Mom with early late stage ALZ (hopefully that makes sense) just broke a tooth. the dentist said there is still a piece attached as well as roots, some might be exposed. She is referring mom to an oral surgeon for removal since mom won't keep her mouth open, if we can get it opened at all. We could leave it as is and watch for an abscess to form, which is highly probable, or have it taken out but that would mean putting mom under some type of anesthesia which has a high probability of making her ALZ worse. I'm so torn on what to do. She doesn't seem in pain but if the roots are somewhat exposed there's going to eventually be pain. I wish we could just use novicane but because she won't keep her mouth open, it just won't work. Has anyone dealt with this before?
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I think I would ask the oral surgeon which is the worst option - leaving the tooth as is, with the possibility of dementia complication and to the roots, tooth and perhaps mouth and throat through infection, or using as light a sedation as possible to remove the tooth.
My father faced something similar when a tooth broke off and his dentist recommended removal. He didn't have dementia though, and was easily able to tolerate the surgery, not by an oral surgeon, but by a specialty oral surgeon, an "endodontist." This was a category of dental practice of which I was unaware.
Dad's female dentist was very compassionate, very, very thorough, and highly skilled. I don't know enough abut endodontics though to know if it would be a better option than treatment by an oral surgeon (the endodontists have additional years of training), but I was certainly glad she handled Dad's tooth issue.
The potential abscess issue would really concern me. I've had somewhat of a similar experience, knocking loose 6 front teeth when a mulberry tree that didn't want to be cut down whopped me in the jaw.
Six teeth were knocked loose; the nerves of 3 were almost severed. I could actually have pulled them loose - they were just hanging in my mouth. I had root canals in them, but eventually one of the root canals failed, the tooth blackened, and had to be removed. Then another of the damaged teeth broke off, leaving roots in my jaw. I just don't remember if I developed any abscesses or not though.
That tooth had to be removed too, and it was kind of a tedious process as the oral surgeon really had to dig the roots out. Sedation wasn't the issue; just sitting still with my mouth wide open was uncomfortable. (I think it was harder on the oral surgeon - he told me when he finished that he needed to lay down and take a nap after that ordeal!)
Other than a little bleeding, I didn't suffer any discomfort - no side effects at all from the light sedation. But it did leave gaps in my mouth.
That's another issue I would explore, is what happens to address the gap after the tooth is removed (if that's the route you pursue). W/o a replacement, the remaining teeth may shift - that's what happened to me.
Another issue: Does she have any cardiac issues? If so, that might be a concern as well as we've been cautioned several times that (a) Dad needed to take anti-biotics before any dental procedure, especially an extraction, and (b) bacteria from an abscess could accidentally be swallowed, affecting the heart of someone with a cardiac condition.
You can also ask the oral surgeon what he or she would do if the patient was his/her parent. I've found that's a good indication of how safe a doctor might feel a surgery is.
Good luck, and please let us know what decision is made and how it works out.
But this is just one situation. Yours may differ and the procedure may be justified.
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