Case Report: A 75 year-old “retired” pharmacist was diagnosed with advanced stages of Alzheimer’s disease over the past 18 months. The wife noticed that he was supporting his head on the left hand during the daytime. She also noted that the would chew his food only on the right side. When asked, he could not verbalize what might be bothering him. Confused and concerned, he was taken to his dentist for a consultation and exam. His dentist had been treating the pharmacist for the past forty years. Many of the restorations were failing due to gingival recession, caries, and deep periodontal pocketing. Unable to make a diagnosis, the patient was referred for evaluation and treatment.
What stood out during the clinical exam was 7-9 mm pocket depths on the distal of #15. A closer look at the CBCT-scan revealed an impacted #16 with deep caries. The scan demonstrated the caries to be within the pulp and the source of moderate maxillary sinusitis on the left side. The recommended treatment was to extract this tooth and withdraw the granulation tissue while elevating a large flap within the pulp maxillary sinus cavity.
Using a local anesthetic, the tooth was removed from the sinus area being careful to not disturb the maxillary tuberosity, sinus cavity, #15 crown and fracture the endodontic treated roots of #15. Lots of controlled force was used for this difficult impaction. A foul odor with pus and a significant amount of granulation tissue were evacuated from the sinus floor. The other high risk to be on the lookout for will be the formation of an oro-antral communication in this elderly man who has a chronic infection.
As our aged population develops Alzheimer’s and Parkinson’s diseases, it will be the responsibility of the care-givers, dentists and hygienists to see these patients every three months. They must monitor and treat root caries, periodontal diseases, broken restorations and teeth for people who no longer have the dexterity or ability to perform routine oral hygiene and can communicate their problems. Add this to the list of of an elderly person that may have diabetes, osteoporosis, anti-coagulant therapy, as well as other problems.