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She has moderate to late stage dementia, we really don't want to go with the Anesthesia, due to past experiences this has put her through. We are not sure she would allow or understand the Novocaine. Any advice?
Hi Harpcat, thanks for the info! It's not just a tooth issue for me, however. Every few years I get a severe muscle spasm in my middle back. Vicodin doesn't even touch it. A shot of dilaudid (sp?) is required as well as flexeril. My overall point was that some people have higher or lower tolerances for pain and that should be considered.
Hobbesmom...when a tooth has an abscess it is often impossible for local anesthesia to numb it due to the infection. Hence why we should try not to let it get to that point. Sometimes fear and anxiety prevents people from breathing the nitrous oxygen mixture deeply enough. Too shallow breathing coupled with mouth open for the procedure prevents good sedation.
All of the above are good answers. Do you know your mom's general pain tolerance? I have an extremely low tolerance. A number of years ago while attempting to get a root canal, they used nitrous oxide gas (my 1st experience with it) and likely local anesthetic but I can't say for sure. The gas did NOTHING whatsoever even though it was supposedly at the highest allowable dosage. I literally grabbed the dentist (he was more than that, but I cant remember the title). Turns out the whole thing was a wash and had to be surgically removed while putting me under. Perhaps the pain level was due to the fact it was beyond a root canal. In contrast, my mom had a kidney stone we didn't know about until it became abscessed which then became septic because she didn't indicate she was in pain. How crazy is that? I've never had one but I hear they are extremely painful.
My point is, please be mindful of your mom's pain tolerance and convey that to all doctors, etc. involved to make it a good experience.
Disregard the general. A good oral surgeon will evaluate the patient's condition, and use a good local, as suggested by Harpcat. Stay away from Versed, which was used as an anti-anxiety pre-op. No need for meds that will affect memory.
In response to a previous comment about using an oral surgeon rather than a general dentist... I'd have to say that depends on the particular dentist and/or the prior relationship of the patient to that dentist or the caregiver. I had my own dentist extract a number of teeth, and due to previous experiences, trust him more than "specialist" oral surgeons... He is knowledgeable in a number of modern procedures and has a more "personal" and compassionate approach than some of the very busy and sometimes disconnected specialists can be. JMO...
A dentist and dental hygienist are taught to ask for a thorough medical history and list of medications to know if a medical consult is needed with the person's doctor. We are taught to handle all types of patients. And yes, certain patients are not candidates for nitrous oxide. This was just an option I mentioned. Oral surgeons receive lots of training in IV sedation. This is not the same as general anesthesia which is done by an anesthesiologist or nurse anesthetist. IV sedation has been done for a very long time by O. surgeons. . It was used on me when I was 23 for wisdom teeth extractions 40 years ago. The dentist who does the extractions should be able to determine from meeting the patient and doing a medical review how best to treat the patient. Be there when they discuss the treatment so you can have questions and concerns answered. For those that said nitrous didn't work on them, that can be true. It is not always going to work and there's a whole list of reasons for that, but I won't go into because that's not the persons question. I hope this is helpful and relieves any anxiety. Once again IV sedation is not a general anesthetic. Also we are taught not to wave the needle around in front of your face. :)
I'm having the same issue, SIL on hospice, but she's better right now, her teeth have been an ongoing problem, she needs all of them removed, causing her extreme pain. Several appts to get them removed have had to be missed because she was hospitazed. She already has paid and has a whole set of dentures waiting. At this point unsure of WHAT to do about this
Harp kitty - thanks for sharing your pro experience.
For my mom, she did a thousands in spend down on dental and worth every penny. In addition to the health issues harpcat mentioned, I'd like to add what the nursing staff @ mom SNF told me: their being able to fork or hold food, to bite, chew, grind, swallow is central to their cognitive ability. There is a whole set of brain synapses at work in eating. You need healthy teeth & gums to do this.
