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Dental appointment - Carers UK Forum

Dental appointment

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I have a problem in that my brother, who is 80 and bedridden, is confused but gives the impression that he understands when things are explained to him - then it turns out he didn't. The problem has come up with doctors and paramedics. Only recently when I was away for a week a GP explained everything about scar tissue to my brother, even though it says on the practice's notes that he doesn't understand and his sister or the care agency has to be told.

His teeth are in a bad state and he suddenly decided he wants dentures, although he apparently doesn't have toothache. Eventually the community dental service came, some months ago. They advised him that he could either decide to do nothing, or else have all his (few) teeth out except two, and some roots should be examined, possibly x-rayed, to make sure they are safe. This would happen on August 10th and we would have to go to the clinic. They can handle a wheelchair but I just realized I have left it rather late to get a private ambulance and above all to get more advice.

They told my brother either he goes to the clinic and they remove teeth, or he can decide to do nothing, and he immediately agreed to the former. As soon as they'd left, it appeared that he thought they were coming to our house the following week to remove teeth. I am not sure his decision, definitely to have teeth removed, was based on full understanding.

Can anyone tell me what it's like having so many teeth removed? How long do they take to heal so he can eat a bit? He normally refuses to drink Complan, for example. I know I will have to phone the service on Monday to get some information. I just have the feeling that both he and I have not been informed, which is my fault because I keep forgetting how little he takes in. The visit was months and months ago. I know it would be better for him to have better teeth, indeed I told him that three years ago, but he has never wanted anything done. The dentists' visit was more a case of working out the state of his teeth than informing him, and I wasn't concentrating enough to see the problem.

Has anyone had the problem of such treatment, for example for people with dementia?
Two issues - can he give informed consent? If not, then does anyone have Health and Welfare Power of Attorney? When I was in hospital once, the lady in the bed next to me, with dementia, had been booked in for treatment without all the proper procedures. Panic ensued in the hospital staff!
Is it really worth having done? I have had seven teeth out, now have dentures. Would never have an extraction unless absolutely necessary. It hurts and usually takes me a month to get over, but I've got "difficult" teeth. Long story.
Dentures will require a number of moulds being taken, and fittings. Will that be done at his home, or the surgery.
Finally, the NHS ambulance should be able to do the transporting. Why is your brother bed bound? How is he going to be affected by all the transporting? Pain?
If it was my mum, I wouldn't take any action unless she was in pain. Your brother had ample opportunity to get dentures done when he didn't have dementia, so why now?
Thanks very much, BB.
My brother can give informed consent - he doesn't have dementia, but confusion. But I notice that when doctors, districts nurses etc. talk to him, he unconsciously tries to cover up things. So he decided he wanted his teeth done and didn't listen to the details. His informed consent is conscious but not very informed, because I think he can't be bothered with the details. The reason I asked about dementia is because it seems comparable to me.

I have a PoA over finance only. I know I could get the other but I don't want to.

Private ambulance is my decision. He can't stand and is very heavy, and the NHS ambulance have several times let him down, so that two appointments have been missed. Getting a private ambulance actually reduces the strain on me! There are fewer bariatric ambulances and sometimes they get an emergency call and can't come in time. We got cataract surgery, which was brilliant, by the skin of our teeth because the ambulance came 3 hours too late and the consultant had finished but fortunately was prepared to see him - this was after losing 3 months on the list because the hospital he first went to could not get his wheelchair into the equipment room. Another time he slid out of the wheelchair when we got home and we finished up going to A & E all night (long story). Even if an NHS ambulance got him to the clinic, we might have to wait 3 or 4 hours to get one back, and he can't sit up in the wheelchair very long, especially if he's had several teeth out.

They can do everything at our home except this one visit, I imagine because of equipment at their clinic.

I think I need to interrogate my brother closely to see if he is in pain. I don't think he is, and he said he wasn't. It's just that his teeth are so bad. I may also ask for opinions from a couple of the more experienced careworkers who come.

