Guidance on Tooth Extraction and Sedation or General Anethesia in SF Bay Area

compass needed

I'm brand new to the caregivers forum. I called the support line and they suggested I post something here to get some peer feedback. Has anyone needed to have their parent have dental extractions. My 84 year old mother needs a few extracted in a few different sessions. Actually several teeth have fallen out and many have broken off in her mouth since diagnose last year. Her mouth is a mess.

Mom is on the cusp of early to mid-stage Alzheimer's based on what I read and her MMSE score. Her normal neurologist, which we have only had for 6-months is on maternity leave and I have concerns on my mom's reaction and what to give her to sedate her or possibly put her under. I have concerns with general anesthesia from what I have read and I don't think she would sit still through it without jerking if not under some sedation or something. 

I need help with:

- Recommendations for trusted oral surgeons in the south bay that know how to deal with Alzheimer's patients and their needs and risks. 

- Suggestions on something safe to possibly just sedate an Alzheimer's patient with vs having to put my mom under General Anesthesia. 

My mom does not remember things long and we have discussed the need to remove her broken off teeth as it will affect her heart. We just got her dental insurance this year as she did not have it last year. She developed an abcessed tooth and we needed to take her in as she had fever, swelling and severe pain in her mouth. Despite telling her she needs her teeth removed she screamed at the surgeon that she was not allowing any teeth to be pulled. (we have medical right of attorney for her).

In addition, my mom had an episode of vasovagal syncope (passing out) while in the office with the surgeon as well. And my mom has tons of antibiotic allergies and the surgeon is concerned about doing procedure on her. Essentially the fainting and non-responsive issue freaked the surgeon out even though I explained it happens from time to time and I just needed to get her flat. The surgeon indicated she does not do extraction under general anesthesia and if my mom moves she cannot help her. I am thinking many likely do that and that research is next on my list. I was told I would have to either go to the ER and tell them my mom needs teeth extracted, a hospital (but to whom), or a single specialist in SF bay area in SF to get this done. I feel deflated and I'm grappling for where to go next as I feel they are just kind of turning us away.

We asked mom's primary care doc for a prescription for something to calm her down and she said mom is good for general anesthesia to be put under but I am reading that can have possible big side effects on memory going forward. And driving her to SF and supposedly only one oral surgeon does that does not seem right to me. 

- Has anyone who has had this situation have any recommendations you can share for dental extractions for a nervous patient. 

- Anyone have an oral surgeon they trust and would recommend? I'm working between this oral surgeon, my mom's primary care who I do not know if she understands the risk for Alzheimer's and her back-fill neurologist as our is out on maternity leave.

Many thanks in advance.

Stuck in the middle

Your LO may be good to go for general anesthesia from a cardiopulmonary standpoint, but you are correct that general is not recommended for PWDs.  You are also correct that rotten teeth can infect the heart, as well as other organs including the brain.  Simple extractions can be done with local anesthetic, but broken teeth probably require cutting the gum and a local won't be enough pain relief.

I suggest you look for an oral surgeon who uses nitrous oxide.  

I had gum surgery with bone grafting several years ago with NO.  I had no pain (until later) and no fear, was awake the whole time, and drove myself home afterward.  The only problem I ever had with NO is a lingering desire to try it again, as it is very pleasant.  It is called "laughing gas" for good reason.  If she can tolerate the mask used to administer the gas, she will soon be enjoying herself so much that holding still may not be a problem.

I am not a doctor and have no suggestions about antibiotics.  Did you find one that worked without side effects when she had the abscess?

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dayn2nite2

I think at this point, you're not really in a position to decline anesthesia (her general condition and the condition of her mouth, which could turn into a raging infection), so please arrange for this to be done as soon as you possibly can.

King Boo

First find an Oral Surgeon who has a separate nurse anesthetist in the practice: many oral surgeons do their own monitoring and sedation.  For my teens, I chose a practice that had a Nurse Anesthetist to do the dedicated sedation and monitoring part; this way, the surgeon focused on the extractions.  

