Dental implants in very elderly

Rushie

Rushie

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Rushie
My 91 year old mom has been told she needs a molar extracted. It's got a crown and bridge covering the next missing tooth so when they remove it, she will have two molars missing. They told her that after she heals she can decide if she can live with the big "hole" on that side of her mouth. If she cannot she has the options of 1) implant(s) or 2) a removable bridge.

Do any of you have experience with implants in the elderly? I only know of two people who have had them. One young person who loves his implants, and an older person who said it was extremely painful and they'd never do it again.

They tell her the removable bridge is worn during the day, then she must remove it and clean it every night. I have a bad feeling about that, she already has enough trouble fooling with hearing aids, I don't see her dealing with another appliance.

But if the implant process is that painful, I'm not sure we should put her through that either. She is very confused these days and looks to us to help her make decisions so I'm trying to gather as much information as I can. Money is not an object, she can pay for implants if that is best for her.

Have any of you dealt with this with your parent?
 
She will likely adjust perfectly fine to the missing teeth and avoid the pain and bother.
Heal up and do nothing.
 
Rushie said:
Have any of you dealt with this with your parent?
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i'm dealing with bridge vs dentures in combo with crowns at 60, so all ears on this one,

heard a 4 tooth bridge is a bit of a stretch, nevertheless is done
 
Man, 91 years old? I would say no unless she really insisted, especially as it sounds like she is having cognitive issues. At 91 years old she has endured enough pain, let her have some peace.
 
I have an implant and its just like anything else at the dentist, they numb the pain. Afterwards, it wasn't painful at all. Toughest part is the waiting for the hole to fill in with bone, then they implant the metal appliance and waiting another 3 or 4 months for that to grow into the bone. The tooth itself takes just a few minutes to attach. Nothing to be afraid of.
 
I have a couple implants and my experience was like Tim’s, during my 60s is when I had them done.
 
I recognize the decision may be different for the elderly, but fwiw I had one of my front incisors extracted, then a piece of my bone from my jaw harvested and grafted to my jawbone to provide needed thickness in the buccal ridge, followed by the implant placement, then the crown.

It took about 15 months to get it done. Minimal pain and I would do it again! That Incisor is stronger than it’s natural neighbor!

-Skip
 
Bone healing is very extended in the elderly. My mother wanted implants at 75, but settled for replacing her dentures. Not dealing with bone healing was the deciding factor.
 
I think the amount of pain is relative to the skill and care of the surgeon. If done right, with proper pain medication, it should not be unduly painful.

But to couch that opinion, there is also a BIG difference between individuals in pain perception. Some people think an ordinary injection is painful; other don't eve notice it. What is your mother's pain tolerance history?
 
JOhnH said:
I think the amount of pain is relative to the skill and care of the surgeon. If done right, with proper pain medication, it should not be unduly painful.

But to couch that opinion, there is also a BIG difference between individuals in pain perception. Some people think an ordinary injection is painful; other don't eve notice it. What is your mother's pain tolerance history?
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She is very tolerant to pain.
 
bflynn said:
Bone healing is very extended in the elderly. My mother wanted implants at 75, but settled for replacing her dentures. Not dealing with bone healing was the deciding factor.
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Yes that is a concern.
 
PaulS said:
Man, 91 years old? I would say no unless she really insisted, especially as it sounds like she is having cognitive issues. At 91 years old she has endured enough pain, let her have some peace.
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If she seems accepting of the missing teeth I think we will definitely leave it alone. In fact, the more I think about it the more uneasy I am about the extraction in the first place. It was my sister, not me, in the office with the dentist and I don't feel comfortable with what she said he said.
 
Rushie said:
If she seems accepting of the missing teeth I think we will definitely leave it alone. In fact, the more I think about it the more uneasy I am about the extraction in the first place. It was my sister, not me, in the office with the dentist and I don't feel comfortable with what she said he said.
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Most dentists will try to sell you whatever costs the most!
 
What’s she eating?

When my Grandma was in her 90s she had some dental issues, but the end decision was since she was eating primarily soft nursing home food, significant gaps in her teeth weren’t critical.

