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?
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.
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.
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.
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
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.
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.
Wishing you and mom the best of luck with a difficult situation.
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.