeth effectively. I would also encourage the use of a dental rinse to strengthen the tooth enamel and reduce the decay rate.
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gdaughter Mar 1, 2020
Any ideas on a dementia impacted person who stopped brushing? You seem to know your stuff well:-) Mom always was OCD about brushing and flossing and recently was found to have 13 cavities and still has a couple questionable teeth the DDS says are not restorable...I live with mom and dad is here is as well, but her dementia makes her quite unpleasant if she is asked to do something, i.e coaching is not gonna happen/work. She grazes all day on snacks and often sweets, her fluid intake isn't what it should be but she does drink pop from time to time when she does...
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My sweet daddy was on such strong painkillers, a tooth would flare up and give him problems--he'd have huge abcesses and he didn't feel them!

Getting him to the dentist was a 3 person move--and then he had to be put in the dental chair--it was an all day operation. His dentist took a very gentle approach and pulled a couple of the teeth--but did root canals on others. He did see the dentist twice a year, always, and they really tried to stay on top of them so nothing got out of control.

Dentures were out of the question--he couldn't have stood the time in the chair. Just trying to stay one step ahead was the best. Fluoride rinse and helping him brush was about all we could do.

I do know he clenched his teeth really hard as the Parkinson's got worse and a bite guard was discussed and dismissed. For some people, that would be a helpful device. I've worn out 2.
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A different take on this is whether you can do this against your mother’s wishes. You say that she is only in the ‘very beginning stages of dementia’ and ‘is against having any teeth removed before it's completely necessary’. On the other hand your words are ‘I am torn between removing all of her teeth now’ - obviously something you aren’t actually going to do yourself, but it certainly it indicates that you feel it’s your decision. If your mother is still fairly competent, perhaps it’s her call, not yours.
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Before she has her remaining teeth pulled try a periodontal mouthwash. The one I used is Nature's Answer PerioBrite Alcohol-Free Mouthwash, Cool Mint,  My periodontist noticed an improvement in my oral health after using this religiously.

I know at her age it’s hard to maintain oral health but she has to be diligent. Abscess’ are very painful & sometimes the Novocain won’t even work with a bad abscess. After 9 shots of Novocain I was sent home & had to go to an oral surgeon the next day to have it extracted under anesthesia. Best wishes to you both!
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Ask your dentist what he or she would do if it was their mom...my dentist is not doing a lot of invasive stuff for my 93 year old mom with dementia, but he did do a fluoride treatment to help prevent decay.
It is important to keep teeth and mouth healthy as an infection can end up in the brain. My mother-in-law had that happen...they found it in the hospital.
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I would take the opinion of the oral surgeon, myself. Also, chipped teeth are not necessarily a problem, while fractured teeth are, and xrays should tell a good dentist which teeth are truly a problem. At 88 with diabetes your Mom is doing well to be alive; every single system in the body from heart, lungs, kidneys are under constant stress. Healing is difficult, and removing teeth leaves an open socket for some time; could in itself be a killer. Something WILL come at Mom sometime in the future; you cannot predict what it will be or which way to go to prevent it. I am just giving you my opinion of what I would do. This is an individual decision on which you now have the opinions of several qualified people. To me, in extraction issues, the oral surgeon is likely the best to follow if you are going to follow expert advice. However, there is no guarantee here either way you go. Wishing you best of luck.
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The best thing is to call your dentist and ask that question. My guess is that they will need to be fixed. I don't know if they are infected or not but a bad tooth can cause an infection in the heart, which is not good.
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I’m following this for the same reason as LooseIt. To learn. My mom is 94 and has about six teeth that her dentist said can not be saved. Dentist suggested pulling all her teeth and getting dentures. But mom’s medical doctor said no, this would be too traumatic at her age. It’s a delemma. The plan now is for her to see a dentist who is more experienced with elderly clients, but this will take a while. I do worry about these teeth becoming infected. It seems that this must be a problem often in older people, and I’m curious what others have done.

By the way, I had all of my teeth removed and got dentures long ago. It was no picnic. Liquid or soft foods only for months. Dentures just do not chew like real teeth, so lots of digestive issues since then.
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sunshinelife Mar 4, 2020
Please be careful of dentists. They are mechanics of the mouth. With a very similar approach and mentality to used car mechanics. Please consider leaving your Mothers teeth alone. Foods high in sulphur will prevent infections, raw garlic, cauliflower, cabbage etc (cauliflower is the easiest to digest.) And some crushed garlic swallowed on a spoon before meals will boost her health including gums and teeth. Cleaning with the Water Pik will keep teeth & gums clean & is, in my opinion easier and more thorough than cleaning with a brush, and commerical toothpaste...which contains fluoride which increase the absorption of aluminum and has been proven in medical studies to be associated with causing of Alzheimers. Raw apple cider vinegar (dr barges) with 1spoon raw honey and a dash of warm distilled water before each meal will help tremendously with your indigestion. Keep smiling :)
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