This was 25 years ago, just for frame of reference.
 
Rushie said:
If she seems accepting of the missing teeth I think we will definitely leave it alone. In fact, the more I think about it the more uneasy I am about the extraction in the first place. It was my sister, not me, in the office with the dentist and I don't feel comfortable with what she said he said.
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My mom had really bad dementia and lots of teeth problems as a result. We just let her be with the dental stuff as it was so extensive, it took us a while to realize she had stopped seeing the dentist as she was very independent, as long as she wasn't in pain we let her be, but it wasn't ideal.

That said, I would get the extraction done, teeth can be very painful and if there is an issue better to address it, make sure the dentist knows she is having memory issues. The problem with cognitive issues is recovery and aftercare issues which would definitely concern me with the implant. Same thing with dentures, getting used to them is tough when you don't have issues, with issues it's pretty much impossible is what I was told for my mom. I'm thinking if the dentist knew there were memory/cognitive issue his recommendations may have been different, most are pretty compassionate.

Suggest you discuss her wishes with her, get a durable power of attorney and health care proxy in place while she is still capable of executing those agreements. Hopefully it won't get worse, but it will make life easier if it does. Also discuss her memory issues with her doctor, don't leave it up to her to do this, there are lots of things that can make her life easier. Be there for her, if she needs to move, get it done sooner rather than later.

I dealt with this in three elderly relatives a few years ago, pm me if I can answer any questions.
 
I would be very wary of doing anything orthopedic to someone who is that old, particularly to a woman. My mother lost a couple of molars when she was in her early 80s, simply because of bone loss, the supporting bone just broke and the teeth fell out, and she was not very osteoporitic.

At some point , people get so frail that many medical treatments seem more like an assault than something theraputic.
 
pigpenracing said:
Most dentists will try to sell you whatever costs the most!
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The tooth is not bothering her at all. They did an X-ray at her routine cleaning and that led to them telling her she needed the extraction.
 
Rushie said:
The tooth is not bothering her at all. They did an X-ray at her routine cleaning and that led to them telling her she needed the extraction.
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I went to my dentist six months ago and he did a panoramic x-ray. After he saw it he wanted to refer me for sinus surgery. I've never heard of anyone who had sinus surgery done that was satisfied with it long term.

Sometimes medical people tend to overtreat their patients.
 
PaulS said:
My mom had really bad dementia and lots of teeth problems as a result. We just let her be with the dental stuff as it was so extensive, it took us a while to realize she had stopped seeing the dentist as she was very independent, as long as she wasn't in pain we let her be, but it wasn't ideal.

That said, I would get the extraction done, teeth can be very painful and if there is an issue better to address it, make sure the dentist knows she is having memory issues. The problem with cognitive issues is recovery and aftercare issues which would definitely concern me with the implant. Same thing with dentures, getting used to them is tough when you don't have issues, with issues it's pretty much impossible is what I was told for my mom. I'm thinking if the dentist knew there were memory/cognitive issue his recommendations may have been different, most are pretty compassionate.

Suggest you discuss her wishes with her, get a durable power of attorney and health care proxy in place while she is still capable of executing those agreements. Hopefully it won't get worse, but it will make life easier if it does. Also discuss her memory issues with her doctor, don't leave it up to her to do this, there are lots of things that can make her life easier. Be there for her, if she needs to move, get it done sooner rather than later.

I dealt with this in three elderly relatives a few years ago, pm me if I can answer any questions.
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I've got the documents in place. We are transitioning to me making decisions for her. But aside from that she looks to us anyway and has been for quite a while. She won't need to move, one of my sisters lives with her and we all plan to bring in whatever resources necessary to keep her in her home. She is lucky, she has four living children all focused on her comfort in old age. But she was a fantastic mother so maybe it's more than luck.

The thing about the extraction is she has no pain at all. So I am inclined to leave it alone as you say. But according to the sister that talked to the dentist there is threatened infection. She's had jawbone infection before, so is this extraction necessary prophylacticly? Or will a procedure actually cause osteomyelitis? She's on the darn bisphosphonates. (Extractions/procedures lead to osteonecrosis?)

