Dental Issues: how much do I push

NizhoniGrrl

My mother, 86, now living with us, has had MCI for about 10 years. After my father died, it was clear her executive function was gone and she needed to live with us to keep track of her finances, doctor appts, medications, meals, etc. 

She has extensive dental issues. She has about 5 teeth on top and on the bottom is down to one molar and three bare implant posts in front. She has bad dry mouth from auto-immune disease and all of her teeth are full of cavities, or hollow from decay. For about 10 years she has been advised to have them all pulled and transition to full dentures. She's refused and they've rotted and broken one by one. Now that she is down to one molar on the bottom, I think it is time. We've gone to all the appointments (dentist, prosthodontist, oral surgeon) and now she's announced she only wants the three broken teeth nubs on top removed and that's it.

I'm worried that her rotting upper teeth, with some roots extending into her sinuses, are giving her a constant drippy nose. When her final molar fails, it will take a long time to get dentures (appts, impressions, scheduling oral surgery to remove the other teeth) and she'll be miserable with soft foods. Also, it's a risk for infection, especially since she is immune-suppressed. But she is living a fantasy that this won't happen.

How hard should we push? She said she hopes she dies before she is toothless. The problem is she has really become much like a child and logic does not work with her at all. I've her health-care proxy, but she hasn't been declared incompetent. She could say no on the day of the surgery if we scheduled it without her consent. I'm very annoyed because constant dental emergencies in our future is going to put more stress on us as her caregivers.

Sorry - I initially posted this in the wrong forum!

Cobalt

Actually, this is a great forum for this problem of dental care.  We have these concerns too, for my son will never be able to have dentures or partial due to the type of grand mal seizures he may have.  So to try to preserve as many teeth as possible, he has a special silva-fluorodine (or something like that) seal on some front lower teeth.  It stops the decay right where it is so it can hold him out for many months or maybe a year until we can afford a root canal and crown.

The thing that is tricky for decisions is that a broken off tooth still have the root in place.  Over time, it can get decay under the gumline and abcess.  Seriously, we don't want to deal with our LO experiencing bad dental pain.

Your mother's decisions on her dental care sound like bad moves.  It would have been good to have POA in her case.  But it is what it is, now.  Sorry for your dilemma!

ninalu

Hi NizhoniGrrl,
Your mom sounds as though she may be a good candidate for a specialized Oral Medicine evaluation. Specialized dentists & oral surgeons can be found to manage high-risk patients. If you live near any universities with programs in Dental / Oral Medicine, you could call them and ask how to approach this. In the city where I live, one of our top Dental Schools has a teaching clinic in partnership with a local hospital. The care is at a reduced rate and supervised by doctors who specialize in the various health conditions that put these patients at high risk. In effect, it bridges the gap that seems to exist widely in this country between "dental" care and "medical" care. Some autoimmune patients need more support than a regular dentist can offer.

That said, dental care for patients with cognitive deficits is ALSO complex. My take, given your mother's underlying autoimmune issue, is to have her evaluated by a doctor who understands her medical condition and from that place draw up a plan. 

As for how hard you should push to treat her dental decay? For me, it would depend on what the risk/benefit looks like if you do nothing vs. do something. 

Cobalt

hey ninalu, you reminded me of something I totally forgot to mention!

My son gets his dental care at the area dental college in the Phoenix metro: A. T. Still University, at the Arizona School of Dentistry and Oral Health.  This is a special clinic that treats patients with disabilities.  Makes a huge difference in the quality of care and their experience working with challenging patients.  I hope you are in driving range of such a resource but I will also suggest you have someone go with you as an assistant.  It really helps to have a helper you and your mother know.

NizhoniGrrl

Thanks for these ideas! I think the issue at hand is that we know what needs to be done to spare her pain and suffering in the future, but she is refusing the treatment. She is focused on now (I don't want to be "toothless") and not the consequences (she'll suffer more pain, more interventions, and be on soft-food for months). It's too late to spare any of her teeth as they are all decayed and some completely hollow.

This is also a good reminder to me that maybe we need to update some of her legal paperwork. I have POA but I think it is only if she is unable to make a decision.

abc123

I am thankful for this thread! My mom has a bad tooth right now. At this point, her regular dentist is not an option.

NizhoniGrrl

@abc123 - Another reason I want to get in front of this problem!