90 year old mom to have teeth removed - 6 years post oral cancer

Posted by hilsy @hilsy, Jun 27 7:53am

My mom had oral cancer and follow up radiation 6 years ago. She has dementia and it has been hard to make sure she looks after her teeth properly, and that has been exacerbated by severe dry mouth post radiation during this period. Now she needs a few teeth removed including 2 molars on the radiated side. We had multiple oral surgeons and dentists concur on the need for this. One is saying she might need hyperbaric oxygen treatment to heal, which, when I investigated the treatment, looks like it might be quite tough for my mom – both the daily nature and the confined sitting time. Any views or recommendations on any of this to help her through it or what to expect? Thank you!

@hilsy, I'm bringing @alpaca to this discussion. She talks about her journey with teeth post oral surgery in this discussion from a couple of years ago and may have some experiences and thoughts to share with you.
– Teeth and Head & Neck Cancer https://connect.mayoclinic.org/discussion/teeth-1/

I surely can understand that you want to make the right decisions for (with) your mom given that she also has dementia and the realities that go along with that. Are the doctors suggesting that they observe if she heals well on her own before turning to hyperbaric oxygen treatment? How long and how frequently would she need it?

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Hello @hilsy

I had an elderly relative pass away late last year at age 93. She also needed dental work done and the dentist was pushing to get it done because chewing and sometimes talking was an issue. As she was not very tolerant to have her teeth worked on, I ran the idea by her geriatric psychiatrist. Her opinion was not to put her through that kind of ordeal.

Perhaps you have already talked with your mom's mental health professional (or her PCP) about this issue. If not, you might consider it.

Some things to consider would be whether there is active decay, painful teeth or gums, etc. When dealing with the elderly (with dementia), it is important to be a good caregiver to the patient. Sometimes the physical treatments that doctors are willing to put elderly folks through might not be in their best interest emotionally.

Just something to consider.

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@hilsy What a dilemma for your mother. Sounds as if the teeth have to come out if a whole team agrees. There's a risk of necrosis of the jaw after tooth extraction from the radiated field, depending on how much radiation that part of the jaw received and HBO is used to improve blood flow and healing. However, dentists are not so certain now that it is useful. It sounds like a quite pleasant experience for people with normal cognitive function but there's pressure on the ears and its every day for weeks so as you say it might be too much for her with dementia. You could ask them about Pentaclo which is a drug combination used to improve healing after the bone starts to play up. Trental and Vitamin E. What treatment will give your mother maximum comfort? Good luck with these difficult decisions.

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Hello @hilsy

As your mom is age 90, with a history of cancer treatment and dementia, have you considered comfort care at this point in her life?

Here is some information on Palliative Care (different than hospice care) which might be considered in addition (or in place of) the extreme ordeal of the dental work that is being suggested.
https://www.mayoclinic.org/tests-procedures/palliative-care/in-depth/palliative-care/art-20047525

Liked by hilsy

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Hi,
Thanks everyone for your responses. This is what played out. On June 26th, before I wrote, she started having swelling on her right cheek where some of the teeth were located. I called into the dentist who asked that she start on amoxycillin right away leading up to the extractions, which were scheduled for July 2nd. The day after I posted, on the 28th, she was noticeably weaker. I don't know if it was the antibiotics or the infection. In any case, at that point I was happy we had the extractions scheduled. She had 5 teeth removed the 2nd. The doctor found a lot of infection and large abcessed areas. She had a really tough time with her recovery and is still getting her strength back. Not a lot of mouth pain but just huge general weakness and fatigue,. sleeping much more than usual. We went for a follow-up today and so far he says she's healing well but there was a lot of packed food in her mouth which he was very unhappy about – saying she won't heal and will become infected unless her mouth gets better cleaned twice per day. This is going to be a challenge for her helpers. I am going to speak with each of them about it individually and hope they can cope with it. I don't know if this is something they will feel comfortable practically doing for her at this point (gently), as she is unable to do it on her own….

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@hopeful33250

Hello @hilsy

As your mom is age 90, with a history of cancer treatment and dementia, have you considered comfort care at this point in her life?

Here is some information on Palliative Care (different than hospice care) which might be considered in addition (or in place of) the extreme ordeal of the dental work that is being suggested.
https://www.mayoclinic.org/tests-procedures/palliative-care/in-depth/palliative-care/art-20047525

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Thanks for this. I have to better educate myself on the difference between the home care she is receiving and palliative care. My parents currently have 24 hour care from a group of caregivers, 3 of 5 of whom have worked for them for 2+ years.

