Accessing dental care

Do you find it hard to take your family member to the dentist?

What can be done to make it easier?

Being healthy is important to all of us, including having a healthy mouth and teeth. However, supporting someone with learning disabilities whose behaviour can challenge to look after their teeth and go to dentist appointments can be a stressful experience. Families might worry that their relative isn’t getting the dental care that they need to stay well. Dental pain can also cause an increase in behaviour that challenges. Here are some things you can do to support good oral health and make visits to the dentist easier, for you and your relative.

Try to maintain good oral health

By working on everyday activities that will maintain good oral health for your relative, their need for dental work (like fillings) will be reduced. Becoming more relaxed with brushing and other similar activities might make your relative less anxious about dental treatment in general. There is some general information on oral hygiene for carers with children from Healthwatch Oxfordshire.

Using a different toothbrush or toothpaste may help if your relative experiences sensory or other challenges when it comes to brushing their teeth. More information and practical ideas for different types of toothbrush and toothpaste can be found in this “Mini Mouth Care Matters” information sheet.

There is also an information sheet to support children who experience sensory issues when brushing teeth by “Mini Mouth Care Matters”, which is availablehere. 

Help your relative get used to the dentist

Medical settings can be scary to some people with severe learning disabilities, especially if they process sensory information differently, for example, they may find the lights, noise or smell of the dentist overwhelming. You could ask your dentist if you can visit the surgery a few times before the appointment to help your relative get used to it. They could try sitting in the waiting room, meeting the receptionist and dentist, sitting in the dentist’s chair, and turning the lights on and off without any treatment. 

Practicing procedures on a teddy or doll can help lessen anxiety around what will happen at the dentist. Some dentists have toy medical instruments so your relative could ‘practice’ on themselves. 

See the following website for more information and advice on what to do before, during and after a trip to the dentist: Going to the dentist | toothPASTE. 

Use resources to prepare them

A picture story could help someone to understand what will happen at the dentist. It is also a useful way to show positive behaviour, e.g. sitting in the waiting room. The National Autistic Society has information about making and using a picture story about going to the dentist here. Some residential schools now offer a remote oral health check. There is a new  picture guide to having a remote oral health check  available from NHS England.  

Dental mirrors and other tools can be bought online and used as objects of reference or for practice at home.

There are other practical preparations that you can make. For example, taking sunglasses to guard against bright lights. Some people also find it difficult to open and close their mouths at the right time – actions like this can be practised ahead of an appointment.  

Agree with the dentist in advance that when your relative indicates they want to stop or leave this should happen immediately to build trust.

Plan reasonable adjustments with your dentist

The Equality Act 2010 says that services must make reasonable adjustments so that people with additional needs receive the care they need – just like everyone else. You could talk to the dentist before the appointment to plan these adjustments. Some examples are: 

• Booking the first or last appointment of the day, so the surgery is not busy and there is less wait time. You could also ask for a longer appointment so there’s no rush. 

• Asking the dentist to explain and demonstrate each procedure before it happens. 

• Asking the dentist to use familiar support tools such as ‘now and next’ boards.  

• Asking the dentist to give a ‘count down’, e.g. ’10 seconds then finished’. 

• Reducing the amount of medical equipment and clothing where possible, if these make the person anxious. 

• Some people may need to have a dental procedure under general anaesthetic if their anxiety would make the procedure too distressing or unsafe. 

It could be helpful to bring a copy of your relative’s Dental Passport, which includes their medical history and details of any specific caring needs they might have. There is also a new Dental Pain Communication Chart available from NHS England to help children and young people with a learning disability communicate when they are in pain. 

Search for special services 

If your relative has struggled with accessing dental care in the past, you might want to consider using a specialised dentist. You can search on the General Dental Council for a specialist dentist near you here: Specialist lists (gdc-uk.org) 

Ask your Dentist or GP to refer your relative to the Community Dental Service if there is one in your area. They specialise is special care dentistry and in some cases your relative can be recalled to them for regular check ups instead of your family dentist. Longer appointment slots, desensitisation programmes and an understanding of learning disability often come as standard in this service.  

Capacity to consent to treatment 

Usually, the dentist would need permission from anyone over 16 years old before doing any tests or giving treatment. If the dentist thinks the person they are treating may not have capacity to give their own consent to treatment, they will need to assess whether they have capacity to consent to or refuse treatment. E.g. does your relative understand what will happen if they don’t have the treatment? The CBF’s FAQ about healthcare has more information about capacity (see the first question).