I think I want to call them in the morning and get answers to some of these questions.

But if she does need it and you say the problem with cognitive issues wrt implants is recovery and aftercare, I agree but if she gets the removable bridge I think that will also be problematic with cognitive issues.

It's like having a baby again, you're responsible for making decisions for them that affects their lives. We can say, "Mom, what do you want?" And she will say, "I don't know, what do you think I should do?" Every time. She will not even say which TV show she wants to watch! "I don't know, put it on what you want to watch," she says. Today was the last time I will ask her on a financial matter. Should we move money from account A to a higher earning account B? She said "I don't understand this stuff. You decide, I trust you." So I sent the durable PoA to her investment manager and said from now on take direction from me.
 
FormerHangie said:
I went to my dentist six months ago and he did a panoramic x-ray. After he saw it he wanted to refer me for sinus surgery. I've never heard of anyone who had sinus surgery done that was satisfied with it long term.

Sometimes medical people tend to overtreat their patients.
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This thread is very helpful. All y'all are making me think this through more. They're going to remove two molars based on a single X-ray. The more I think about it the more I don't like it.
 
MauleSkinner said:
What’s she eating?

When my Grandma was in her 90s she had some dental issues, but the end decision was since she was eating primarily soft nursing home food, significant gaps in her teeth weren’t critical.

This was 25 years ago, just for frame of reference.
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She eats mostly soft food at the senior center but also enjoys salads, bagels, chili, apples. She avoids tough meats, won't eat jerky, but it's not like she just eats mush.
 
Rushie said:
I've got the documents in place. We are transitioning to me making decisions for her. But aside from that she looks to us anyway and has been for quite a while. She won't need to move, one of my sisters lives with her and we all plan to bring in whatever resources necessary to keep her in her home. She is lucky, she has four living children all focused on her comfort in old age. But she was a fantastic mother so maybe it's more than luck.

The thing about the extraction is she has no pain at all. So I am inclined to leave it alone as you say. But according to the sister that talked to the dentist there is threatened infection. She's had jawbone infection before, so is this extraction necessary prophylacticly? Or will a procedure actually cause osteomyelitis? She's on the darn bisphosphonates. (Extractions/procedures lead to osteonecrosis?)

I think I want to call them in the morning and get answers to some of these questions.

But if she does need it and you say the problem with cognitive issues wrt implants is recovery and aftercare, I agree but if she gets the removable bridge I think that will also be problematic with cognitive issues.

It's like having a baby again, you're responsible for making decisions for them that affects their lives. We can say, "Mom, what do you want?" And she will say, "I don't know, what do you think I should do?" Every time. She will not even say which TV show she wants to watch! "I don't know, put it on what you want to watch," she says. Today was the last time I will ask her on a financial matter. Should we move money from account A to a higher earning account B? She said "I don't understand this stuff. You decide, I trust you." So I sent the durable PoA to her investment manager and said from now on take direction from me.
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Rushie, sounds like you have it under control, she is a lucky lady.

I'm not a doctor and I'm just telling you what I was told when I was dealing with this, so take it with a grain of salt. Tooth aches are really painful, I tell my kids if the dentist says you need a root canal, then do it, the pain can come on quickly and is agonizing. I would call the dentist and make sure he knows what is up with her cognitively and go by his recommendation. Talk to him about your concerns with infection, again, I'm not a doctor, but my understanding is that it is better to get the diseased tooth out and let the gum heal over rather than having it there as a conduit to infection, but I'm just a lay person. Were it I, depending on the what the dentist said, I would probably do the extraction, which should be quick and relatively painless, but I would think real hard about the implant or bridge. A gap in her teeth is better than a messed up implant because she couldn't follow instructions. Keep in mind too, that if/as the dementia progresses they have trouble verbalizing pain or what is hurting, it really is an awful disease.

