Dentist wants to pull 10 teeth on my 87 yr old, demented mom. Any suggestions?

My only comment is regarding dentures. With my mom, it got to the point where it was virtually impossible to get them in and out to clean them because of her dementia. She didn't know to open and close her mouth. She would hold her mouth tightly closed when someone tried to take them out or even try to bite us. She quit wearing them and just went on soft/pureed food. Also, she would randomly take them out before she got really bad and we'd have to look everywhere to find them, including regularly going through the garbage. Best of luck with your decision. Do what you feel is best.

Windyrige here is another perspective. My 87 year old Mom who has medium dementia and is in fair health was recommended by her dentist to pull her 6 remaining upper teeth. She had a partial, a huge cavity in one tooth and an abscess in another. She made the decision with my encouragement to go ahead. He measured her for an upper denture and it was made prior to pulling the teeth. The teeth pulling and the preliminary denture fitting were made the same day in two appointments 6 hours apart. I was amazed.
Another instance was my daughter's father in law who had many teeth pulled and is happy just not to wear dentures. Once the gums hardened, he could eat fine.

Hubby is a dentist and would refer a case like this to an oral surgeon for pt care and safety. Removing 10 teeth may not be as difficult as it sounds especially if teeth have been loose and/or infected already. The thing that will affect her most is her current health or blood thinners, osteoporosis meds. These are both contraindications. Blood thinners can be removed for a time and then procedure is safe. Not so with bone density drugs if there is a history of ever taking them. The pt would be at risk for osteonecrosis (bone death) of the jaw.

The other issue is the I.V. sedation anesthesia problem. The dementia will get worse temporarily and she may not go back to current status. The oral surgeon may be able to give her local anesthetic alone depending on how well she can cooperate.

Minimum is best but if they see something brewing they should do that too.

Hoping it is an easy experience for her.

I'm both a RN, and a direct patient caregiver for my 86 year old father with frontal temporal dementia. I was amazed that both your mom's dentist and facility recommended dentures. For a patient with dementia, dentures are a huge choking hazard and I've seen them actually cause death due to the person swallowing them, and the airway is blocked. Your mom is likely grinding her teeth. .common with dementia ...leading to chipped, fractured, and infections of the teeth. It's our role as children to make best possible decisions for them, which is difficult from far away, and I'm sure causing additional anxiety. Think about this...how far advanced is her dementia..is she end stage? Does she has awareness and any real quality of life currently? Is she currently on a regular diet? If so, would she have sufficient teeth placement to continue a regular diet if these teeth were removed? Is she already on a soft or pureed diet? If she is, then being able to bite and grind her food would not be needed. When I took over care of my dad, I found he had neglected himself....many teeth were unsalvageable. My father has 10 remaining teeth, no dentures, eats a regular diet, including meat because he is mid stage, has 4 opposing (upper and lower teeth that meet). When patients no longer have opposing teeth, and/or dementia progresses, they would have to change their diet to soft, and sometimes to pureed...again considering # of teeth, placement of teeth, and level of dementia. It is highly likely that Mom is grinding her teeth, which can fracture and chip teeth, huge risk for infection, etc. My dad does this too...but we were able to smooth out his teeth that he damaged. Now he does not cut his tongue, inside cheeks on those jagged teeth. A night mouth guard to prevent grinding is as inappropriate as dentures for dementia patients. If a tooth is badly infected, or will not likely to hold a filling, then yes, sometimes they must go. My view as their children is to cause no harm, to maintain them the best we can, with as much quality of life, and dignity as possible. I find parents in facilities get best care, when children know all the details and are highly involved.

Trevor--I posted a question about this several months ago and received a number of responses, some suggesting the family members have to provide this in the nursing home while others mentioned obtaining a prescription for it making it required in the NH. Unfortunately, I don't know how to find that string again, but perhaps you do or another reader does. As I recall I worded it something like "how much responsibility does a nursing home have for providing dental hygiene?" I hope this is of some help!

I have not read all the responses yet. But I can tell my Dad's story. Dad does not have dementia and is now 89.

