My advanced late stage dementia mother (91) may need to have a tooth pulled and we don't know what to do.

Thank you SD for giving us more information and for the steps you plan to take. Those smiles are pure gold. I have one to call to memory from my mothers last days and it's precious to me.

Thanks for all your comments. My mother does have a DNR. We have been referred to an oral surgeon and will use that route once we have exhausted the speech therapist who has started to observe the situation and make recommendations. My mother is completely invalid. She has macular degeneration, has to be lifted out of her chair with a hoya lift and talks very rarely and when she does it is gibberish. Her quality of life is horrible, but we still can get a smile out of her once in a while. She is only eating 25% of what she usually eats but that has been with mechanical soft food. If it is pureed, she might be back to eating the full meal. She also grinds her teeth ALL the time and getting her to stop that is all but pointless. She will not cooperate to have a mold made and even if we got one, she would not keep one in her mouth. She is not screaming in pain, so that is good and we do know when she is in pain as she tells us, from other situations.

Sometimes, you have to weigh the benefits vs. the risks. If a dementia patient is still functioning, then I would think that risk of anesthesia vs. living with pain, infection spreading and not eating.

I would explore the least invasive course of treatment. Like cwillie said, what about gas? I know that they were going to use it for my LO when she had 3 extractions last year. But, she did so well, that they didn't need to use it.

I would look for a dentist who works with dementia patients. Try one that accepts Medicaid. They normally do. The one that we dealt with was kind, gentle and patient. So was the staff. With just a Ativan and local numbing, she had 3 extractions with zero problem. It was over very fast and she healed quickly. They were prepared to use gas, but didn't have to.

If you have a DNR, take it to the dentist appointment with you. Our dentist would not treat her without having it in hand.

There are still dentists who use nitrous oxide sedation, could that be a viable option?

My mthr has had teeth fall out for the same reason. She is on hospice so she can have stronger pain meds, but refuses to admit her teeth hurt.

Long and painful are the words that I think are the most important. Whatever would make those words go away. Especially painful. I think I would ask her primary and her dentist to conference over the best course of action given all the circumstances you've mentioned. Fold in a dietician or nutritionist to your health care team to help you purée the healthiest mixture with plenty of protein. The last thing you want is for her to feel hungry.