Is it more prudent to allow damaged teeth to remain in a senior diabetic's mouth or to remove them?

can dementia come on rapidly from a fall

Your Mother sounds like a lady who 'knows her own mind' well. Teeth are not pieces of bone...they are organs. I have seen many patients that have told me very clearly that "when they removed all of their teeth is when their health rapidly declined. Without teeth she will NOT be able to chew her food. 35% of digestive enzymes are in the mouth. If she doesn't have natal teeth to chew & grind her food...she won't be able to absorb the nutrients. Preventative surgery' in my experience only benefits the dentist/surgeon....never the patient...nor the patients health. A Water Pik with distilled water and hydrogen peroxide for cleaning her teeth after meals will keep the teeth & gums clean and healthy. You can find videos on Youtube to learn 'how to use Water Pik".

It really depends on many factors, but when you say "chipped", if they are only chipped and not exposing root, it might be better to leave them alone, for now.

You could also inquire about the "sealer' that TNtechie suggested. That might be a better solution.

IF the damage is enough that decay might begin, I would honor mom's request to only take those that cannot be saved. Would she sit for "repairs", if it is possible to drill/fill any cavities? If she is only in the beginning stages of dementia, that might be a better way to deal with it as well. If a tooth would be better removed (repair too extensive?), I would recommend local anesthetic (novacaine) vs any anesthesia, if possible.

My mother was in early stages when I started taking her for cleanings (she hadn't been to anyone for a while.) Each time she would say they poked around, etc but didn't clean her teeth! This was a dentist I had been going to for decades, so I know they would clean them! They identified one tooth with a crown that had decay under it and had to talk with me (between her bad hearing and minimal dementia, she wasn't really understanding.) I basically approved the work for her. The crown had to be removed to repair the cavity and then have a new crown made. She tolerated this okay. She was still getting bills, etc at that point and was seriously questioning the charge she got for this as she had no clue what work was done!

My mom was in her early 90's when it was recommended she have her remaining lower teeth removed but although she was becoming physically frail she hadn't yet descended into dementia. I was fortunate enough to find a dentist that also worked in long term care facilities so he was well versed in dealing with elders, he removed the teeth over two appointments and preserved mom's four front teeth in order to clip on the lower partial (which he explained is much less problematic than a full lower denture). It worked out well for mom because she already had an upper denture so she was familiar with them, plus she still had the capacity to understand.
Both the teeth and dentures were a problem once mom was in the nursing home - she had bleeding gums because nobody bothered to brush regularly, and cleaning the dentures was hit and miss, some days when I went at lunch she wasn't even wearing them. Of course by this time she was on a pureed diet and she didn't need to chew BUT I knew that when she had her wits about her she would never allow anyone to see her without her teeth!

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.

This post has been very informative as I am in the same predicament with my dad who is in advanced Alz. He definitely needs his teeth pulled. But he dont follow direction well. He'll sit for a few. He "wants" to get his teeth pulled. But he s always ready to go and I'm afraid of his reaction to anesthesia which all his doctors are against since he has dementia and diabetes and on hospice. So I dont know what to do. He is given a mouth wash he can swallow that has lidocaine in it.

This post helped me weigh the good and expected and the unknown. I wish I had some advice to give you. I'm sorry I don't.

Don't leave a toxic tooth in the mouth. Go to the oral surgeon.

Have the worst one removed one at a time. Better if local anesthetic rather than intravenous.

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?

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.

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.

Did you feel good about the oral surgeon? An oral surgeon who is not ready to jump in and remove teeth is my kind of guy, i.e. I would trust their judgement. Consider setting up an appt just to talk to him without mom. They are well trained and re-trained in our state annually with reviews of anesthesia, so some light sedation may be helpful or needed if anything had to be done. You have a good point...about mom's diminishing capacity to handle such a thing in the future. I also wonder about touching base with the oral surgeon for visits to check on the status of the remaining teeth, but realize that just the hassle and energy to get mom there might be a challenge. However, if she's able to recognize/remember the surgeon, there may be a chance for some rapport to develop between the two, and if at some point he does suggest removal, she might go along...might be the key word. I completely understand her perspective as I am too young to have what I have going on, but my teeth remaining (more than 7 thank goodness) still don't allow much ability to chew, and I am not a good candidate for expensive implants and I too feel rather rejecting of the idea of dentures. Once you take the remaining teeth out, they are gone forever. But, even in a healthy person without diabetes...not taking care of what remains and having an infection risk remains. If you feel you need another opinion, maybe if you have a dental school nearby? I have told my oral surgeon friend/big brother that there is an opportunity to create a subspecialty dealing with elder adults and those with dementia. Good luck to you and your mom...but I still stand by the fact that if an oral surgeon was not pushing a removal of all...he may be onto something...

My 94 year old dad was recently hospitalized for an infection-took the hospital days to sort out-bladder infection or blood infection-went back and forth a couple of times before they settled on blood infection. Dad already has irregular heart beat going on-blood infection is never a good thing in the first place. The doctor decided the infection came from the mouth-teeth with decay. We went to dentist 6 months ago to address cracked tooth-then removed-and told of decay in other teeth. Dentist says it is up to you as to whether or not you want to redo fillings-Dad says no. Dentist this weeks says there are now 2 more teeth needing to be pulled. One is cracked in half the other very loose. Yes we will have teeth pulled. Dentist says decay is worse than before-home care is not helping to brush or remind dad to brush. I have told care manager what is going on with dad teeth-doubtful things will change much on that front. Dad has dementia he would not remember on his own to brush either.

Sis teeth are getting worse at facility. they are not helping to keep her teeth clean-decay is worse since 6 months ago. She can not remember to do for herself or if staff help every day or not. She is not allowed to keep toiletries in her room-thinking residents will be confused and think mouthwash is juice or spill or something else.

Both sis and dad had teeth pulled in the last 6 months-seemed to do okay, but not sure how it will go the next time-they both need to re-do fillings, dad needs two more teeth pulled. Neither one is going to get the daily assistance with brushing or rinsing to keep things from getting worse.

Sorry I don't have an answer for you as to a sure way how to get the job done, I wish I did. Maybe her doctor would prescribe a mild-temporary medication to help mom be able to sit in the chair and get some work done might be worth a try.

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.

Always have the tooth pulled. This is a personal opinion. I have seen too many people get heart damage from becoming septic due to a tooth infection. (Septic/sepsis is when bacteria gets into the blood stream)

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.

As many of us know, dementia carves it's own path in the brain. Often, one day is dissimilar to the last. Everything becomes unpredictable: pain detection, diabetes
control, dietary needs. Next, will she stop recognizing you? I feel the dentist did you a serious favor by recommending removing the remaining few teeth. A very
soft diet can be easily "gummed" and delicious. This back and forth, trying to figure how bad is the situation , need for pain anesthesia = 100% removal. Then
start collecting favorite Mac 'n Cheese recipes.

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!

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.

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!!

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.