Dad's teeth started breaking in 2015. At least that is when his front teeth started to break and it was noticeable, I have no idea about the back teeth. It took until 2016 to convince Dad to go to the Dentist. The dentist discovered he had a few abscesses and treated those with antibiotics before commencing treatment. Dad had to have about 10 teeth removed, mostly they had broken off at the gum and would continue to be a source of infection. Dad had 6 removed in the office by the dentist (just local anesthetic) and was scheduled to have the rest removed later. Dad refused to go back. Fast forward to 2017, Dad had yet another skin cancer removed, this time from his back. Within a week it was infected. A month later I was at a social event with him and his dentist was there, he was complaining to anyone who would listed about the post op infection, he was blaming the hospital. His dentist pointed out that he had not completed the dental work, likely had yet another abscess and that would have been the source of infection.

We cannot force dad to get the rest of the dental work done. But it has to be noted on his medical records that he needs a round of antibiotics prior to any invasive procedure to remove any potential infection ahead of time. Will the condition of his teeth continue to impact his general health? Yes, but it is his choice.

Now if he had dementia and my brother had to invoke the POAs, then I would have, in 2015, advocated for the teeth to be removed by an oral surgeon under general anesthetic.

Lastly, although Dad is missing many teeth, including noticeable front teeth, he has no interest in false teeth. He has mostly eaten soft foods for years, so chewing is not a problem.

Windy, I am so glad you asked this question and received such sound advise from her personal dentist. My dad was told that he needed 14 teeth removed, 10 have rotted at the gum line from a life time of bad (non-existent) oral hygiene, he was told he needed a deep cleaning and dentures. I can not believe the lack of integrity in the dental field, I have been told multiple times that deep cleanings are a bunch of hooey and just a way to charge 500.00 for a cleaning, my husband has been told the same thing from a maxi-facial oral surgeon (?), he had a dentist crack a tooth during a routine crown repair, never told him even though my husband was in pain and went back like 10xs, nope no problem says dentist. Thousands and thousands of dollars, bone graft and no pain 6 years later. My poor dear dealt with tooth pain and jaw bone damage because of this unscrupulous "professional " it does my heart good to hear that there are ones out there with integrity. (Sorry for the rant) Back to dad, so he actually wants to have teeth removed even though he has no pain and can eat whatever he wants, then he gets the 5,000.00 quote, nope not gonna do it. There has to be a better way for dental care then going to Mexico to get affordable care.

Hi Windy... I’m in agreement with most folks on this one. We just went through the rotted off broken tooth thing a month ago. It was only one tooth that broke off and left a jagged mess at gum line. She also had cavities and some other issues. Dentist pulled it and filled cavities and wanted to do a partial denture or implant. I’m like really? No way. Aside from the need for a multitude of visits and after care, I weighed the options. Spoke with 2 other dentists. Both agreed if no active infection, go on as needed basis from this point on. Leave the pulled tooth alone and don’t worry about asthetics. My mom forgot about the missing tooth the day after the jagged mess was removed. Until it got pulled, it was all she could focus on and played with the area with her tongue non stop. Although there’s a big space where the molar was, she has no pain. We don’t have to worry about dentures. I now make sure we brush and floss together and pray no more teeth fall out. My mom has a dead black tooth too that we left alone because it still was functioning. Dentists basically said if no pain and no infection, leave alone and address on tooth by tooth case. So difficult to make decisions for someone incapable. Best to you...

I worry about this too. Dad's dentist was his high school friend. He went only when he had a problem. But when the friend/dentist retired that was that. So about 5 years ago I took dad to one of those "dentures only" places. They took xrays and said dad's bones were very dense and it would be an effort to get his teeth pulled. And like others have said, dad didn't even want to spend the $80 to get the eval so he certainly was NOT going to pay thousands for dentures when "he didn't hurt". Fast forward, his teeth are worn to the gums, front teeth broken, etc. He doesn't brush at all unless I tell him to and I'm not there every day (he lives in his own home). So, I just let it go. I ask him if he has any pain and he says no so I guess if he ever has pain I'll get him to a dentist. And yet I worry. Ugh.