For NH, staff quite frankly doesn't have the time to monitor or help with each residents brushing & flossing. They need to enter the NH with their teeth as tippy top good in shape as possible & as proactive in ability to brush daily on thier own too. NH dental care usually means those pink sponge tip disposable dental swabs at best.
Yes it's costly but an investment in your future good health.
Sonny harpcat is a certified dental hygienist and educater and i absolutely agree with her advice. However she does not say she is experienced or educated in dementia care. I can still see many problems with putting a mask over a patients face to give nitrous oxide, It is likely to be very scary. I would also poimt out that however well educated an oral sugeon is he is not triained as an anesthesiologist which is the reason one needs to be present when an anesthetic is administered. all the emergency equipment in an office will be fine but it is far better to have the knowledge and training to know how to avoid the need to use it. iI stick with the view "better safe than sorry" no offence to harpcat or sonny
I agree with what someone above said..the nitrous absolutely nothing for me either...whatever they use to numb it is all that my Mama needed and it went fine.
I vote for "Harpcat".. She has the professional experience rather than individual suggestions from many caregivers.
I feel that "Harpcat" has an objective view and sounds the most logical.
Sonny ............................................................................... PLEASE RE-READ THIS FROM "HARPCAT"
Harpcat Give a Hug 13 hrs ago I am a dental hygienist an an educator in a dental school. There are several options. One is to take an anti anxiety medication before the appointment at home...most dentists prescribe Valium in low dose. The anesthetic injections ( they no longer use Novocaine) are perfect for extraction. and will wear off and not affect her mentally. You do not say why your concern so more info would be helpful. Is she easily frightened, combative? Nitrous oxide gas (known as laughing gas) is a wonderful sedative and the patient is awake but just sedated and the gas immediately is flushed out with 100% oxygen before she leaves. And therefore she is totally in control and no longer under any influence. I like others would advise against the general anesthetic. But I doubt that is what they would use. I would get an actual name (s) of what they would use as an anesthetic. It may be what is used for procedures like a colonoscopy. The doctor needs a full list of her medications before seeing her that day also. It would be nice if she had already met the doctor first as well.
They will numb the gums before putting in the local anesthesia and I have yet to see a dentist standing over me brandishing a syringe. They are usually very discreet and put a finger in the patients cheek so they don't feet the needle comming. having a trusted caregiver in the room to hold her hand and talk to her will help a lot. As well as discontinuing any asprin type products make sure she is not recieving any kind of blood thinner
I would avoid anesthesia at all cost...I went through the same procedure personally and it involved extensive cutting and tugging but they numbed it up with novocaine alone and I was fine.
I recently had to have two of Mama's teeth extracted as well. She has advanced dementia and due to a horrid irreversible issue with anesthesia during her last surgery for an ankle fracture, we did NOT want to use anesthesia...She is 90 and actually tolerated the procedure extremely well on just novacain (sp) she had to be transported by ambulance because she it totally bedfast but we were literally home within an hour from start to finish...it went great...had the teeth not been causing a problem, one of them abcessing, we would have most likely left them alone but the abcess caused such an infection that alone was causing major issues...but the procedure went fine.
Someone mentioned if the teeth aren't hurting leave them alone. Did you all know that any infection in the mouth has access to the entire body via the vessels that supply and drain the tooth? Therefore that same infection can affect the heart, brain, etc. You can get a fatal infection of the heart. Infections can also raise the level of CRP (C reactive protein) in the blood which can lead to strokes. So removing infected teeth with a poor prognosis, whether hurting or not is wise. One British study showed that the same bacteria that we find in periodontal disease (used to be called pyorrhea) can be found in the brains of people with Alzheimers. Our teeth are connected to the body. Ok...off my soapbox now. (can't help it, it's the dental educator in me)
Many many oral surgeons use IV sedation, and that is indeed safe to do in an office. Do not let that worry you. Oral surgeons go through dental school (4 years) and a 4-5 year residency to become an Oral Surgeon. That is part of their training to learn IV sedation. They also carry emergency equipment in their offices. Like all procedures there can be issues or even negligence. Which is why we all sign a informed consent form.