  It is unlikely Mom needs full general anesthesia; rather a twilight sedation that puts her out but not “under”:  A mixed adult and pediatric practice is more likely to have this.   Common for wisdom teeth renewal. 

   You can usually choose from 3 sites of care: the office, an ambulatory surgical center or a hospiaTal. This will open options for her.  Keep looking if you do not find a practice that does this.  

My Stage 5 LO for some reason life enjoyed going to the oral surgeon.  Bizarre.  He had a whole mouth e xtraction over 4 visits using only novicain 

mommyandme (m&m)

We just went through this. My mom had two teeth extracted. She’s on the border of stage 6-7. 

We are in CO so I have no recommendations for oral surgeons. Fortunately the one we used was awesome!! They knew how to handle my mom. They allowed me to help some like holding her head while i was stooped down on the floor for the pano film of her whole mouth. She can’t follow directions at all and didn’t know what was going on which may have helped a bit as she didn’t have any ability to refuse treatment. They didn’t use a general anesthesia. They did use the twilight med (similar to what’s used for a colonoscopy) thru an IV every 15 minutes, as needed, and Novocain. 

I could hear her screaming (which was horrible) but they assured me it was mainly from fear.  The Doc had 2 assistants helping. Pretty sure one would hold her still and try to comfort her.  They were only going to do one tooth if she couldn’t tolerate the other. Even with the screaming apparently he felt confident she was handling it and was able to do both.  She did have to go two days in a row because the first day was a consultation but since she was abscessed he drained it the first day to relieve the pressure. She did say she didn’t want to go the next day and was scared but then again she had no idea when we got there what would be happening.  

Anyway, I hope you can find the best doctor possible. If any of the staff have experience with dementia it helps immensely.  Both our dental office and oral surgeon had some . They completely knew how to handle my moms case. I couldn’t be happier with the result.  Of course the constant picking at the stitch in her mouth was very worrisome.  Later in the evening the doc called to check on her and told me if the worst thing that happened was she picked it out, it wouldn’t be the worst thing. 

I called our local Alzheimer’s chapter to see about recommendations for dentists etc… They didn’t have much for me here but maybe in your area they will have a good list. 

Good Luck!  So sorry you’re here and dealing with this. 

compass needed

Thank you for your info. Very helpul. Funny, I too had gum work with bone grafts when I was in my 20s and awake. So glad I took the Alzeheimer's support line suggestion here to post.

compass needed

Thank you!

Marp

Maybe that oral surgeon was just extraordinary and made the procedure feel like a party!

King Boo wrote:

First find an Oral Surgeon who has a separate nurse anesthetist in the practice: many oral surgeons do their own monitoring and sedation.  For my teens, I chose a practice that had a Nurse Anesthetist to do the dedicated sedation and monitoring part; this way, the surgeon focused on the extractions.  

  It is unlikely Mom needs full general anesthesia; rather a twilight sedation that puts her out but not “under”:  A mixed adult and pediatric practice is more likely to have this.   Common for wisdom teeth renewal. 

   You can usually choose from 3 sites of care: the office, an ambulatory surgical center or a hospiaTal. This will open options for her.  Keep looking if you do not find a practice that does this.  

My Stage 5 LO for some reason life enjoyed going to the oral surgeon.  Bizarre.  He had a whole mouth e xtraction over 4 visits using only novicain 

Rescue mom

My DH with stage 6 Alzheimer’s recently had a bad tooth extracted. Iit had to be done and the extraction itself was fine. 

What took me aback was the amount and type of “aftercare” needed. Not that hard (for normals) not long time-wise, but still more of a challenge than I imagined. 

Things like biting constantly on gauze pad, using ice packs, not chewing, not brushing (he didn’t do that well or regular but did sometimes find any small brush and poke it around in his mouth, of course the surgery “reminded” him to do that. )

Anyway, it wasn’t described well to me beforehand, and it meant watching him much more closely for a few days. Ever tried to regulate how a PWD bites on a gauze pad ?? (Rhetorical) or watch them with an ice pack?

Rescue mom

My bad. I just noticed how old this is. But maybe still helpful to somebody.