Dental implants in very elderly

[Rushie]

I'm not as elderly as your mom, but I've had two implants and I've had less pain/issues than I've had with traditional crowns.

If it were me I think I'd do it even at 91. I am planning to have cochlear implants if my hearing gets as bad as hers but she refuses to even consider cochlear implants even though she cannot hear much at all even with the best hearing aids. But people are different.

 

[Kenny Phillips]

I'm not as elderly as your mom, but I've had two implants and I've had less pain/issues than I've had with traditional crowns.

I just had four crowns installed earlier this year (Three prep sessions, including some ancillary fillings, plus three fitting sessions.) Zero pain during the procedures, a little soreness from having my jaw open for quite a while. Maybe my dentist is better at numbing.

 

[PaulS]

If it were me I think I'd do it even at 91. I am planning to have cochlear implants if my hearing gets as bad as hers but she refuses to even consider cochlear implants even though she cannot hear much at all even with the best hearing aids. But people are different.

Dementia is a game changer for this stuff, on top of that you are following your mother's expressed wishes, you've done well.

 

[MikeS]

> "If we had a crystal ball and knew she was going to live to 100 it would be worth the implants."

Or not. Even if she lives that long or longer, the mental/physical trauma of going through all the appointments and procedures (benign as they are) and risk of infection with the multiple visits that will be necessary, are things that she doesn't need. The slightest thing going wrong when you're 91 could ruin what's left of her life. She'll be fine without that molar and the attachment on it. Those things are just food traps anyway and as I mentioned, I wouldn't be surprised if it wasn't the damage done to the anchor tooth by the contraption that's responsible for the problem in the first place.

> "Bad teeth can really affect the whole body, including the brain. It is not just a matter of a painful tooth."

Very true. If antibiotics don't knock out the infection in that molar you're talking about removing, then the tooth should be extracted. Persistent, low level infection in the mouth is not a good thing. It's a short trip from the infection site to the heart or lungs and will be a small but constant drain on her immune system. Eliminate the pathology is the priority here. An antibiotic could knock it out and if she's diligent with antiseptic mouth wash, you'll know in a couple months whether there's still infection. Meanwhile, take that bridge thing out of her mouth and put a crown on the molar if it can be salvaged. The bridge can be a source of gum irritation and in any case a major collector of bacteria. Bridges and root canals are 17th Century dentistry. If a tooth cannot be saved for whatever reason, an implant is the only intelligent procedure. Anything else (and dentists damn well know this) is just ADA "standard of care" money extraction.

 

[Rushie]

> "If we had a crystal ball and knew she was going to live to 100 it would be worth the implants."

Or not. Even if she lives that long or longer, the mental/physical trauma of going through all the appointments and procedures (benign as they are) and risk of infection with the multiple visits that will be necessary, are things that she doesn't need. The slightest thing going wrong when you're 91 could ruin what's left of her life. She'll be fine without that molar and the attachment on it. Those things are just food traps anyway and as I mentioned, I wouldn't be surprised if it wasn't the damage done to the anchor tooth by the contraption that's responsible for the problem in the first place.

> "Bad teeth can really affect the whole body, including the brain. It is not just a matter of a painful tooth."

Very true. If antibiotics don't knock out the infection in that molar you're talking about removing, then the tooth should be extracted. Persistent, low level infection in the mouth is not a good thing. It's a short trip from the infection site to the heart or lungs and will be a small but constant drain on her immune system. Eliminate the pathology is the priority here. An antibiotic could knock it out and if she's diligent with antiseptic mouth wash, you'll know in a couple months whether there's still infection. Meanwhile, take that bridge thing out of her mouth and put a crown on the molar if it can be salvaged. The bridge can be a source of gum irritation and in any case a major collector of bacteria. Bridges and root canals are 17th Century dentistry. If a tooth cannot be saved for whatever reason, an implant is the only intelligent procedure. Anything else (and dentists damn well know this) is just ADA "standard of care" money extraction.

Both the dentist and oral surgeon confirmed that there is no infection. There is no fracture (yet). There is just decay in the tooth itself. That's why the dentist suggested extraction. No doubt it will eventually need to be done if mom lives long enough, but the oral surgeon said it isn't urgent.

The risk of infection from having an extraction itself vs the risk of infection if we leave things as they are was the crux of my written questions to the surgeon. He recommended "wait and watch" and gave instructions on how to watch. My sister already takes her temperature daily and now she will monitor her for tooth pain.

I think you're right about the technology. Mom hasn't had that thing in very long, less than ten years I think. Probably the thing to have done was get two implants back then, but she had an old dentist who is now retired, I'm sure he had been doing bridges his whole career.

 

[MikeS]

Ten years is a long time for that bridge to last without problems. Good work I'd guess, despite the fact implants would have been a better solution - maybe. Maybe what he did was exactly the right choice considering the long drawn out process of getting implants installed and crowned vs the relatively simple process of carving up the anchor tooth and casting a bridge.

On another note, dentists don't emphasize enough that the procedures they do and charge so much for are defined as temporary within the profession. We as patients, after spending all that money, think of them as permanent and are often surprised to find out they're not.

Isn't decay just another name for infection? There's a fine line there that I don't know enough to comment on.

 

[Rushie]

Ten years is a long time for that bridge to last without problems. Good work I'd guess, despite the fact implants would have been a better solution - maybe. Maybe what he did was exactly the right choice considering the long drawn out process of getting implants installed and crowned vs the relatively simple process of carving up the anchor tooth and casting a bridge.

On another note, dentists don't emphasize enough that the procedures they do and charge so much for are defined as temporary within the profession. We as patients, after spending all that money, think of them as permanent and are often surprised to find out they're not.

Amen! I was fooled twice. When I was a kid and got all those amalgams I thought each one was the fix for that tooth. Then as an adult when I got crowns, I thought that was the end for each respective tooth. Apparently not, even if the crown itself lasts forever you still get decay below it or under it and I don't even want to think about gum recession. You can end up losing teeth even if nothing ever goes wrong with the teeth themselves. I wish my childhood dentist had explained all this to me back in the beginning.

Isn't decay just another name for infection? There's a fine line there that I don't know enough to comment on.

I see decay as bacterial damage to dead tooth material and infection as bacterial invasion of living tissue. With tooth decay your body isn't mounting immune system defenses in the way it might if soft tissue or bone is involved (inflammation).

I'm not a dentist but guessing here: the two concerns would be 1) bacteria from decay entering the pulp and gaining access to the bloodstream and 2) bacteria from decay adjacent to gum or bone moving from the tooth structure into one or both of those tissues.

In mom's case she has no live pulp. One might presume she will begin to have symptoms if bacteria from the decay invades tissues. But the mouth is full of bacteria anyway. I don't know how much greater is the risk of infection from tooth decay over just general risk. People get periodontal disease without necessarily having cavities.

Eventually I suppose the decay will sufficiently weaken the structure so that it cracks and fails. No doubt the thing will eventually need to come out, if she lives long enough.

 

[rbridges]

I've placed thousands, and honestly, the procedure is not generally uncomfortable. With no grafting being required, it's pretty straightforward. Healing in the elderly can be slower, but I've had good results with people in their 70s and 80s. Bottom line, it's a case by case decision. If she has the desire, means to pursue it and is in good general health; I'd say it's an option. If the answer is no to any of the above, then maybe go with a removable partial or leave the area edentulous. Just make sure to get information and make an informed decision.