I went through this (dementia) three times with my mom and her two brothers, teeth issues were part of it. Really if you can, someone should supervise teeth care, just like a kid, it will save aggravation later on. Each one of my relatives was happy when they weren't responsible for the financial decisions any more. You are in for a roller coaster of a ride, just take it one day at a time.

Finally, a good primary care physician is essential to help with this. Keep in mind that more complex stuff just confuses and frustrates them. Better just to handle that stuff as you have found. Usually short term/ recent memory is gone, but older memories are in tact and can be good, stress free subjects to talk about when visiting.
 
Get a second opinion from another professional.

How old is too old for this kind of procedure? I know it’s an individual case by case basis, but is 95 too old? 100? 90?
 
455 Bravo Uniform said:
Get a second opinion from another professional.
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^^^
Best advice. Preferably a doctor experienced with geriatric patients.

But one factor that needs to be considered is that dental health affects overall health to a great degree. Bad teeth can really affect the whole body, including the brain. It is not just a matter of a painful tooth.
 
Rushie said:
This thread is very helpful. All y'all are making me think this through more. They're going to remove two molars based on a single X-ray. The more I think about it the more I don't like it.
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Yep. That seems to be an insufficient basis for such a decision. I wouldn’t like it either.
 
455 Bravo Uniform said:
Get a second opinion from another professional.

How old is too old for this kind of procedure? I know it’s an individual case by case basis, but is 95 too old? 100? 90?
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Very good question. I'd say no age is too old if the person wants it and is in good enough health to tolerate it. She is in good enough health and as for whether she "wants it" now it's up to me to figure that out.:(
 
Rushie said:
Very good question. I'd say no age is too old if the person wants it and is in good enough health to tolerate it. She is in good enough health and as for whether she "wants it" now it's up to me to figure that out.:(
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Your mother is one lucky lady. Too many old people are dumped in nursing homes and have strangers making their decisions for them. That will probably be me in a few years.
 
Rushie said:
Very good question. I'd say no age is too old if the person wants it and is in good enough health to tolerate it. She is in good enough health and as for whether she "wants it" now it's up to me to figure that out.:(
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I told my mom the other day how thankful I am that she's still fully functioning mentally and I don't have to try to guess these kinds of things. She's 84 and stopped driving on her own, makes informed decisions about her medical care, handles her finances, etc. I am VERY thankful.
 
The good thing: three grown female children all wanting what's best for mom (the fourth child usually lets us make these decisions). The bad thing: we three do not automatically agree on stuff.

Sister 1.) If one Dr. recommends it, she's totally on board. Full steam ahead. Resists any second guessing.

Sister 2.) Sceptical of everyone and has no qualms telling anyone to pound sand. Extremely protective of mom.

Me.) Always wants all the facts, risks, benefits, get educated on the matter before committing to anything irreversible.

Sister 1 has already scheduled the consult with the oral surgeon - it's this Thursday. Sister 2 is looking up other dentists this morning to take mom for a second opinion.

Because people don't always agree on stuff is the very reason the attorney set up the documents for a single child to have the final say, so that will be me. Ugh.

Interesting how these things bring out the whole dynamic of sibling relationships.

Thank you! You all have no idea how helpful you are!:)
 
pigpenracing said:
Most dentists will try to sell you whatever costs the most!
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Not this one.

At 91, provided she has adequate occlusion on the opposite side of her mouth, I would not put her through it, not that it is as painful as is being implicated. If it were an anterior tooth and it was an aesthetic concern, an implant would be on the table for consideration.
 
We went through this with my mother, although Brother #1 was remote and therefore didn't get as involved. However my sister is local and was very much wanting to give input on everything. It's because she cares so much.

Right now - there are lots of cooks in the kitchen. One of you needs to be the primary care giver and the three of you need to figure that out or you will eventually wind up arguing over every small thing. It won't be easy and the other two might occasionally disagree. Whoever it is should doubt their own superior knowledge and stop and listen, but especially to your mother. I'm pretty sure this isn't a problem for you, but respect her wishes above all others. As sad as the elderly decline is, the goal is to manage it with dignity and grace, because you will never prevent it. It took me two parents to realize that. Or just tell me to pound sand, I'm just SGOTI.