I would definitely get another opinion to start....maybe from her old dentist, the one you trust. I, myself, had a situation with a dentist when I was in my 30's. Went in for a cleaning and was told my teeth were in terrible shape, I was going to get gum disease and lose all my teeth, and was accused of not even brushing daily! They put me on prescription mouthwash and everything! Eventually I went to another dentist, who basically laughed when I told him what the other dentist said! Today, at 52, I have had no issues, get 2 cleanings a year, never use prescription mouth wash, and am no longer scared to death of the dentist! He said I do have a higher plaque buildup than most people, and periodically I will add an "extra" cleaning in the cycle....but that is due to my body producing more acidic saliva (or whatever they call it) and it is nothing I can control, even with proper brushing and flossing. So my point is, don't trust the first opinion, esp. of a dentist you don't know. I'm betting there are better options available other than pulling 10 teeth! Even just taking care of each problem as it occurs seems to be a better option than putting mom through that trauma this dentist is suggesting.

P.S. The dentist who told me I would lose my teeth is out of business, or I would have taken him to court!

The dentist wanted to pull DH's (96 yr old)  front 3 teeth and crown the 4th. He already has a partial and there were no plans on the dentist's part to add teeth to the partial.

As luck would have it, they forced my hand when they made me leave him alone in the waiting room to pay $103. He was supposed to return in 3 days for the work. I totally freaked. After 28 years with them, they couldn't trust me 3 days for $103.

Went across the highway and found another dentist that rebuilt 2 of the teeth - pulled nothing - for 1/3 the cost.

Get your 2nd opinion.

Thanks all for sharing your experiences. I’m good here.....NO TEETH PULLING

The AL is arranging to take mom to her old dentist. I talked to him yesterday. He’s going to grind off the rough edges. Done......

Mom's dentist chose to polish down root tips and make a temporary partial (a softer material) to protect the 4 teeth left on her upper palate. The decision was to basically leave them alone unless a problem like infection became evident.

Hi Windyridge,

Sounds like you received excellent responses! I wouldn't have my Mom's teeth pulled either.

I had 8 teeth pulled for a denture a couple of years ago and I used a product called Nature's Answer PerioBrite Cleanse which helped heal my gums and prevented infection. I don't know if your Mom would rinse with this but I just wanted to mention it because it helped me.

Jenna

You should be very concerned about the rotten teeth turning into sepsis.That alone with kill her.

My mother-in-law, 92, advanced dementia, has one remaining tooth. The others broke off over the years. Her dentist, we were told, was able to pull one of them several years ago with the plan of making her dentures. She refused to go to the next appointment, and her son, then her caregiver, didn't force it.
When my husband gained guardianship two years ago, he took her to a dentist. The dentist said there was very mild infection, but it would be too traumatic to pull the other broken teeth, and could cause her more harm than good (risk of anesthesia at her age, infection, inability to eat). She was eating a soft diet well. He said if she complained of mouth pain, to bring her back, and only then would he consider doing something, if the benefit of treatment outweighed the risk.

Kind of a trying decision either way, but rotten teeth can be painful and result in infections. While we all dislike the idea of pulling teeth, in fact, today it can be done quickly and painlessly. The teeth of elders are also not as imbedded (attached) as when we are younger - and can be extracted quickly. I had a similar experience when taking over health care advocacy of an old friend - we both worried about the dental work that had been avoided for years. In fact, we were in the dentist office less than an hour - and he pulled 7 teeth in about that many minutes, they didn't bleed and healed quickly. Of course, each case is different - there may be crooked roots, impactions, exposed nerves, reactions to pain killers, etc. You'll just have to weigh the positive and negative factors.

Sometimes I think Dentists, like a lot of other disciplines, want you to look perfect. They are thinking of how to make you look your absolute best. They forget your age, finances, etc. They don't understand that a lot of older people can't or won't wear dentures. I think of it this way. They have pride in their work.

