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My 90 yr old mom in hospice with dementia is unable to speak, bed bound, and her teeth have begun to turn black from decay. I noticed some bleeding in her mouth the other day and believe these teeth/her gums have begun to hurt.


I don't have any "geriatric dentists" in my area, so I'd have to take my chances with a regular dentist who might not grasp the unique challenges of dementia. I won't let anyone put her under general, and they would have to get a prop just to hold open her mouth otherwise she would bite them out of confusion (hence why I brush her teeth rarely).


My concern is that there's no way to simply use Orajel or other methods to control what could turn into severe gum pain. I have a hard enough time determining when she's in pain already, let alone what the source of the pain is, so I would like to have extractions done if practical.


Has anyone been in a similar situation and found a way to have extractions done?

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Talk to your hospice doctor or RN/NP about applying morphine topically.
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Reply to MissesJ
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Dentists can give her enough sedation to make her drowsy and more cooperative. She will likely need a bite block to hold her mouth open - most folks do. Shots to numb her mouth will keep her from feeling anything happening. Talk with her dentist beforehand - and her usual medical doctor. Together, they can come up with medication and treatment plan to deal with removing the rotting teeth and help with pain.
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Reply to Taarna
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Rusenko, for the pain of dental extraction, the combination of a non-steroidal + acetaminophen (e.g., Tylenol) is often advised. Your dentist did not prescribe adequately for your pain, based on what I was taught (and your pain experience). I'm bringing this up because if your mother does have the extractions, she will hopefully be given a better pain medication schedule than you were!
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Reply to Igloocar
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Dementia means broken brain and unable to cooperate. I wish I could say more but hope the best care for your mom.
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Reply to Patathome01
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I agree with you she should not have general anesthesia at her age especially with dementia. You are being wise to choose her oral surgeon carefully. Hopefully your personal dentist would understand your concerns and refer you to someone they know who would treat her with the TLC she will need. There are times, these type of situations are handled as outpatient surgery in the hospital.

People have extractions all the time without general anesthesia by using regular local anesthetics along with possible nitrous oxide (laughing gas) or even propofol (like with colonoscopies). I am sure there are a number of choices of non-general anesthetics to use. Hopefully you will find an oral surgeon who will understand your concerns and even have the same concerns as you do. There are special props to use in dental procedures to help patients keep their mouth open and they probably wouldn't even be put in until she is totally relaxes from a medication given. The last time I had a dental crown replaced they used this tool: https://ndscare.com/dryshield/

Depending on how many teeth she needs removed, I would suggest talking at length to the dentist about the options. Ask is it better to do them all at one time or separate her mouth by "quadrants" or "upper and lower" to remove select teeth in multiple visits. There may be concerns for the healing process as to how it should be done best to lower her risk of possible infections. They may even put her on an antibiotic for a week or so before.

A good dentist should be very capable of making it as comfortable as possible as well as safe. Best of luck in moving forward with her care. Please let us know the results... any one of us could have the same concerns for a LO in the future.
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Reply to KPWCSC
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Hello. A question immediately comes to mind regarding your Mom. Why, with her age, the dementia, and a critical situation happening with her oral hygiene would you not consent to general anesthesia to help her? Without the oral care she needs and the extent to which you describe, she is probably in great discomfort, if not the possibility of pain. The extent to what infection can do in her body alone should take precedence, along with any pain she is experiencing and not able to verbalize. The advantage far out weighs any risk. My husband is 80, has late stage alzheimers, and is still able to see our dentist , thankfully, every 3 months for a cleaning. If my husband were under the exact circumstances, i would do it for his best comfort and quality of life.
There are also small sponge brushing methods you can use with cleaning gels to get into her mouth to help clean and protect as much as possible for those that are not able to open their mouths for a dentist.
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Reply to Rosez4u
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You won't allow your mom to have general anesthesia? Why?? That's what she needs for this!
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Reply to SusanM56
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JoAnn29 May 18, 2025
The woman has Dementia. General anesthetic is not good for people with Dementia. It could cause further decline.
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Hi! First I’d like to applaud you for stepping up to the plate and taking care of your mom, it’s no easy task I know because I take full-time care of my 89 yr old grandfather. So in my experience with my grandfather who hav several broken decayed teeth, he never liked anyone probing around in his mouth. A couple of years ago I tried taking him to see an Oral Surgeon because they’re better trained to handle such cases, that at the time was going to put him under general anesthesia he had me cancel twice the day of the appointments. Definitely call an oral surgery office and explain the situation with your mom. They can probably give you good advice. I hope this helps
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Reply to CristinaA
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I am going to tackle the pain part first.
In order to tell if she is in pain look for facial cues and body language.
If she is grimacing, furrowing her brow that may well indicate pain.
If she is flinching, moving away that can indicate pain.

There are topical numbing agents, stronger than OTC Orajel that can help pain.
Mom is bedbound.
How are you going to get her to the dentist for an exam then to an oral surgeon for the extraction? then back again for follow up exam?
She is not going to do well with anesthesia. I can not imagine a dentist doing multiple extractions without a general or twilight anesthesia.
I can not imagine how frightened she would be being placed in a chair, a guard put in her mouth and being aware of the procedure being done.
How are you going to manage wound care?
If you think she is in pain now....she will be in pain after the surgery and while her mouth heals.

