Older Patients, Wiser Care

To Pull or Not to Pull? Deciding Whether to Get Late-Life Dentures

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Dear Dr. K,

My 89-year-old father has been having pain and difficulty when he chews for quite some time. He has partial upper and lower dentures. An oral surgeon recommends extracting all his teeth and getting a full set of dentures. But he's also warned us that it will take weeks for the swelling to go down, and Dad can't get fitted for his new dentures until then.

Should we go ahead with getting all Dad's teeth pulled? We're all "“ Dad included -- a bit nervous about him having to go through a procedure with such a long recovery time.

Your father's situation is relatively common, and an important issue for caregivers to pay attention to. Being able to eat comfortably is a vital aspect of one's quality of life, and to maintain health and nutrition. Too often, however, dental care is neglected in older adults, especially since Medicare doesn't usually cover it.

But is pulling out the teeth your dad has left and replacing them with full dentures the way to go? I myself wasn't sure: I'm a doctor, not a dentist, although as a geriatrician, I know that oral health doesn't stop at the tonsils.

So I turned to a UCSF dentistry colleague, Dr. Susan Hyde, who has a particular interest in geriatric dentistry. Here's what I found out:

  • After teeth are extracted and the swelling goes down, it actually takes 2-6 months for the gums and jaw to heal, and to adjust to the teeth being gone. For dentures to properly fit in the long term, they need to be created after the body completes this process.

  • To avoid leaving an older adult toothless for so many months, it's possible for the dentist to make an "immediate denture" (also called a "temporary denture"). This is a set of dentures made in advance, and put into a person's mouth immediately after all the teeth are pulled. The plus side: The person has teeth to chew with right away, never has to appear in public without teeth, the immediate denture protects the tissues and reduces bleeding and swelling, and the person can learn to speak with a denture early on. The down side: Over months, these dentures will become loose or uncomfortable as the gums adjust to the loss of natural teeth. So an immediate denture eventually has to be replaced, or extensively adjusted and relined, which means several visits to the dentist, and a certain amount of expense.

  • Dentures take months to get used to (whether or not an immediate denture is used). This can be really difficult for someone with Alzheimer's or another dementia -- especially if they've reached the moderate or severe stage.

In other words, although getting dentures late in life can work out for some people, starting this process shouldn't be taken lightly.

Dentures or no dentures? My prescription:

  • In making the decision to get dentures late in life, consider the person's health and state of mind; if he's physically declining, there may be better ways to support his nutrition and comfort.

  • Get a second opinion regarding the state of the current partial dentures and existing teeth: perhaps cavities using newer, less invasive techniques, or maybe partials can be adjusted. (Consider getting this second opinion from a dentist who is not an oral surgeon; after all, every health professional tends to recommend the solutions he or she is most familiar with.)

  • Consider other comfort measures to make eating more pleasurable. Some senior clinics have dieticians available to advise regarding what foods may be easier or harder for a person to chew.

Unfortunately, there's usually no perfect (or inexpensive) solution. As with many quandaries in geriatric care, the "right thing" in this situation is to identify your options and inform yourself as to their benefits and burdens, then think about how they relate to your loved one's specific health and life situation.