Drs. Terry Lindquist and Ronald Ettinger’s May JADA article, "The Complexities Involved With Managing the Care of an Elderly Patient," was interesting and represented treatment approached in an individualized and professional manner. I was especially impressed with the emphasis on the patient’s medical concerns.
I wish to ask the authors if they considered the use of telescopic copings on teeth nos. 18 and 31? Figure 3 appears to show tooth no. 31 with a large amalgam restoration and with an overdenture preparation. However, it appears that dentin is left exposed to the oral environment. I have found that telescopic copings reduce recurrent caries and, therefore, increase the longevity of such overdenture teeth.
On a more general note, I found the comments about the patient being in a "unique" position of wanting "to be in control of the decision-making process," the extended length of therapy and the patient not always following their advice entertaining. Having worked on both sides of the Atlantic, I have come to appreciate how much dentistry is respected in the United States, and how well the profession has done in educating the public.
On a final "international" note, the authors utilize the Universal/National tooth numbering system used in the United States in their article (nos. 1-32). After some years of being exposed to the International Standards Organization, or ISO, tooth numbering system, I feel that U.S. dental schools should change the manner in which they identify teeth.
The change would not be as difficult as it seems. The ISO system has much in common with the Palmer Notation Method. More international dentists now read American publications. Using [the ISO] system will facilitate communications. Even I was momentarily confused when the authors discussed the fixed bridge from teeth nos. 18–22.
In addition, the Universal/ National System’s pedodontic tooth identification leaves a lot to be desired. It is much easier to remember nos. 51–55, nos. 61–65, etc. I personally do well with teeth A, B, C and R, S, T, but am often hard pressed to assign a letter to other deciduous teeth.