I know it is difficult but please do not do this to her.
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Reply to Grandma1954
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KPWCSC May 18, 2025
People with dementia do not always interpret or react to pain the way we would. I have felt bad several times when I realized my husband had plenty of reason to complain about pain and he didn't even wince. Then again, there have been times he would complain loudly because he thought it was suppose to hurt! At times, it can be very hard to discern whether a LO with dementia really needs to be checked out or simply give them a kiss on their hurt!
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I am surprised the nurses in hospice have not advised you
i think you need to speak with them
as you rightly say ordinary dentists may not be trained in special needs
the hospice shd refer you for sure
bad teeth can cause other health issues so do asap
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Reply to Jenny10
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Yes, I take care of my wife who has Dementia. I take her to MUSC dental emergency and they did the extraction.
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Reply to gaillard
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Oh yes, antibiotics should be given before and after.
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Reply to JoAnn29
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Speak to her doctor about how she might get care in order to prevent sepsis and death. To be honest, when I was an RN, we occ. saw people who had to come in for full mouth extractions under anesthesia, with antibiotics given prior to and after the extractions. It was a dire situation that occurred only after many years of neglect.
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Reply to AlvaDeer
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You can Mix a solution - warm water with sea salt in a Glass with a teaspoon of Hydrogen Peroxide and Can she rinse her Mouth ? Then rinse with clear water . If she is in Pain after war rinsing apply some Arnica gel On a cotton Ball and swipe the Gums - It stops the Pain . I have done this with my teeth and it works . Also Clear aloe vera gel from a fresh cut stem the Goo can be slathered On the gums is healing . Lily Of the desert Makes Aloe gel also But I prefer it from a fresh Plant . You Can also Put a couple drops of Lavender Oil behind the ears for a calming effect . These new whitener tooth Pastes are very Harmful to the Gums - they Kill My teeth . I Use Himalaya Botanique Neem and Pomegranate You Can find at whole foods or Amazon . ( No whiteners or harsh chemicals )
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Reply to KNance72
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Rlisenko May 15, 2025
Yes, I got a Orajel mouthwash that is hydrogen peroxide based, and it does appear to be making a difference. I do not trust her to spit it out, so I'm putting the mouthwash on with a sponge on a stick, then another wet one to "rinse" but really just dilute it, but I'm concerned about what hydrogen peroxide getting swallowed might do to her delicate digestive system.

Regardless, so far it does appear to be helping so I'm assuming its gum pain rather than tooth-nerve pain, so I'm praying adding this new routine after eating will help her. She appears to have forgotten the muscle memory of how to get food from being stuck in front of her teeth so I should be doing something after she eats.
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One of the challenges with old teeth extraction is that the bone could be broken by just pulling them or the tooth can shatter and dentists don't want to take that chance.

I am much younger than your mom, and I recently had to have a tooth extracted, what a project. I had to see the dentist, who referred me to an endodontist, who referred me to an oral surgeon, who then scheduled the procedure, that included general because a tooth that breaks during extraction is a difficult process for the patient and I have a bite reflex when someone is in my mouth for very long. It took 4 appointments to get it done. Not to mention the pain I still experience with eating, after 2 months. I can't imagine multiple extractions on someone in your moms condition. Just a heads up on what she could be facing with extraction.

I like the idea of peroxide on a sponge. This will help keep bacteria at bay and help with her gums bleeding.

Just curious, why no general on your mom? She can't really get worse based on your description.
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Reply to anonymous749199
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Mom wasn't on hospice but had bleeding gums (the nursing staff tried to tell me that was normal 😒) and her dentist prescribed a peroxide based mouth wash. She wasn't able to swish and spit so they dipped those oral sponges on a stick and swabbed around her gums.
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Reply to cwillie
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Rlisenko May 14, 2025
A peroxide based mouthwash is interesting. I'm already using sponges on a stick for "brushing" her teeth, I will ask about this, thanks!
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I had gum desease surgery. My gums never hurt. They get red, bleeding and puffy but there is no pain. Now the teeth are different. If the nerve is effected, then there is probably pain. You need to ask the Hospice Nurse what can be done?
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Reply to JoAnn29
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Have hospice administer pain medication to your mother on a regular schedule now, or request that you give it to her every few hours. Pain meds cover gums and teeth too. It's not reasonable for you to take your mother to a dentist now for tooth extractions, imo. There are traveling mobile dentists who can come to your home, but again, this would be a traumatic experience for mom, if it were even possible.

Wishing you and mom the best of luck with a difficult situation.
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Reply to lealonnie1
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Rlisenko May 14, 2025
Contacted a mobile dentist site, not available here. I actually think taking her to a foreign place might make her more cooperative, more so that extractions take time that might make her become uncooperative. She has no lung issues so laughing-gas and locals might make this possible.

I was on the heaviest doses of Tylenol an adult can take for my wisdom teeth, barely took the edge off and was in constant agony. Hopefully her teeth don't require this.
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