Seeking advice about elderly dental care.

Dear "Nancymc,"

I see a couple similarities between your mom and my mom.

My mom is 95 with Alzheimer's. She has all her natural teeth as well but, has Periodontal Disease. My mom is in fairly decent health too for her age but, frail as well. She's weak, little appetite (has lost about 28 lbs), has beginning stages of Macular Degeneration and the facility memory care director thinks she may be depressed. I'm not sure about that part but, hospice and I have decided to try a very low dose of an antidepressant this past week.

Prior to the pandemic, I would take her to our dentist every four months for the special periodontal cleaning. At that time, she was mobile and I did get her a rollator just to start getting her used to it in case she wasn't able to walk.

Now that the lockdown has been in effect since March and she did nearly die from severe dehydration and COVID, she no longer has the ability to walk and I can't take her to the dentist anymore. I provide her with her favorite toothpaste which is Sensodyne and recently decided to try the Perodontax. I finally emailed our dentist telling him my concern that I can't bring her in and asked for his advice/suggestions.

So he told me to buy the 3% Hydrogen Peroxide which basically are all the ones you can buy directly over the counter (others have 10%). He wanted the facility to have her use the peroxide as a rinse 2 - 3 times a day for 1 minute to keep the bacteria levels down and prevent an infection/dental emergency.

Honestly, at this stage of her life I can't imagine having all her teeth pulled. It's expensive and can be very painful which would be traumatic and the aftercare would also have to be followed to a "t" so she wouldn't get infections. But, that is strictly my own opinion - I could never put my mom through all that.

Several years ago, I had just one tooth pulled. The dentist didn't even have the strength (she was a female fill-in for my male dentist) to get it out. It broke in so many pieces. I was in my late 40's/early 50's and it was awful!

One of my mom's brothers had all his teeth pulled simply because he didn't want to take care of his teeth but, he was probably in his late 50's/early 60's.

I hope you can find a reasonable solution to you and your mom's dilemma - good luck to you both!

I agree with Midkid, I would have the worst ones pulled, otherwise an abscess can develop then will probably need to be pulled anyway. For the time being I would recommend a water pick to clean all the food particles away, it is easy and does not cause discomfort and you can use mouthwash instead of water. I use it everyday and love it, gargle with mouthwash after eating and drinking. use soft toothbrush with toothpaste after each meal. Cwillie had good advice about a local anesthetic.

I went through this with my mom at age 87 and very poor health. A clinic she was sent to by the assisted living admin wanted to pull all her remaining teeth and have her fitted for dentures. I heard all about life threatening infections etc.

No way I was going to put her through weeks of agony and the dentures would have been lost on about day 2.

I was able to find her old dentist who did some minimal treatments, grind off some sharp edges. If was a major improvement for her.

As it turned out mom died a couple months later. She would have been right in the middle of that horrible process during her last days.

Dental hygiene is pretty critical to all over health. (Used to work for a dentist).

The mouth is a gateway to the rest of the body. Unchecked infections can causea myriad of health problems, one of the worst being rheumatic fever that can infect the heart valves. Also kidney disease. The list goes on.

Dh had a liver transplant 14 years ago. Before ANY dental work, he takes a 'push' of antibiotics to protect him. he goes to the dentist every 3-6 months. The transplant docs were absolutely insistent on this. It was already a 'thing' for me--every kid had a checkup and cleaning every 6 months. All 5 had braces. Knowing how sick you can get from unchecked infections made me absolutely fanatical about good hygeine.

I'd have the worst teeth pulled and work from there. No, you don't 'want' dentures, but it is amazing what can be eaten with few teeth.

And, like getting a car fixed, get different estimates and dxes before you go forward.

POA,,, TAG YOURE IT? Nobody is going to be happy no matter what... Whatever.. .make sure she has a polst signed, and a DNR. look those up POLST/DNR ask her doctor.. sounds like other family members are involved and you don't want to be the one.. cuz it will be your fault....

She needs a POA FOR HEALTH AND FINANCE. If not you, then who?.. Don't answer here. It's for you to ponder... who is closest phyiscally and emotionally?... I bet it is you.
Don't push the tooth cleaning until you find a dentist you trust.

