Dental options/risks - dentures, implants, etc?

rk0914

My 70 year old mother is in a moderate stage of Alzheimer's, and I recently moved back to manage her care. She currently lives alone in a house (though we did try to move her into AL a couple years ago, but this failed before we even got through her front door).

Her teeth are in horrible shape, and one broke off shortly after I moved back. The dentist extracted the root and referred us to a prosthodontist/oral surgeon for either dentures or implants for all of her top teeth. I know my mother is unable to manage her overall dental hygiene or follow up care for whatever we end up doing. She definitely cannot follow instructions or learn new routines.

Looking for other experiences with dental issues to get a sense of risks. Did you opt for dentures, crowns, partial crowns, implants, extractions, just let the teeth fall out? How long was recovery and how did it go? Did your provider have a special background or expertise? What was the ballpark cost (both money and personal)?

Thanks! I'm new to this platform, but so glad to find a community!

King Boo

Teeth decayed beyond imagination was what we faced.   We were referred to an oral surgeon for removal of all teeth but 7 in the front.   It was a gradual process that was well tolerated by my LOWD.  it was done with local not twighlight or general sedation.   We had 5 visits to accomplish this, several weeks apart.

He did quite well in his MC with finely chopped or pureed food.  We did have dentures done because at only the moderate state, there was a chance he would/could adjust (but he did not use them, but I felt we had to try). 

You cannot just leave them, dental nerve pain is beyond terrible.  

harshedbuzz

rk-

I am sorry you and your mom are dealing with dental issues on top of dementia.

It sounds as if the decay issue is the result of poor hygiene and that the time for mom to live alone may be past. You mention it was a fail a few years ago, but given that this disease is progressive, perhaps MC needs to be revisited. If she can't manage toothbrushing, the hospitality AL ship has sailed for her. 

I would not consider implants. The procedure, while not horribly painful, is time consuming and expensive. My mom, who does not have dementia, recently got lower implants to hold dentures. She'd already lost those teeth, so there was no interval in which she needed to heal from extractions before starting. The time from scheduling the procedure to installation of the permanent lowers was about 8 months. There is a risk she could start the procedure and decline in that interval leaving her unable to complete the process.

For much of that time (about 6 months), she was on a strictly soft food diet to avoid displacing the actual implants while the bone filled in around them. Once they're in, they need to be cleaned around them to avoid gum disease and infection. There were many appointments to get this all accomplished maybe 20-ish. My mother's teeth- custom uppers and lowers, temporary lowers, implants and fees to the dentist and endodontist were in the neighborhood of the cost of a new car. And not a stripped down model. Unless she has unlimited funds, that money might be better directed to home health aides or a MCF. I personally would not choose implants for a person with a terminal illness like dementia. 

In your shoes I might try dentures in midstages but it's possible she may never adjust to using them. It's hard to say. My dad had always worn them and did pretty well until the very end stages. If she goes to MC, I would label them because they are often something that appeals to "shoppers" and "hunter gatherers". 

I don't feel like this can be ignored entirely. Tooth pain can be intense and decayed teeth have the potential to cause dangerous infections, so at a minimum the affected teeth need to come out. 

HB

mommyandme (m&m)

I’m so glad to read this thread. My mom’s teeth need attention too. I’m just not sure what to do. 

I guess just doing something should be a first step. 

rk0914

Thanks for your insights @King Boo! I am absolutely agreed with avoiding as much pain as possible for my mom. I'm concerned about that and I'm concerned about infection too.

Based on my mom's current ability level and your own experience, I'm thinking she won't be able to manage dentures. Though maybe she just needs to know she has them as an option? She's embarrassed by her newly missing front tooth. This might be where Covid masking is helpful for other things

I'm glad to hear that your LOWD is able to eat ok without many teeth. That gives me some optimism. Thanks again!

Arrowhead

Do what needs to be done with the teeth she has. After that, look into your options. I have an upper denture and only my four front teeth on the bottom. I have found that most of the foods I eat, I do very well without my denture. I need it for solid meat like steak or chicken, but that is about it. Without it I can eat hamburger, hotdogs, pasta, cooked vegetables, most fruit, bread, and more. If a denture doesn't work for her, you can experiment with foods to find out what she  is able to eat without it.

rk0914

Thanks, HB! 