Thanks for replying and also for the 'one month' recovery in your case. I got in a bit of a panic because it's really all my decision and because I hate going anywhere by ambulance because something always goes wrong.
Hi Greta, I'd forgotten that your brother's size caused additional difficulties, especially as far as ambulances were concerned. In those circumstances, I think I'd have a private one too. You mention root treatment - presumably for teeth they are planning to save? I'm having root treatment at the moment. It involves a good half hour in the chair, twice. I don't know why it's a two stage process, but it always has been for me, requiring injections. So if your brother needs root treatment both sides of his jaw, they will do one side one time, and the other side another time, to avoid a totally numb mouth and tongue. That will be at least four visits, spread over a few weeks, going solely on my own experience.
Then for the dentures, they will need to do a series of impressions.
So in your position, I'd like to make absolutely certain that they really can do root treatments at home, and don't require attendance at the clinic, which with a private ambulance could be very expensive indeed. Extraction recovery can vary, depending on which teeth are involved. Front teeth are generally easier, as they have fewer roots. Teeth at the back are about double the size with double the roots. My family always need special treatment for the wisdom teeth, and the next ones forward, because they are genetically an unusual shape. I need sedation for them!! I hope this information is helpful, so that your brother is making a good decision. I have upper and lower dentures, the metal type, they are very comfortable and mean I can eat steak again, and it was well worth the process to have them. On the other hand, mum lived to 87 eating only mushy food for years.
Hi Greta,

coming at this from a totally different angle ! Your brother is now 80 and you say that you don't think he is any pain from his teeth although they are in bad way ? So my question is - given his age, is it worth him going through the trauma of having his teeth extracted ?

To get a good 'fit' with new dentures it often requires a number of return visits to the dentist for adjustments to be made. My Mum had full dentures from her mid-thirties - each time they had to be replaced (either 'cos she'd broken them or, as she aged, her gums changed shape) we knew that we would be in for a number of visits before they were comfortable for her. She also hated the 'impressions' stage - she said it was like having a mouthful of plasticine.

(The 'metal' skeleton dentures that BB mentioned are usually only available privately; NHS dentures are generally the pink plastic looking ones which can rub and cause sore spots in the mouth until they have been adjusted and 'bedded' in.)
Thanks again, BB, and thanks Susie.

I have not explained the situation clearly, I see. My brother's teeth are largely not worth saving, and there are some roots left from previous problems which they want to x-ray just in case any problems seem likely - not root treatment, but possibly removal. They would prefer to leave the old roots in. What they want to do at home will be making dentures and possibly a remaining extraction or two. That much was clear. The single visit to the community dental centre was all they thought my brother could manage.

Today I did manage to discuss it with him. He admitted that he answers doctors quickly and does not take things in. He has clearly been thinking he could keep a number of teeth (though they specifically denied this) and have an attractive bridge at the top. It may even be the cosmetic elements he thinks of most.

At all events I will be requesting a new home visit for more information, which will probably mean cancelling the appointment on August 10 and waiting more months. It was my fault not to make it clear to them how little he understands, but I think they should have given us more information in any case.

Of course I think he should not bother, but I was simply taken aback when he said yes, he wants his teeth out - but he was consenting to a misunderstanding on his own part.

As for dentures, I am ashamed to say I have had a complete upper denture since I was 17. I had not heard of the metal ones - are they good? I have been told that if my lower teeth go, I will need implants or I will not have secure teeth below. I am open to advice, though this is completely off topic! I have not had many problems over the years, except that my wisdom teeth below were left in and above were removed, all of course after the age of 17, so there has been a tendency for cracks at the end where the statics are uneven. Taking impressions is no problem for me, nor have my gums really shrunk in 51 years, but it does worry me how long my brother would be without dentures. And I don't like the idea of a bridge at the bottom, as I think it would be awkward.
Btw, I don't eat steak or grilled lamb chops at home out of consideration for my brother, who might smell them and be envious!
I had not heard of the metal ones - are they good? I have been told that if my lower teeth go, I will need implants or I will not have secure teeth below. I am open to advice, though this is completely off topic!
When discussing with my dentist the possibility of needing a bridge for two upper molars she did say that the metal 'skeleton' is usually more comfortable; as I'm a pensioner (!) she went onto say that she could make a 'skeleton' bridge using the material used for NHS dentures but this would be still dearer than the standard NHS bridge, but not as expensive as the metal one. As it turns out she was able to root fill the teeth in question with the proviso that I'll probably need the bridge eventually; three months on and they are still OK. We did discuss implants as an alternative, but I don't have enough viable bone for them to be secure. My bro-in-law does have a metal skeleton bridge and he says he doesn't notice it at all.
I'll think about this if I ever get time to worry about my own teeth. But I think I'm past the bridge stage.
The upshot of all this was that I got a dentist to phone me and explain the whole situation. It turns out that not only my brother, but I too had misunderstood the information we were given. In fact it was yet another case of miscommunication. It seems that on the appointment day, one big tooth at the bottom will be removed and a number of exposed remaining roots will be smoothed off, and an x-ray will be done. At that point the dentists can decide how best to proceed and my brother can still decide whether to go ahead or not. As far as I know, everything else including extractions and denture fittings can be done at home. So we will be going to the clinic and the private ambulance has been booked.