Advice for a parent with teeth issues

[Deleted User]

Hi all,

This is a general post asking for advice on the way forward for my 69 year old dad. His teeth are in a likely ropey state state (phobic of dentists and has refused almost all dental treatment for about 40 years, with maybe 1 or 2 consultations done but no actual work). He regularly mentions losing pieces of tooth but can still chew his food and has a number of teeth remaining. 

For many years he ostriched the issue despite our best efforts but has just recently decided to get everything fixed. He is considering implants and has flat out rejected dentures on the basis that they are horrible (but I don't think that is really correct). He has done a preparatory visit to an implant specialist near London who has said implants are possible and given a large-ish quote.

We have a budget of £20k or so (and fairly flexible in both directions).  I am concerned about a few things, namely (i) the long term prognosis & suitability of implants especially given age, (ii) his ability to keep any major repair work once completed in good condition with regular visits to the dentist in future seeming possibly unlikely (given his history of decades of refusal), (iii) it's so hard to know how to find a good dental implant practice. We are considering UK dentists and also overseas dentists although the risks of overseas are concerning.

So I'd appreciate constructive comments on, in general, (i) what his options are likely to be (not asking for specific treatment advice since that's so patient specific, but what categories of treatments should he be investigating other than dentures and implants?) and (ii) any other general advice on how best to proceed? What are the factors we should be considering?

Basically: HELP

Undervalued

Deleted_User said:

Hi all,

This is a general post asking for advice on the way forward for my 69 year old dad. His teeth are in a pretty bad state (phobic of dentists and has refused almost all dental treatment for about 40 years, with maybe 1 or 2 consultations done but no actual work). He regularly complains about losing pieces of tooth but can still chew his food and has a number of teeth remaining. 

For many years he ostriched the issue despite our best efforts but has just recently decided to get everything fixed. He is considering implants and has flat out rejected dentures on the basis that they are horrible (but I don't think that is really correct). He has done a preparatory visit to an implant specialist near London who has said implants are possible and given a large-ish quote.

We have a budget of £20k or so (and fairly flexible in both directions).  I am concerned about a few things, namely (i) the long term prognosis & suitability of implants especially given age, (ii) his ability to keep any major repair work once completed in good condition with regular visits to the dentist in future seeming possibly unlikely (given his history of decades of refusal), (iii) it's so hard to know how to find a good dental implant practice. We are considering UK dentists and also overseas dentists although the risks of overseas are concerning.

So I'd appreciate constructive comments on, in general, (i) what his options are likely to be (not asking for specific treatment advice since that's so patient specific, but what categories of treatments should he be investigating other than dentures and implants?) and (ii) any other general advice on how best to proceed? What are the factors we should be considering?

Basically: HELP

Hopefully one of the dentists that post here regularly will give a more expert response but I think you have pretty much answered your own questions in the part I have highlighted.

I certainly wouldn't even consider going abroad in the situation your describe.

Toothsmith

You are right to be concerned about long term prognosis of implants if he does not return for regular checks once the work is completed. 

If that is likely, then the simpler the treatment the better. 

In the days when people had their teeth out and dentures when they were very young, denture wearing was relatively easy to get used to, as young people adapt to things really well. Now, people are coming to dentures much later in life, and it is a problem. Older people are much less adaptable, and they do find it difficult. It's by no means impossible - but you need a patient willing to accept the difficulties and push on through them. From what you write, that isn't sounding like your Dad! 

Treatment options will vary depending on whether he has any saveable teeth or not. 

But the order of treatment when treatment planning should be firstly to find out what the patient wants. Secondly, get rid of anything that can't be saved. Third, to stabilise and treat anything that can be saved. Then assess where you are and decide if the more complex, high maintenance treatments should be tried, or whether it should just be kept simple. 

If your Dad doesn't have many or any saveable teeth, then he's not really chewing on anything much at the moment anyway. Does he seem to be malnourished because of this? 

If not - then another option to consider would be just taking out the rubbish, and leaving it at that. Just managing on healthy gums would be better than doomed expensive options that would cause him more pain & suffering as it deteriorated & broke down. 

It is a difficult one, and will depend very much on him finding a dentist he feels he wants to keep going back to. 

brook2jack2

In your fathers calculations there may be a good intermediate option which is implant supported dentures. 

In all on four type implant work the bridges are cemented in permanently and if not cleaned properly and maintained meticulously can fail very quickly. 

implant retained dentures are smaller than normal dentures and are taken out to clean but stay firmly in once in. The success rate of implant retained dentures is high and maintanence is alot less than all on four and cleaning is alot easier. . The cost will be circa £6000 for upper and lower full dentures. 

If he is keeping some of his own teeth then really simplest treatment is best .As TS says complex treatment needs complex maintanence which will be on going. As people age dexterity etc can decrease and , as you say, your Dad does not go regularly so this should be taken into account and planned for. 

It's all in the discussion with the dentist and your Dads expectations and future commitment . or not, to dental maintanence.