I agree with a lot of other people. I would go slow and want to know why each tooth needs to be pulled right now.

Reminds me that when my mother was in her 80's she wouldn't go to the dentist. She pulled her own teeth. My mother was tough.

MaryKathleen...just read your post it my dad...we had a good laugh! 😁

Wow, this is a tough one....I would really have to think long and hard about putting someone through this...Just a month or so ago, I was visiting with my husband and noticed something wrong and thought maybe he had fallen and knocked out one of his next to the middle front teeth.. He is in a Memory Care Home and didn't seem to be in any pain but I made sure I got him to the dentist...After checking, he had lost a filling (looked much worse than it really was) but the dentist said, after making sure the nerve wasn't exposed, all he would do was file it smooth and not put him through any more....My husband is 87 and would not be able to tell me what to do if he had needed to have teeth removed...It's really hard making decisions when you're really not sure....My heart goes out to you......

Windyridge
DO NOT FEEL GUILTY.
Get the Dentist's diagnosis in writing along with xrays to consult with Oral Surgeon AND her doctor FIRST.

Yes, abscess are extremely bad no matter one's age, but especially your Mother's.

If these should rupture the infection will enter her blood stream and it is the heart that is effected the most.

Do you need to take penicillin before having any dental work done? If so, it's so you have a greater chance of not having an infection happen and mostly due to some type of heart issue.

I'm lucky enough that I don't have to yet, but I did end up with a rare infection caused by the hygentist accidentally getting too close to the salivary glands which is where you have lymph nodes under your tongue. Suck them dry with that suction wand. I hold it and contol now.

I ended up in the hospital immediately after I had to go to an ENT because I could not swallow and my throat was swelling to the point I would have died within the week if I had ignored it.

You're in a no win situation too.

The infection that could happen and doing the procedure at her age is also a danger due to anesthesia.

Opinions are like butt holes; we all have one. My opinion is to consult with the 3 doctors, but I would have the removal done. At her age, they may not fit her for dentures either. It may be better that she be placed on a soft food diet with supplements like Assure.

My Mom died about 2 1/2 months ago. She was 97, almost 98, and went out with all of her own teeth! For as long as I can remember she flossed religiously. When she had to go into a NH after a bad fall and broken hip/wrist, she had to be her own advocate for her teeth - she had to insist on the opportunity and practical setup to brush her own teeth, because the NH staff never would have. About a year ago, she complained about a tooth that was sharp, and I took her to my dentist (not the Medicaid dentist) and he gave her a good deal that I could afford. She had two bad cavities in back molars, and he said if they were left, infection could set in and go to her brain or cause heart problems. We had them pulled, with local shots, and she was fine from then on. (I guess technically she went missing two teeth!) With your Mom's situation, I'd have sharp, or jagged, teeth filed or as a last resort pulled, but wouldn't opt to pull all of them. (I have total dentures and would hate to think of your Mom going through all the adjustments, both physically with the "fit", and then the trauma and "practice" to use them. Dentures aren't for sissies - especially the bottoms. And even dentures need to be cleaned regularly.)

I am curious if anyone knows what role Medicaid plays in dental care in nursing homes.

My Dad had oral surgery (at the VA) and they pulled all the bad teeth out at once. I can't remember the count, but I think it was around four. I thought it was going to be traumatic and painful for him, but it seemed to be fine. He was laughing and joking with the doctors and said he had no pain. After the drugs wore off (anesthesia) his mouth was a little sore, but no bad teeth = no more pain. I'd suggest going with the oral surgery -- the complications from not having it done are far worse, and once the teeth are out, she will not experience pain any longer. Worth it. I wouldn't wait - waiting makes it worse.

Windyridge et al: I follow Aging Care regularly & I was struck by how this topic is rarely addressed in information re: caring for the elderly! My parents (88 & 92) have had regular dental care over many years, so I think they're in pretty good shape. But you never know - problems can develop at any time! I'm glad you came to this site to get opinions & I'm grateful for all the responses.

