Oral surgery risks?

Nvart

I've read through various posts about dental care and oral surgery on this site, going back in time, and I am not sure what to do. If anyone knows an oral surgeon who works with people living with dementia, in the Boston area, please let me know.

My mother, who I think is in Middle Stage (it's been about 7 years since MCI diagnosis) stopped going to the dentist a while ago. In truth, she didn't go much before dementia. My siblings and I don't know who her regular dentist was.

My mother was complaining of dental pain and we managed to take her to a dentist recommended by an aide at her day program. The dentist said she had an infected wisdom tooth. We've gotten evaluations from two oral surgeons: they both are reluctant to operate on her because of her age and her dementia. The first said, "wait and see, and if it gets worse, let me know." The other said he doesn't use anesthesia with anyone and referred us to an oral surgeon at Mass General who would be able to give anesthesia in a hospital setting. It's been difficult to get through the red tape to even talk to the Mass General oral surgeon.

My mother is now taking the maximum amount of Tylenol she can. We got another round of antibiotics and Tylenol with codeine from the first oral surgeon, who will operate on her with only novocaine -- not even a sedative -- in four days.

I've read posts here by caregivers who said the surgery and recovery was worth it because the infection/pain was worsening the dementia. And other posts about the difficulty of the recovery. I read on the Alzheimer's UK website that anesthesia might be harmful to dementia patients.

Neither oral surgeon has discussed with us any of this -- the impact of anesthesia or the difficulty of recovery. My mother's geriatrician offered no help or insights.All he said was that he thought no oral surgeon would do anesthesia or nitrous gas, then walked it back when I questioned him on this.

If anyone can tell me of any oral surgeons in the Boston area who have experience with people living with dementia and using anesthesia, nitrous gas, sedatives, etc, I would appreciate it. Any other insights or advice are welcome.

May flowers

Have any of them said why they wouldn’t use laughing gas? Is it contraindicated in dementia? I know anesthesia can be really hard on them but I haven’t heard that about the gas.

Nvart

Hi May flowers, Several months ago my mother had an episode when she lost consciousness for a moment and couldn't speak. We took her to the ER and the doctors ran tests and deemed it a UTI. Her PCP wanted to give her a heart monitor in case she had a heart murmur or other heart issue, but she also figured my mother wouldn't tolerate wearing it. So because of this shadowy history, the first oral surgeon has a concern that she has a heart issue. My guess is that's why he is insisting on novacaine only. I have no idea about the second oral surgeon. He actually may use it...but it seemed that he felt anesthesia at the hospital was a better fit for my mother...Thanks for asking, I will inquire about it with the first oral surgeon.

harshedbuzz

Nvart-

This is difficult. Even in later stages, an abscessed wisdom tooth would generally be treated because of the risk of systematic infection and pain. My BIL has had 2 bouts of endocarditis and a new heart valve as a result of untreated dental infections. (He's a physician and should know better)

That said, there are a range of approaches from full-on general anesthesia in a hospital, to sedation in a in a free-standing surgical center or nitrous and an IV benzo in the office.

When looking for a dentist, I would look in one of 2 routes-- look for a special needs dentist who is used to treating individuals with neurological and/or developmental conditions. They can generally handle patients who may need extra support and sedation to undergo procedures and will have admitting privileges and access to a surgical center. 

Another option would be to call your mom's neurologist or a local MCF's Director of Nursing and ask who they suggest for this kind of thing. Most facilities have a dentist affiliated and see this sort of issue regularly. My aunt had an abscess treated while a resident at a CCRC/MCF; I don't know if she was treated at the facility or taken to an outside office as my aunt managed her care. She was in Peabody at the time, so I will assume there is someone in your region who can care for your mom safely and appropriately.

HB

Nvart

Thanks so much HB, this is helpful advice. We got a referral for an oral surgeon in a hospital but he isn't seeing patients until August. And we had checked with my aunts Assisted Living to get referrals but they were out of the way. For now we are going with the first oral surgeon,  who has now prescribed valium. If it doesn't work out, I'll keep seeking out oral surgeons associated with MCF as you've suggested: thank you.

Margueritejudy

If your loved one has atrial fibrillation, be aware that novocaine or epinephrine will cause an Afib episode right in the dentist’s chair which will require an ambulance to the hospital. They must use a different anesthetic called MEPIVICAINE. My sister had this happen. My dentist happens to have AFIB and he told me what to use.