I really appreciate the detailed information about the implant process. A lot of what you experienced is what I'm worried about. The timeline, the cost, the pain, risk of other problems and overall management. I was leaning toward implants, but not so much anymore. 

Maybe slow extraction is the way to go. That way, she won't suddenly be toothless, but we can attempt to control the transition and then wean her onto soft food. I'll need to keeping considering. 

Re MC, you're absolutely right. We should've put her in MC a while ago. And now, I just need to decide which traumatizing way of moving her might be the least traumatizing (for all of us - the previous attempt at AL did not work). And then I need to suck it up and rip off the bandaid - it is so hard to do it! But that's definitely a separate post for another time...

MN Chickadee

My mother had a couple teeth that had to come out. The dentist wanted to do implants but we said no. We opted for a partial bridge that was secured to surrounding teeth.  It is not a solution that would work for most people but in this case it was fine. The dentist said it wouldn't last forever, and did eventually fall out recently after about 2 years. Her dementia has progressed and she is having trouble swallowing, so we are just leaving it alone. She doesn't notice it's gone and she is eating softer easier foods anyways. Don't assume the dentist or oral surgeon will have any clue about the limitations dementia will bring and they may just recommend whatever fancy expensive thing they would for a cognitively normal person. You will have to weigh pros and cons of anything invasive. I would not do anesthesia that puts her out if possible as it can wreak havoc on dementia. Perhaps something like King Boo mentioned where it is a slow but steady process. Communicate explicitly with the dentists about her dementia.

rk0914

Thanks, Arrowhead and MN Chickadee, I feel a LOT better knowing that my mom can lose some or most of her teeth and still eat a variety of foods. I had in my mind that I have to fix her mouth, i.e. replace her teeth whenever they come out. It's definitely tempting to just listen to what the doctors say and go with it, since it's hard to find real pragmatic advice for this kind of thing. 

MN Chickadee, a coworker had randomly mentioned to me that using anesthesia on his mother-in-law caused some dementia behavior for her, but now I'll definitely remember this.

BassetHoundAnn

About a dozen years ago my mom had an implant to replace a single tooth in front of her mouth that fell out. She was in her 80s at the time but not yet into her Alzheimer's journey. She tolerated the procedure well, had no problems and still has the tooth. 

Fast forward ten years, after I moved her out of her house I took her to a dentist. Though it had been only a little over a year since she'd been to a dentist (according to her medical records) her mouth was in bad shape. A dozen cavities, teeth falling out, a bad scene. 

A couple teeth have been removed, a few have chipped, some have fallen out. She keeps demanding implants to replace them but I humor her. 

I will say that the dentist, her staff, and the staff of the oral surgery clinic where I've been taking her have been absolutely phenomenal in dealing with a dementia patient. She has fits, meltdowns, panic attacks. They're always great at soothing her, calming her, assuring her that she's in control. They're so incredibly patient with her I have nothing but admiration for them. Once when we were in the waiting room she dropped to the floor and started screaming that she wanted to die. The staff was all over her, soothing her, getting her into a wheelchair, calming her down. Wow, they're pros at this! I kept marveling. 

One day I took her to have several cavities filled (her decision that she wanted them all done in one day). After having one tooth filled she had a major meltdown. The dentist and I concluded that it would be best if we indefinitely delayed the other fillings. 

She had five mostly-rotten teeth that should have been proactively extracted, but since she's not good at tolerating extractions, the dentist and I decided to hold off. One tooth broke and partially fell out, leaving behind the roots. We didn't think she could tolerate a root extraction, so the dentist simply put a filling over the root to prevent decay.  

It's been baby-steps. I've taken her to the dentist 8 times in as many months. The dentist has been phenomenal, patiently explaining to her again and again what procedure she should have done, and helping her come to a decision about it. The priority is keeping her mouth pain-free and in a state that allows her to eat. She does still brush her teeth, but how well is questionable. 

