My mom, who has dementia, needs major dental work, and she is very stressed about it. Any tips on how to handle this?

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My mom, who has dementia, needs major dental work, and she is very stressed about it. Any tips on how to handle this?

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After my mother had a fall with a head injury, she was complaining that her teeth hurt. So we went to a dentist, who said the upper teeth were fine, but that two lower teeth have bad decay below the gum line (I was in the room the whole exam and saw the xrays) - these are teeth supporting a bridge, and I'm sure she had food stuck in there under the bridge which caused the decay. At any rate, the plan is to remove one tooth that cannot be saved, remove the bridge, and do a root canal and crown on the other. My mother is really stressed about this, which is causing more problems with cognition. She would like to be put under for the procedure, because of a traumatic dental experience with extraction when she was 12. Then she said she wants to just leave the teeth in until she dies, because right now they are not hurting her. I told her I could not guarantee that the decay would not hit the roots before she dies, and that if she really needs sedation, I will talk with the doctor. At her age I suspect that means an oral surgeon and a hospital stay. And concerns about more adverse affects to her cognitive skills. Anyone else have any experiences with this?

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OK, here's my answer from 2014: "OK, her dentist calls it a "Composite split bridge". It's made of composite material. He only does it on older patients. Like I said, it's worked very well for my mom. We're both thrilled with the results! I asked if another dentist would know what that meant, and his receptionist wasn't sure. So I hope you can find someone who could do that for your mom. "

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24 hours later, she seems to be fine. although obsessed with the gap where the tooth used to be. She wants "something" to hide it. I told her that once she is healed we can talk to the dentist about a partial, because another bridge would eventually cause her the same problems that this one did.

She is happy with the dentist at least, so that is something.

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I'm with SunnyGirl on this one. You need a conservative dentist who understands how dementia works. A dentist can be very gentle and patient, but they can recommend work far beyond what may be necessary, given the dementia. I'd also get a second opinion, just to be on the safe side.

Dentists today (particularly younger ones) go to marketing and sales classes and can recommend options that are overkill given the entire situation. I've had it happen to me. This may not be the case with your mom's dentist, but I'm just saying what I've experienced.

I'd question why a woman with dementia needs a crown at all. Pull the teeth and be done with it, unless that has to happen to replace the bridge. Even then, I'd question whether that's a necessary option, given your mom's situation.

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Well, this was an experience I would not wish on anyone. 3 1/2 hours in the chair, I was perched on a small stool in the corner. She did pretty well all things considered, the worst was the Novocain injections. And answering her questions between procedures. The staff was amazingly good and so was the dentist. I am upset because some of the decay is very old, and she told me she went for cleanings at least once a year before she moved down here with me, so either they let the cavities slide, or told her and she didn't remember to get them taken care of. I now suspect that the dementia started long before I had her come down here.
It was a challenge to realize that she was not totally aware of what had happened or why it happened, and to get her to comply with the after care.
I don't think we will be replacing the tooth that was removed, the space is not huge, and I am hopeful that she will not have any trouble eating.

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I had a similar experience with my loved one. My cousin who has severe dementia. (She doesn't remember that she is afraid of dentists. Which is good, I guess,) She was diagnosed with gum disease and needing a couple of extractions. Her bridge had to come out as well. Their office did not do this and was going to refer her out.

I got a second opinion at a place that I know the dentists better. We discussed palliative dental care. Meaning we are trying to keep her comfortable and not frighten her or cause undue stress pain and anxiety. We want to keep her ability to eat and avoid abscesses/ They came up with a plan to do the cleanings in a more moderate way over time, instead of the major work the other dentist had suggested.

She tolerated the cleaning just fine as well as the extractions. He gave her a prescription for a pill to take one hour before her appt. That really relaxed her. She almost went to sleep and was as calm as could be. They would ask her if she was okay or felt pain and she was fine. The dentist told me that if necessary they would give her gas, but that was not necessary for her.

I think I might get a second opinion, discuss sedation options and try one procedure to see how she does, before doing anything major.

Oh, a root canal is not painful, IMO. I have had two and the second one only took about 15 minutes in the chair. But, that was with a good Endodonist. They do them all the time and it really makes a difference. They are expensive though. Are you private pay?

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Is your mom on an anti anxiety medication? My mother is much calmer in general on a small daily dose. My mom also has dementia and as the dementia got worse her anxiety increased. I have much less trouble getting her to the doctor now. I would still investigate all of her options and see is something less drastic could be done. When I had an implant it was my front tooth. While I was waiting for my mouth to heal from the extraction I wore something called a flipper that was basically a retainer with a tooth attached so no one could tell I was missing my front tooth. I would suggest this but I'm not sure that a device would be ok for an elderly person. Also, if the issue is the bridge that is a whole other problem. Anyway, I would discuss all options with the dentist to see if there are any other options. Best!

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Thanks! The dentist did say we could go with a removable partial if she has trouble eating. I was a dental lab technician in a prior career for 10 years, so the concepts and lingo is easy for me. Mom has acrylic bonding on her upper front teeth to get rid of the gaps caused by the removal of her molars, and four bridges between the canines and the first bicuspid. I do need to talk to her doctor about the anxiety meds (as well as some depression going on that she is in denial about). I appreciate all the answers.

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Anxiety meds can be very helpful. My cousin takes Cymbalta and it really helps. Before that she was extremely nervous when seeing a doctor or dentist.

I would keep in mind that anything removable for a dementia patient is risky. As they progress, they may forget how to open their mouth to put something in or take it out. They may also take it out and hide the thing or throw it away. They can't recall what they did with it. That's one reason dentures are so impractical for most dementia patients.

If she has the funds and insists on the crown, then I would go with that as long as it's feasible. I believe in keeping our loves ones who have dementia happy as much as possible, when we can. My loved one has severe dementia and I do not have high expectations that her life span will be much longer. That's why we are opting for conservative care. She still eats well and is not in pain, so for us, that is successful. You can't tell she the extractions either.

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Mom is also rather vain, and the tooth that will be crowned is the canine in the front (lower). She is not happy about (as she puts it) "being a toothless hag". I'll let you all know how this goes.

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I also wear a flipper, but I'm not sure how well that would work with an elderly person, because you have to take them in and out. My mom (who's 96) has broken off several teeth, one near the front top, which looked awful. I took her to a dentist and he built her up a fake tooth that took 90 minutes. He's done that at least twice and maybe three times for teeth she's broken off at her gum line. Those fake teeth have worn just fine for her. It was like a miracle. I'll try to find my old post to see what it was called.

My mom, who has dementia, needs major dental work, and she is very stressed about it. Any tips on how to handle this?

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