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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.

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I work in medicine & never cease to be amazed at the innate intelligence of the body. If the tooth does eventually fall out, there will be no infection...the body closes the tissue as the tooth is pushed up out of the gums by bone loss & inflammation Giving your Mother 2 capsules of tumeric powder (no black pepper, added not standardized, or additional, just simple tumeric powder. Or the powder added to foods) before each meal 6 days a week, 2 or 3 times a day..This would ease inflammation. Additionally tumeric is helpful for brain function (been shown in studies to ease the symptoms of mental decline) ease the stiffness and pain of arthritis. If you care to mix a little White Oak Bark powder into a soft 'mud' with water & pack it between the lips & gum Looks like a 'mouthful of mud'..however is a powerful astringent & has an organic form of calcium that is readily absorbed. Has a soothing effect, patients have no complaints..Over time the tooth/teeth will tighten up nicely Although the tooth is loose, the body holds the teeth into the bone structure with very small yet powerful connective tissues. It would be distressing for her to have it mechanically removed. The mentioned foods are available on amazon
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Dental issues and hygiene are not paid enough attention...
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:-)
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Imho, you should search for a general dentist who will tend to your mother's tooth. You do not want infection to set in and also you may not know if the tooth has had a root canal treatment.
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Tough situation. My 95 yr old mother on hospice for 2 yrs for chf and metastasized breast cancer. She has squamous cell carcinoma and always needed to see the dermatologist every 3 months to have her squamous cell tumors removed by MOHs surgery, or just shaved off like in this past year. She has a squamous cell tumor growing out of her left cheek now and it gets bigger by the day. I can’t get her out to the dermatologist anymore. She has accepted this. But it does bother her and it’s going to get worse. What a dilemma. Took her to the dentist over a year ago because the implants in her lower left jaw were loose. Dentist ended up removing the 4 teeth attached to her jaw because of bone loss. Nothing could stay attached anymore. But that was our last trip out to the dentist. Just hoping the rest of the bone in her mouth is strong enough to hold the rest of the implants. These last minute things in their lives make day to day living more uncomfortable. We just do the best we can.
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sunshinelife May 2021
Look into Dr Christophers black Drawing Ointment. There are videos you can watch by people who had the same/similar problems with the skin. They share their own experiences with mohs & black ointments...and the good results No brands were mentioned, no money requested. I mention Dr Christopher due to experience with his product. Quality products by his family. Interesting the ibody rejected the dental implants, yet not the natal teeth. A tea of BARBERRIES...1 pint distilled water just boiled...Add 1oz berries...stir...let sit over night covered in the pot. Strain...Store refrigerated in a covered glass container. drink warm or cool..1/2 cup x 3 times daily. My Grandfather joked about "marrying his dermatologist " due to the number of visits for skin lesions...The scaring from the mohs is not good. I gave him the above , plus got him to have 1 or even 2 if possible colonic irrigations a week ongoing..Its been about 18 months now since he began the above. His dermatologist had 'nothing to slice into' his last 2 visits grandpa reported. I am pleased and relieved. My Grandpa turns 86 in October. In my humble opinion it is not length of life that is important, it is the 'quality' of life.
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Search and find a dentist who will go to where she is. I know they exist. I talked with one recently. That tooth must come out or infection will sooner or later set in and then there will be more problems. It can be done at home - but start looking for dentists and talk to senior health facilities for opinions and information.
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when our dad went into the NH he only had 2 teeth left in his mouth (he had top plate only..........one day when visiting i noticed he didn't have any so i am guessing that they came out at some point. its hard to remind people to chew on the "other side" where the tooth is NOT loose.......is she eating solid foods or pureed foods? if the last one there really shouldn't be too much of a problem. i would not put her thru the trauma of going to a dentist. too bad that NH don't have someone that is a dentist to visit for just routine checkups and things like loose teeth that can be done quickly with a numbing gel and then pull. cause i would imagine that no one after 93 or whatever that there teeth are deeply rooted. wishing you and her luck.
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The tooth will fall out on its own when it is ready.

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.
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Do Not take her to a Dentist. It would be a unnecessary traumatic experience!

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.
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gdaughter May 2021
salt water way better.
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I think the general consensus posted here, is that if the tooth is not infected or is not painful for her then leave it alone and let it fall out on its own.

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.”
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gdaughter May 2021
You just didn't have enough people to call or connect with the right one. Everyone needs some dental attention and some are better suited and willing to deal with people with special issues than others. They may be rare but they are out there.
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her and I suspect the dentist as well.

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.
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TouchMatters May 2021
Thank you. I was going to ask about this.
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
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I had the same dilemma with my Husband.
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.
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Agree with all of the above. I am a Dental Hygienist. If the tooth is loose, then she has lost the bone support that normally holds it in. Normally this is not a painful process, and the only down side is may interfere with eating comfortably. The most tx that could be done is a mobile dental unit in the area could numb the tissue and extract the tooth, making eating easier. If you don't think it is interferring with ability to eat, I would leave it alone. The stress and hardship of going into an office is not warranted in my opinion.
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TouchMatters May 2021
Thank you for providing your expertise as a dental hygienist. Very helpful. Gena/Touch Matters
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I agree with the nurse, although I may also be tempted to suggest to mother that if its bothering her she should just pull it out. Moving it repeatedly will just speed up the process. There is no reason why she should get an infection, we don't normally when teeth either fall out or are taken out but if you can somehow get her to rinse with salt water every hour when it first come out, it will heal from underneath very quickly and the salt will act as an antiseptic.
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If she is 92 and under hospice care, I would certainly leave well enough alone. Putting her through the trauma of it all just doesn't make any sense does it? You want her to be calm and comfortable in her final time here on earth.
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.
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gdaughter May 2021
Maybe Hospice knows a resource?
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I'd ask a dentist or a dental nurse to come to her to have a look at it. The problem with allowing it to fall out on its own is that it is just about the perfect size for choking on. Especially if it happens because/when she is eating.

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!
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Unless you use medical transport (like an ambulette) and get some anti-anxity meds to give her before the extraction, I would just let the tooth fall out.

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.
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I don’t think I would bother with bringing her to the dentist. Let the tooth fall out on it’s own.

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.
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