Managing mom's dental health has certainly become a project. The goals of managing the dental health of a frail elderly lady with dementia are very different from those of a younger healthy person and I'm grateful that her dentist understands this. 

danielb

My grandmother, 83 had a similar experience. She is bedridden and requires two people to take care of her. Even though we have a home nurse, an extra hand is always required. One day she fell from her wheelchair and thrashed down face losing more than a tooth. Her face was all swollen and had to get to medical attention immediately. After the blood bath stopped, we had a discussion on what will be the better choice as she is aged. 

As she is a senior citizen, implants can have a great impact on her overall health, and it is difficult for her to maintain it. We decided to get dentures is it is much better than implants. Even though it cost less, we took the decision. which will be better for her health. Dental implants require sedation and even the dentist suggested the opposite. Dentures are much easier to maintain rather than dental implants. 

SonShine Lady

@rk0914

She's embarrassed by her newly missing front tooth. This might be where Covid masking is helpful for other things.

I just had to respond to this!!  My family has genetically bad teeth.  My mother (my LO now in MC) got dentures when she was 19-20.  Same with her brothers.  Ditto with my cousins.  My mother was determined I'd keep my teeth and I did....until I was 63 BUT that included several oral surgeries, MANY root canals, caps, etc.  I truly wish I'd opted for dentures earlier in life.

My denture experience was excellent.  Love the way they look.  However, I have full dentures and my gums shrank very quickly.  If there is even one tooth that can be saved DO IT!!  Mine were too far gone but, especially with the lowers, even one tooth can really help with gums not shrinking and being able to use a partial.  I have been on disability for many years.  I had my back teeth pulled 1 or 2 at a time at a free clinic.  My parents paid for my front teeth to be pulled & dentures made at the dentist I used.  I experienced no significant pain nor bruising, but everyone is different.  My dental plan was to get a new pair after one year as, by that time, all shrinking is done but my parents only agreed to pay for the initial work and I can't afford a new pair.  My dentures are now way too big for me so I only wear them when I go to church or someplace similar.  Otherwise....I wear a mask.    The funny thing is, I began wearing a mask years before Covid, especially if I was just running to the grocery.  People gave me odd looks, and some backed away from me.  The pharmacist asked if I was ill.  NOW I don't have that issue.  I also eat at home without my dentures and do just fine; it's amazing how adaptable humans are.

I would recommend dentures if your mother's teeth are too far gone for crowns - although for an entire mouth - they are MUCH more expensive than dentures.  The most expensive part of getting dentures is having the teeth pulled.  Some insurance covers it; basic Medicare does not.  When I shopped for a dentist to pull my remaining 15 teeth plus the dentures I went to three completely different types of dentists.  (1) A "store front/supposedly very good prices/chain" dental practice.  Total cost approx. $6,000 and I had to beg to get a tiny bit of valium.  I've had extensive dental work done in my life and, while it does not hurt to have teeth pulled if there is sufficient novacaine, the sound of the teeth cracking and the pressure of them being pulled at the free clinic was not pleasant.  (2) The private practice of the dentist who volunteers at the free clinic and did most of my work there.  Same price and, again, had to beg for medication to help calm me during the procedure.  (I am on disability for an anxiety disorder.)  (3) The dentist my step-father went to when he got his dentures.  This dentist specializes in implants, has the most "high tech" equipment, AND is the only dentist in our town certified to administer sedation.  One would think he would be way more expensive than the store-front "we are affordable" practice.  Nope!  $6,200.  I did bargain the price down a bit for the sedation.  ALSO, this dentist makes the dentures himself - doesn't send them out to a lab.  When/if I have the money for a new pair of dentures - I'm going back to him!! 

My 88 yo mother in MC has worn dentures the majority of her life so taking care of them/wearing them are a part of her.  Whatever is least traumatic for your mother would be my suggestion.

 

TAYTRA

I haven't been on here for a while but so glad I signed in today. I am at my wits end in regards to my Mom's Dental hygiene. She has been refusing to brush her teeth, saying that she brushed them early. She has dentures (top) but she has been refusing to take them out so they can be cleaned properly. At this stage she thinks they are her real teeth and cannot be pulled out and will not let me do it. I can tell they are bothering her now because she keeps messing with them. I too am worried about infection and signed on today to see if anyone else had/has this issue and any suggestions you might be able to offer and then I saw the post here today.