Sir, the papers on implants in general practice (Volume 236 Issue 10), especially the editorial on prevention,1 missed the elephant in the room.

As a community dentist visiting care homes and supporting people with dementia, I was seeing increasing numbers of people with implants. Community dentists will know that oral hygiene in care homes is usually poor to appalling and setting up oral health programmes well nigh impossible. As a result, most residents had moderate to severe peri-implantitis around their implants. This isn't a good situation when the same people were suffering from multiple co-morbidities and taking bisphosphonates. Surgical removal was mostly impossible as a result, and in any case informed consent is really problematic for people with dementia. Contacting their implant dentist was generally impossible. When eventually some of the implants were exfoliated, they left grossly inadequate support for dentures.

My time dealing with care home residents was heart-rending. Poor diet, poor oral hygiene care, lack of socialisation, high charges, bleak outlook. And a mouth full of infected implants as the icing on the cake for a peaceful old age.