My mother is 92, has advanced dementia, has been on hospice for 9 months and now has a very loose bottom tooth (premolar). It doesn't hurt and it doesn't seem to be infected. Mainly it annoys her when she's eating. She is not ambulatory and can't help with transfers anymore. Just getting her in a car is a feat. The last time I took her to her dentist was nearly a year ago...it was a nightmare for us, her and I suspect the dentist as well. The whole process caused her a great deal of confusion and anxiety and all they did was x-rays. I am trying to keep her life as quiet and comfortable as possible these days. I have a hard time imagining her getting her tooth pulled in a dental office BUT, all that being said, if going to the dentist is the better choice, we'll do it. Our hospice nurse said we could let the tooth fall out on it's own if we're worried a dental visit would be too traumatic for her. That sounds really good to me and is the direction I'm currently inclined to go. I'm thinking once the tooth comes out, her nurse could help me watch for and treat infection. So, I guess basically I'm looking for validation (if validation is warranted) but also hoping some of you might have some insights and experiences that would help me think this through.
I would maybe call around...ask the DDS his/her opinion, or if nothing else what oral surgeon they would suggest...They are more experienced skilled and even have dealt with dementia patients if they've been practicing a while...one of them may be willing to come take a look...if skilled they can often tell by looking how it might go. THere have been issues in the past with women who took some of the drugs to prevent bone loss, and believe it or not, the warnings were so scary in some cases as I recall, they might opt for just letting it alone and letting nature take its course....Do you have a local dental school? You might get a referral there. Wishing you all the best and an oral surgeon as warm and compassionate as mine...who became like a big brother to me:-)
If you are concerned about eating, you can change mom's diet to a dental soft diet so she doesn't have to chew or bite anything that might aggravate that tooth.
If she will tolerate, try to get her to eat more citrus fruits or foods with vitamin C. Vitamin C will strengthen the tissue that keeps the tooth in place.
If her tooth falls out and there is bleeding:
1 - have her bite down on gauze to stop the bleeding. Mouth wounds tend to look bloody but actually have a lot of saliva mixed with blood. They also heal quickly.
2 - Offer lukewarm clear liquids to drink frequently after clotting has occurred. "Hot" or "icy" drinks might be painful if there are exposed nerves.
Of course just wait til the tooth falls out but you can help it fall out by just wiggling it several times a day and when it gets loose enough it will come out.
Then she can rinse her mouth with mouth wash.
My patient in his 90s and also has dental problems. One tooth that was previously cracked, broke off above the gum line. He was not in any pain afterwards so we did not go to the dentist. Also, he has one tooth on the front lower jaw that is crooked and I think it is also loose, but he does not seem to be in pain about it.
I have called his dentist and spoke to dental office manager about my patient’s dental condition. The dentist never called back and the office manager was sympathetic, but could not do anything.
The bottom line dentists do not want to deal with the problems or take the risk of treating a dementia patient. I even called pediatric dentists to see if they would see a dementia patient because of the behavioral problem similarities they have with children. The answer is “No.”
Suspect the dentist of what?
I am sure it is uncomfortable for her. There are traveling dentists, one visited my mom's memory care facility. See if you can find one. Try calling the Area Agency on Aging to ask if there is such a service.
Never heard of traveling DDS in Marin County (California).
Often we don't know what is available until we need the service and do our research. Gena/Touch Matters
To bring him to a dentist meant having to put him at least into Twilight sleep.
Then after any dental work, and I knew there were teeth that should be pulled to try to keep him from picking at the wounds in his mouth would be almost impossible then to try to care for the wounds in the mouth would be difficult not to mention any follow up.
I made the decision NOT to do any dental work on him.
He did not exhibit any of the pain signs.
He did loose a tooth or two.
By this time he was on a soft/pureed diet.
He still did allow me to brush his teeth daily and I did watch for redness, tender areas and other signs that would indicate an infection.
You are making the right decision.
If her tooth bothers her when she eats, you may want to give her just soft or pureed foods at this point.
My husband had several loose teeth before he died, but was already on a soft food diet because he was an aspiration risk, so he never complained about them.
I wish you and your mom the best.
I know that "peripatetic" services aren't widespread, and they may not even be offered at all in your area, but if you don't ask you don't get!
There may be a larger issue (like extensive gum disease) going on which is causing her teeth to loosen, meaning that this is not the last tooth that she will lose, but you need to decide if the trauma of dental treatment at this point is worthwhile.
Near the end if her life, several of my mom's teeth broke off due to dental caries, even though she was in a NH and receiving ongoing dental care. We elected not to proceed with extractions or treatment.
I suppose that you could call her dentist and see what he recommends. He may be able to advise you in regards to the best option for her.
Best wishes to you and your mom.