My FIL had a NH dentist request to pull 8of his teeth. He is on Medicaid and I’m sure they get something for their services, but I declined the services as I would have had to take him to the hospital to be knocked out. He has been in the NH for over a decade and I believe Medicaid covers several medical/dental procedures that are not necessary( I also declined pacemaker they said he needed 8 years ago). We declined dental work, teeth fell out or he pulled them out over a month. They convinced him he needed or wanted dentures, total waste of our/your tax dollars as he rarely wears them, he is 86.

Get a second opinion. If there are no infections, pain or discomfort at this time what's the point? 2 questions, can she live with the "jagged" tooth, what's the risk of surgery - i.e. discomfort, pain, infection.

For various reasons, some individuals put off dental work. But into old age, leaving rotten teeth in the mouth is a risk of infection. Yes, I understand that dental work is expensive or the fact that some people have dentalphobia.

Trevor - Regarding Medicaid & dental care, it’s up to your state to make the decision to include dental services as each state manages its Medicaid programs uniquely but within overall Federal guidelines. 
Most states Medicaid dental is only within CHIP - the children’s healthcare program - and geared for prevention which can be done by other than a DDS or DMD. Usually in large mobile units - own by the state but in partnership with a children’s hospital & a dental school- which travel to schools or other community sites. CHIP has a dedicated federal coshare for prevention programs & kids dental can get paid through this so for states it’s a nobrainer to include. Kids dental is mainly visual check up, annual bite wings & paint the incoming teeth.... costs minimal as most work done by a tech but effective long term. Adult dental requires actual dentist time and usually it’s specialist work so it’s expensive plus with medication and sedation, $$$!

Dentures get recommended as those are covered by Medicare. Medicare will pay a set fee for removal & dentures. The only other way MediCARE pays for any dental - to my knowledge- is if the breakage / damage is due to a major trauma that your hospitalized for & being covered by Medicare. So like your 70 & in a major car crash with shattered jaw; the dental reconstruction can be covered by Medicare assuming you find a oral surgeon and dentist who take Original Medicare or are in your Medicare Advantage Plan that has dental providers. But other than that, dental is all private pay. For my mom, she did a huge spend down in dental the decade before entering a NH... got implants, full front bridgework, replaced vintage fillings, gum tx’s; she had the $$ and for her situation, it was $$ well spent. But if she was in a facility and already in dementia mode, like Windyridges’ mom, I wouldn’t have encouraged it.

As an aside on this, when Medicare was being written into law in the 60’s, dentists were left out of any planning. It was a combo of issues as to why.... dentistry then wasn’t at all what it is now; back then loosing teeth was expected part of aging and folks just got dentures or did without teeth; & AMA wanted Medicare to be all about physicians; & AHA wanted it all about care in a hospital. The ADA didn’t present an active organized front to have dental as a part of Medicare. If an “oral surgeon” was needed, those rare guys were dentists who went onto a ENT or Head&Neck speciality residency at a Health Science center (has a medical school), so their DMD’s rather than just a storefront solo practice DDS. Most MDs never ever work with dentists, they usually do not have admitting privileges at hospitals, so got left out of the planning process.   Not to insult you dentists or dentists spouses or hygienists reading this, but back then being a DDS was way way below MD status. Dental school was the default for those who had less than great MCAT, no family/alumni connection and couldn’t do the foreign medical school grad approach to being a MD or do PH.D program. Nevertheless at least Dentures were included for coverage in Medicare planning.

Update...

So many folks chimed in with advice and experiences I thought I’d put out the latest news.

I talked to mom’s old dentist last week. He the called the AL and arranged for her transport to his office today.

He called me about noon. It went very well. He easily ground off a couple jagged edges on two teeth and sent her own her way. He’s refusing to let me pay for his services. She’s been a patient of his for 40 years, it was really nothing etc........

Such a relief. So gang.....Whats a good gift to send to the dentists office? Small place. Maybe 3 people..Fruit basket? Home Depot cards?
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