Nothing but the Tooth column: What to consider when a dementia patient needs oral surgery

Dr. Richard Greenberg
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Morning Sun

Columns share an author’s personal perspective.

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Q: My husband is 88 years old and is in late stage dementia. One of his upper molars, which has had a crown for years is now infected with some decay. Our dentist, in whom we have great confidence, is recommending we have it extracted and that it must be done by an oral surgeon due to its size, multiple roots, and also because it touches the sinus cavity. My concern is whether the procedure will likely cause immediate further mental decline. I understand that anesthesia is harmful for dementia patients, so I would want only novocaine used rather than a sleeping procedure. I have searched so much to find help for our situation. I want to do what is the right and best thing for my dearest one and am hoping for as much guidance and information from a professional before moving forward.

- P. Mc.

A: First let me say how sorry I am for the position you and your husband are in.

In regard to the dementia problem and anesthesia, I believe that if there is harm that could be done to his condition you would be referring to general anesthesia where your husband, the patient, would be completely sedated and unconscious. That type of pain control would only be necessary in very rare circumstances, even considering how severe the dementia is.

I am sure that your dentist has good reason to recommend the extraction and it therefore remains in the hands of the clinical dentist you choose, as to what type of pain control is needed. With many patients who are not overly fearful, local anesthesia (of the novocaine variety) is all that is needed. However, there can be much in the way of heavy pressure that for some can be objectionable. When this is the case then conscious sedation (nitrous oxide) can be administered rather than general anesthesia and this will provide the additional level of comfort needed. With conscious sedation, the patient will usually report after the procedure that they felt the pressure but it did not bother them.

All of this depends on the evaluation that the dentist does prior to the procedure in consultation with you. It is remotely possible that to manage your husband during the procedure that more than local anesthesia and conscious sedation may be needed. But that is very rare. Your dentist has chosen to refer you and your husband to a dentist who specializes in oral surgery. Any dentist that is specialty trained and board certified (a member of the American Academy of Oral Surgeons) will be well qualified to help you choose the type of pain control and patient management that will be necessary in this somewhat unique situation.

I wish you and your husband all the best and I am sure you and your general dentist will refer you to an oral surgeon who will then deliver a very positive result. Your husband is very lucky to have the loving, caring person you are, to be in control of his well-being.

Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at dr.richard@nothingbutthetooth.org.