Sir, D. Howarth makes a fair point about the maintenance of implants in dementia patients but the same problems occur in crown and bridge patients or indeed any patient with standing teeth.

Dementia, serious strokes or any serious brain injury render the patient unable to look after their mouths and it is almost impossible for carers to assist them. Many have multiple other problems requiring attention and time. The speed with which decay destroys teeth renders anything but extractions pointless. Add to this the number of patients taking bisphosphonate drugs with their attendant risk of osteonecrosis post extraction and the need for a new protocol for treating the elderly and infirm becomes evident.

Maybe the denture wearers of the past who drifted into full dentures over the years didn't have such a bad deal after all.

1. Plymouth