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How should we handle a dentist appointment for my father with moderate dementia?

Chapelhilldaughter asked...

My father, who I would classify as early moderate dementia, recently visited the dentist, and our family was told that he should have 10 teeth pulled and a denture made to replace them. Two days later, he does not remember going to the dentist. He is 91 years old. We are reticent to move forward, because he will wake up the next morning after the extractions and not remember why. He has chronic asthma, and we're concerned that he will have a severe asthma attack. How should we handle this?

Expert Answer

Jytte Lokvig, PhD, coaches families and professional caregivers and designs life-enrichment programs and activities for patients with Alzheimer's disease and related dementia. Her workshops and seminars help caregivers and families create a healthy environment based on dignity and humor. She is the author of Alzheimer's A to Z: A Quick-Reference Guide.

This is no easy decision. I would recommend that you start by getting a second opinion from another dentist. You should also talk to your father's doctor. Having ten teeth extracted at one time is traumatic for anybody, but for a 91 year-old it's usually considered major surgery, requiring general anesthesia. You definitely should not agree to anything until you have also conferred with his primary physician and possibly the anesthetist.

The other decision facing you is whether to choose dentures or fillings. If you decide on fillings, you'll want to make sure that he sees a dental hygienist for a cleaning at least four times a year. Ideally, your father should brush his teeth twice a day, however based on the number of cavities it's probably not realistic to count on that. If you opt for dentures, someone will have to make sure that he uses them daily and removes them at night.

As your father's dementia progresses, anything that has to be cared for, adjusted, or fitted will be hard for him to handle. Dentures have to be soaked, cleaned, and possibly set with denture cream. A common issue with dentures is gum irritation caused by food scraps caught between the dentures and the gums. This can be quite painful and is aggravated because a person with dementia may not be able to tell his caregivers that he has a problem. His predicament may not be identified until he has trouble eating or has lost a couple of pounds.

Another common problem is keeping track of the whereabouts of various "detachables". I have found dentures, hearing aids and eye-glasses in many curious places, freezers, shoes, in a bowl of mashed potatoes and of course, in wastebaskets.