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I had a call from my dad's dentist today. They have told me in the past that he has a lot of decay and infection in his mouth and that they should pull his teeth and get him dentures. Today he had the caregiver take him to the dentist because his gums bleed. They told him again that he absolutely needs to have all of his teeth pulled. They are concerned about sepsis. He also has a top and bottom plate but I know teeth keep falling out so those don't always stay in. I'm really not sure at this point if he is maintaining his teeth that well although he says he brushes every day and I have never noticed any kind of odor from his mouth. We have a consult appointment in a couple weeks and I would assume we would meet with an oral surgeon at some point also. I am his guardian so I feel like I should make him do what's best but then I can't force him into having his teeth pulled either.

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If there is infection there might not be any way around having them pulled, but I'd start by getting a second opinion - perhaps with antibiotics and careful oral care (I found colgate's peroxyl worked great) he can get by with perhaps only a few extractions and repairing the rest. My mother had to have all her remaining lower molars puller when she was 90/91, but she didn't have dementia then so although it was physically worrisome at least she was able to participate and understand and had the motivation to adjust to her new lower denture.
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Tell him better to have them pulled then to have expensive root canals done. The infection can cause all kinds of health problem.
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cwillie Mar 2019
Thank god the OP's dentist seems to have at least that much common sense.
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We're kind of back to square one on this. Dad told me yesterday that he refuses to go back to his dentist. At this point, I have tasked his care manager with finding someone else for another opinion. Does anyone know if there is such a thing as a geriatric dentist? If all else fails, she and I will attend the consult appointment with his current dentist without him.
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I was very lucky to find a compassionate dentist who had a lot of experience working with nursing homes, perhaps you could try asking your local facilities if they have a preferred dentist?

editing to add - My mom was originally supposed to see a dental surgeon in an unfamiliar town. I was reluctant for her to have surgery due to the anesthesia and also reluctant to travel there, so I started calling dentists to see if any were willing to do a consultation.
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Babs75 Mar 2019
Our care manager found a geriatric dentist across town. She is looking into that for me.
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My Dad is 90 and does not have dementia. 5 or 6 years ago his teeth started breaking off at the gum line. About 3 years ago I convinced him to go to the dentist, at that point I thought his teeth were falling out, I did not realize they were breaking.

Turned out he had several abscesses and needed to have about 10 of the roots removed plus a couple teeth. He went on antibiotics, had about 6 of the roots removed and refused further treatment. He is continuing to have teeth break, but is not at all bothered by it. He still smiles with missing teeth and all.

He already mostly ate softer foods, so continues to eat well.

His dentist is concerned that he at least be monitored for abscesses, but he refuses.

Dad is 90 now, so close in age to your Dad.

The removals were terribly painful for Dad, he may have refused pain medication afterwards and the healing took a long time.
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Losing ones teeth and moving to dentures is tough but if he's at risk of sepsis then there really is no choice. Sometimes elders will refuse to wear dentures or have a lot of problems adjusting to them so be prepared. My Father in law spent the last years of his life toothless because he refused to put dentures in no matter what we tried.
Now, Pops dentures are getting loose and he has been combative when faced with dental appointments. Pops dentist told us that it's very common for elders to refuse to wear new dentures and has strongly suggested we not change pops dentures out because, at this point he's at least wearing them.
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I am in the same situation. I have set up an appointment with a dental surgeon for my dad but not till June. So far he doesn't seem to be in any pain. So my issues are basically the same. I worry about his dementia worsening with any surgery. I also worry about what the trauma is going to do to him. I have basically decided that dentures is probably out of the question. He is 82 with moderate to late stage dementia. He probably won't wear the dentures. So I am going to talk to the dental surgeon about doing the minimal amount of work possible. Take care of issues that have or will cause infections. I just hope the dentist is honest with me and not just looking for more money.
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