I was a waitress in an old coffee shop. an old gentleman said he had all his original teeth... He told me, teeth are supposed to last you a life time.. :) He smiled. He had all his teeth.. guess he had good genetics too.
everyone ages differently. but the few things that stick in my brain are:
blood travels throughout the body. Mouth infections are bad, and translates to the blood. So ask her primary doctor if there is anything he can suggest or prescribe.
The other is do not trust a college student pracaticing dentistry without consulting another dentist.. You do not want mom ending up paying for a  car she will never drive.
TRUST YOUR GUT

CAREFUL ABOUT NEW DENTISTS, ESPECIALLY OUT OF COLLEGE. WITH ALL THEIR LOANS ETC.
Mom's dentist retired, and new one came in... One day, I looked at mom, and she looked frantic. HER MOUTH WAS FALLING APART, SHE NEEDED ALL THIS STUFF DONE... WHAT HAPPENED? She went to the "replacement dentist:". He needed to put VENEERS on her Molars, in the back of her mouth... COME BACK NEXT WEEK.. She does, and now he is working on the other side of the mouth... WHY? Well you need veneers for them too, and the others are not done...??

WHAT THE.........I said no,MOM YOU COMING OVER TO MY DENTIST. My dentist said why does anyone need veneers aka coverings for the back of the mouth?
This NEW dentist had an office full of elderly patients, waiting for him... (the poor patients had no clue- should have told them )I found his car and held myself together... REALLY WANTED TO BASH HIS BMW or PORSHE FROM front to back end, and back again....dont remember what it was, and don't really care. a car is to get from a-z and back safely.. no matter the distance... who really cares what it is, looks like, or drives like, just as long as it is safe.. seriously...
This man did not deserve to have a license for dentistry or other medical profession. I hope he learned his lesson and is better with geriatrics....

well I took mom for regular dental cleaning... she ended up having a seizure. .the ER doctor asked why I was so worried about her oral hygiene at her age. She was 85. It was our regular routine.

Surgeries are out, I would suggest. Get professional advice. But after what she went through.. especially at this age.. seek other alternatives.. Yes, I know, blood is blood, and tooth decay infection can affect the heart.. so pulling the teeth out? can they just give her antibiotics? which can cause other issues... This is like juggling... don't drop one, or the others may drop too...
my friend told me the coconut oil is good for the gums. swish it around and rinse. makes your mouth and lips moist too. she does this routine daily for 20 minutes, and her plaque has gone away.. look up on the internet. I am tryhing it now since covid, I need to find a new dentist.
At 94 the ER doctor who saw my mother would question WHY.. SHE IS 94.. Put her on blended foods, use the sponge swabs you find at the geriatric store, and keep her happy. Does she want to go through getting her teeth pulled and hopefully no infection after that?
After the seizure and all that.. for just a cleaning.. and my aunt has issues, I didn't want to do that. Blended foods.. sponge swabs..

Thanks for your advice. I wrote a response, but now don’t see it. Will re-write if not visible tomorrow.

Barbbrooklyn- Thanks for the advice. I haven’t heard of sealing off teeth, but will surely look in to that option. She is mentally astute. Not planning to change level of care now. She is sort of stubborn, and she still calls the shots for her care. I refused to be named legal POA, but am involved with her medical decisions.
Somehow I dread what may come in the future.

We were lucky enough to find a dentist that has experience working in nursing homes, he extracted only those that were absolutely had no other option and did his best to preserve the rest. He also did the extractions with local freezing, not the surgery recommended by her previous dentist. My mom did get a partial denture at this point - this was before she began slipping mentally so she was more able to adjust to it. She did have a tooth break off in the last few months of her life (unremarked or noticed in the NH🙄) but that was many years later.

We faced the same dilemma with my mom in her 90s in a NH with CHF and dementia. We turned down what I thought was the preposterous idea of extraction and implants and let mom's teeth decay. She had assistance every day with oral hygiene, but her lower teeth started to break off.

I would ask the new dentist how to best prevent infection (mouthwash? Sealing her remaining teeth?).

Are you considering moving your mom to higher level of care?