I agree with combination of local anesthetics and nitrous with MD's involvement. Also, I suggest making sure she is not on aspirin or insaids for about 5 days before and after as they can cause excessive bleeding.
I would not use IV sedation in a regular dental office you need acess to emergency care. Remember what happened to Joan Rivers. if Mom tolerates regular dental visits she propbably will come to no harm with some oral sedation before you leave home and a local anesthetic.
If she can handle the procedure with only novocaine, that would be good. My wife could not, so the dentist used an IV similar to that used for a colon exam. She did fine and had no problem after the procedure. Problem is fining a dentist that uses the IV method. Be sure that her doc approves the method.
I agree with ferris1, if her teeth are not hurting her, leave them alone. My fathers were really bad, but no pain. When we tried to explain he needed some removed he was upset for days, and I honestly don't think we could have gotten him to the office. We decided against removal, and he was fine.
I was concerned about a MRI on Mom's head but didn't think about the problems it would cause until the night before the procedure. Called the doc, first thing in the morning. She prescribed a very small dose of Ativan to relieve the anxiety and to just help relax my Mom. But, it was too close to her appointment time by the time it was called in to the pharmacy I was not able to pick it up. So, just decided to try the procedure without it. If there was a problem we would just try again another day. Fortunately, Mom handled it quite well and did not need to use the Ativan.
I would definitely avoid general anesthesia because of the problems it can cause and go with the nitrrous oxide. My concern would be if she would tolerate the mask.
I was going to suggest Nitrous oxide gas as well. I agree with ferris1 that if the stage of dementia is advanced and pain isn't the issue it's best just to leave it alone. However, abscesses can be a problem. My mother-in-law needed surgery for that reason. They used a combination of local anesthetics and nitrous. Good luck making this decision. It's a tough one. Carol
Why put her through the trauma of a dental procedure? Unless the teeth have an absess, or they are painful, do not do anything. She has a terminal illness. Try to make her time left as pleasant as possible.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
My point is, please be mindful of your mom's pain tolerance and convey that to all doctors, etc. involved to make it a good experience.
For my mom, she did a thousands in spend down on dental and worth every penny. In addition to the health issues harpcat mentioned, I'd like to add what the nursing staff @ mom SNF told me: their being able to fork or hold food, to bite, chew, grind, swallow is central to their cognitive ability. There is a whole set of brain synapses at work in eating. You need healthy teeth & gums to do this.
For NH, staff quite frankly doesn't have the time to monitor or help with each residents brushing & flossing. They need to enter the NH with their teeth as tippy top good in shape as possible & as proactive in ability to brush daily on thier own too. NH dental care usually means those pink sponge tip disposable dental swabs at best.
Yes it's costly but an investment in your future good health.
I feel that "Harpcat" has an objective view and sounds the most logical.
Sonny
...............................................................................
PLEASE RE-READ THIS FROM "HARPCAT"
Harpcat
Give a Hug
13 hrs ago
I am a dental hygienist an an educator in a dental school. There are several options. One is to take an anti anxiety medication before the appointment at home...most dentists prescribe Valium in low dose. The anesthetic injections ( they no longer use Novocaine) are perfect for extraction. and will wear off and not affect her mentally. You do not say why your concern so more info would be helpful. Is she easily frightened, combative? Nitrous oxide gas (known as laughing gas) is a wonderful sedative and the patient is awake but just sedated and the gas immediately is flushed out with 100% oxygen before she leaves. And therefore she is totally in control and no longer under any influence. I like others would advise against the general anesthetic. But I doubt that is what they would use. I would get an actual name (s) of what they would use as an anesthetic. It may be what is used for procedures like a colonoscopy. The doctor needs a full list of her medications before seeing her that day also. It would be nice if she had already met the doctor first as well.
I would definitely avoid general anesthesia because of the problems it can cause and go with the nitrrous oxide. My concern would be if she would tolerate the mask.
Carol