It is a blessing and a curse to take care of elderly parents.
 
My wife handle her mom's affairs (90 yo). It's no fun. More and more dentists are dealing with geriatric patients because not only are there more of them, but their families are taking better care of them than in the past. It shouldn't be too hard to find a good dentist or other specialist to give you some more ideas. Any surgery, no matter how small or minimally invasive, is going to take energy for recovery and my MIL doesn't have a whole lot of that excess energy left. So, in OUR case, we'd probably choose to avoid implants.
 
Rushie said:
My 91 year old mom has been told she needs a molar extracted. It's got a crown and bridge covering the next missing tooth so when they remove it, she will have two molars missing. They told her that after she heals she can decide if she can live with the big "hole" on that side of her mouth. If she cannot she has the options of 1) implant(s) or 2) a removable bridge.

Do any of you have experience with implants in the elderly? I only know of two people who have had them. One young person who loves his implants, and an older person who said it was extremely painful and they'd never do it again.

They tell her the removable bridge is worn during the day, then she must remove it and clean it every night. I have a bad feeling about that, she already has enough trouble fooling with hearing aids, I don't see her dealing with another appliance.

But if the implant process is that painful, I'm not sure we should put her through that either. She is very confused these days and looks to us to help her make decisions so I'm trying to gather as much information as I can. Money is not an object, she can pay for implants if that is best for her.

Have any of you dealt with this with your parent?
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Not with my parent, but.....


I'm 90, and I have had a failing bridge replaced with an implant. Cost a fortune, required several visits (gum surgery and healing time) but I am happy with the results. However, in your Mom's case I would opt for the removable bridge. "Another appliance" pales into insignificance when the cost of an implant approaches five figures.

Bob
 
bobmrg said:
Not with my parent, but.....


I'm 90, and I have had a failing bridge replaced with an implant. Cost a fortune, required several visits (gum surgery and healing time) but I am happy with the results. However, in your Mom's case I would opt for the removable bridge. "Another appliance" pales into insignificance when the cost of an implant approaches five figures.

Bob
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Wow Bob, I wouldn't have known you are 90. Key difference for you is that you are cognitively all there and have no problem making the right decision for yourself. Dementia makes things like this much, much more difficult to deal with. In the end Rushie will get to the right decision for her mom, which could indeed be the implant, each person is different. The most difficult part of this is trying to deal with this stuff in consideration of where the person is at now versus where they used to be when they were all there. It's tough for all involved.
 
I'm only 80. A few years ago I had a similar problem with a fixed bridge in my upper jaw. I had all the remaining teeth removed and went with an upper plate. I couldn't be happier----despite the predictions of my dentist.
 
The outcome: The oral surgeon agreed that if there are no symptoms then a wait and see approach is best. He confirmed that there is decay in the tooth but that tooth has already had a root canal so I guess that means no risk of it hitting the nerve late one night. There are no signs of infection and little risk letting mom keep it and its connecting bridge for now.

Everyone came to agreement and particularly mom. Prior to the appointment she started saying "I don't want any procedures at all, I don't even know if I'm going to be alive by my next birthday." I had written out questions for the oral surgeon and the sister took them in with mom for the appointment. Prior to that day both myself and my other sister had called and spoken with the nurse. The nurse and the doctor were terrific, very understanding and I am convinced gave the recommendation truly in mom's best interest.

If she does start to have symptoms then we'll cross that bridge (no pun intended) when we get there.
 
Glad it worked out for you Rushie and glad your mom can still make her wishes known, she is in good hands.
 
> "My 91 year old mom has been told she needs a molar extracted. It's got a crown and bridge covering the next missing tooth so when they remove it, she will have two molars missing."