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@alpaca

@hilsy What a dilemma for your mother. Sounds as if the teeth have to come out if a whole team agrees. There's a risk of necrosis of the jaw after tooth extraction from the radiated field, depending on how much radiation that part of the jaw received and HBO is used to improve blood flow and healing. However, dentists are not so certain now that it is useful. It sounds like a quite pleasant experience for people with normal cognitive function but there's pressure on the ears and its every day for weeks so as you say it might be too much for her with dementia. You could ask them about Pentaclo which is a drug combination used to improve healing after the bone starts to play up. Trental and Vitamin E. What treatment will give your mother maximum comfort? Good luck with these difficult decisions.

Jump to this post

Thank you for this specific advice. The surgeon didn't mention Pentaclo or Trental/Vitamin E. He said she's healing well but if we don't keep her mouth cleaner, it will be tough to keep healing and then he'll advise bariatric oxygen which sounds like craziness to me in her state.

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@colleenyoung

@hilsy, I'm bringing @alpaca to this discussion. She talks about her journey with teeth post oral surgery in this discussion from a couple of years ago and may have some experiences and thoughts to share with you.
– Teeth and Head & Neck Cancer https://connect.mayoclinic.org/discussion/teeth-1/

I surely can understand that you want to make the right decisions for (with) your mom given that she also has dementia and the realities that go along with that. Are the doctors suggesting that they observe if she heals well on her own before turning to hyperbaric oxygen treatment? How long and how frequently would she need it?

Jump to this post

Thank you – I'll check that link. The surgeon was talking about 4 weeks of treatments – 5x per week for 20 mornings. It's frankly hard to imagine and also sounds like a covid risk too as it's a group setting. In any case, he won't make a determination until our second follow up at month's end.

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@hilsy

Hi,
Thanks everyone for your responses. This is what played out. On June 26th, before I wrote, she started having swelling on her right cheek where some of the teeth were located. I called into the dentist who asked that she start on amoxycillin right away leading up to the extractions, which were scheduled for July 2nd. The day after I posted, on the 28th, she was noticeably weaker. I don't know if it was the antibiotics or the infection. In any case, at that point I was happy we had the extractions scheduled. She had 5 teeth removed the 2nd. The doctor found a lot of infection and large abcessed areas. She had a really tough time with her recovery and is still getting her strength back. Not a lot of mouth pain but just huge general weakness and fatigue,. sleeping much more than usual. We went for a follow-up today and so far he says she's healing well but there was a lot of packed food in her mouth which he was very unhappy about – saying she won't heal and will become infected unless her mouth gets better cleaned twice per day. This is going to be a challenge for her helpers. I am going to speak with each of them about it individually and hope they can cope with it. I don't know if this is something they will feel comfortable practically doing for her at this point (gently), as she is unable to do it on her own….

Jump to this post

A water flosser might help but it would have to be gentle.

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@hilsy

Hi,
Thanks everyone for your responses. This is what played out. On June 26th, before I wrote, she started having swelling on her right cheek where some of the teeth were located. I called into the dentist who asked that she start on amoxycillin right away leading up to the extractions, which were scheduled for July 2nd. The day after I posted, on the 28th, she was noticeably weaker. I don't know if it was the antibiotics or the infection. In any case, at that point I was happy we had the extractions scheduled. She had 5 teeth removed the 2nd. The doctor found a lot of infection and large abcessed areas. She had a really tough time with her recovery and is still getting her strength back. Not a lot of mouth pain but just huge general weakness and fatigue,. sleeping much more than usual. We went for a follow-up today and so far he says she's healing well but there was a lot of packed food in her mouth which he was very unhappy about – saying she won't heal and will become infected unless her mouth gets better cleaned twice per day. This is going to be a challenge for her helpers. I am going to speak with each of them about it individually and hope they can cope with it. I don't know if this is something they will feel comfortable practically doing for her at this point (gently), as she is unable to do it on her own….

Jump to this post

Hello @hilsy, I appreciate your post about your mom's progress since her teeth were extracted. It sounds like it is a difficult recovery down the road. Palliative care is not the same as home care. Home care workers simply help with household and personal care needs, like grocery shopping, cooking, cleaning, errands, etc.

Palliative Care is about medical treatment for comfort care. I'll post the link that explains it,
https://www.mayoclinic.org/tests-procedures/palliative-care/in-depth/palliative-care/art-20047525. You can talk with your parents' doctor to see if he/she knows of a palliative care medical team in your area.

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