If the molar has to come out it must be bacause at some point it's had a root canal and the root has fractured. Root canals always eventually fracture. If it's NOT a root canal gone bad, why does the molar need to come out? Anyway . . . assuming it has to come out, the dentist/surgeon can fill the resulting cavity with synthetic bone. I've used both natural bone allografts and synthetic allografts and found the synthetic was ready for implant placement two months sooner than the natural bone I had been using on earlier implants. Anyway . . . I would guess for someone 91 it'll be about six months before there's enough hard bone to place an implant. Most of my implants were done in my 60's and it was always 4 to 6 months for the bone to regrow and integrate (using allografts). When younger, bone will fill in by itself but as we get older, that doesn't work any more.

There's no pain for any part of the procedure except the initial anesthetic injection. Because I'm a whinger and because he's a good dentist, my dentist uses a tiny needle, shoots a tiny bit in, lets it get numb then injects the rest. Doing it that way, you don't even have pain from the anathestic injection. However, you say she can easily handle a needle injection so however the dentist does it, that's the extent of any pain involved. Implants are about the most painless medical procedure there is. Once the bone has hardened, it's a fifteen minute procedure to drill a hole and screw in an implant. It will need to set for two or three months before it's "loaded" with a new crown so the long waiting times are about the only things against going with implants. I just realized she'll need two, not one. You won't want to stress the implanted tooth by putting another cap and bridge on it to fill in the adjacent space. It was that contraption that probably caused the failure in the first place of the molar that needs to come out.

You know . . . at 91, I'd just get used to chewing with her remaining teeth. For most of mankinds' existence people didn't have any teeth if they lived past 40. She'll be fine - at her age- with two missing molars. I had an 88 year old landlord years ago who had no teeth at all. His gums were tough as bone and he had no trouble eating anything. He had false teeth to go out in public but at home he just used his gums.

Just some thoughts.
 
MikeS said:
> "My 91 year old mom has been told she needs a molar extracted. It's got a crown and bridge covering the next missing tooth so when they remove it, she will have two molars missing."

If the molar has to come out it must be bacause at some point it's had a root canal and the root has fractured. Root canals always eventually fracture. If it's NOT a root canal gone bad, why does the molar need to come out? Anyway . . . assuming it has to come out, the dentist/surgeon can fill the resulting cavity with synthetic bone. I've used both natural bone allografts and synthetic allografts and found the synthetic was ready for implant placement two months sooner than the natural bone I had been using on earlier implants. Anyway . . . I would guess for someone 91 it'll be about six months before there's enough hard bone to place an implant. Most of my implants were done in my 60's and it was always 4 to 6 months for the bone to regrow and integrate (using allografts). When younger, bone will fill in by itself but as we get older, that doesn't work any more.

There's no pain for any part of the procedure except the initial anesthetic injection. Because I'm a whinger and because he's a good dentist, my dentist uses a tiny needle, shoots a tiny bit in, lets it get numb then injects the rest. Doing it that way, you don't even have pain from the anathestic injection. However, you say she can easily handle a needle injection so however the dentist does it, that's the extent of any pain involved. Implants are about the most painless medical procedure there is. Once the bone has hardened, it's a fifteen minute procedure to drill a hole and screw in an implant. It will need to set for two or three months before it's "loaded" with a new crown so the long waiting times are about the only things against going with implants. I just realized she'll need two, not one. You won't want to stress the implanted tooth by putting another cap and bridge on it to fill in the adjacent space. It was that contraption that probably caused the failure in the first place of the molar that needs to come out.

You know . . . at 91, I'd just get used to chewing with her remaining teeth. For most of mankinds' existence people didn't have any teeth if they lived past 40. She'll be fine - at her age- with two missing molars. I had an 88 year old landlord years ago who had no teeth at all. His gums were tough as bone and he had no trouble eating anything. He had false teeth to go out in public but at home he just used his gums.

Just some thoughts.
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Good thoughts and much appreciated. If she ends up losing them she will probably just live without them. If we had a crystal ball and knew she was going to live to 100 it would be worth the implants. That's hard to predict, she is general healthy but very frail and seems to be "packing her bags" emotionally.There is MRI evidence of past mild strokes and I think that is the cause of her cognitive dysfunction so who knows when "the big one" might strike.
 
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.
 
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