Going to the Dentist

Key facts

People with intellectual disability should go to the dentist at least every six months. Many people find it hard to tell the dentist that they have a toothache or sore gums. And they may be anxious about what is going to happen at the dentist’s.

A lot of dentists are not skilled to meet the needs of people with intellectual disability. It is important to try to find one who does have these skills.

There are things that families, advocates and support workers can do to meet these challenges.

Finding the right dentist

Public dental clinics
Most people with intellectual disability go to public dental clinics. These are located around NSW and do not charge. However, they usually have long waiting lists and the dentists are not always skilled in working with people with limited communication.

To go to a public dental clinic, you need to phone for an appointment. You will be asked questions to work out what priority to give to the person. A person with intellectual disability may have to wait for as long as six months for an appointment, and so it is very important to speak up if that is too long. If the person seems to be in pain, they should get an appointment within a week. You should also explain if the person may need sedation or a general anaesthetic when they have treatment.

If you feel that the dental clinic staff member you are talking to would benefit from specialist advice, you can suggest they ring the Special Care Unit at Westmead or Sydney Dental Hospital.

Specialist public clinics
There are two specialist dental services for people with intellectual disability and other complex needs:

The Special Care Unit at Westmead Centre for Oral Health.
The Special Care Dentistry Department at the Sydney Dental Hospital in Surry Hills.

Some people with intellectual disability need to get their dental treatment at these services. Your doctor or dentist can refer the person by a letter which must include the person’s name, address, telephone, medical history, type of disability and Medicare number. You will get a letter saying the referral has been received.

Private dentists
Some private dentists are experienced with people with intellectual disability but they do charge fees. If you have private health insurance, this may cover part of the fees.

Medicare covers some dental fees if a person’s dental problems are likely to affect their general health, eg some people with respiratory illness. If the person needs a general anaesthetic, the dentist has to get special approval from Medicare.

If you are looking for a private dentist, ask around your network. Other families, disability services or your GP may know a dentist with the right skills. Think about what kind of people the person with intellectual disability is relaxed with. Eg, is the person more comfortable with men or women? See the Finding the right doctor fact sheet for some more ideas.

The Special Care Unit at Westmead may also be able to refer you to a suitable dentist.

Being prepared

Some people with intellectual disability go to the dentist alone and can communicate well with the dentist. Others will need a lot of support.

Who will go with the person to the dentist? It should be someone who gets on well with the person and knows them well. If an accommodation worker is making the appointment, they usually should check if a family member or advocate wants to go too.

If a person is likely to be anxious at the dentist, it may help to prepare them by explaining what will happen and showing them pictures of a dentist. It can help to make the first visit a social visit so that the person can see the surgery and meet the dentist.

You should write down signs that the person has dental problems:

Does the person seem uncomfortable when eating or drinking?
Is the person resisting having their teeth brushed? Do the gums bleed?
Does the person have bad breath?
Sudden or unusual behaviour changes may indicate that a person is in pain.

When you go to the dentist, take the person’s health records and a personal profile for the dentist to look at. See the fact sheets on Personal health records and Helping the doctor understand the person.

If the person has limited mobility, make sure that the dentist’s clinic and equipment is accessible.

Tell the receptionist if the person will have trouble with waiting or if an interpreter is needed. They can phone Translating and Interpreting Service (TIS) National on 131 450.

During the visit

Make sure the dentist explains what is happening and what they are going to do. Encourage the dentist to speak directly to the person with intellectual disability rather than the support person. See the Helping the doctor understand the person fact sheet for other ways to help the dentist communicate with the person.
Make sure the person (or you) gets all the information needed to decide about treatment options. Remember that the dentist needs consent from the person or a “person responsible” – usually a family member.
Ask the dentist to do normal preventive care, eg cleaning off plaque, as well as doing any fillings.
Ask the dentist if there is more that can be done at home to prevent dental problems.
Some people will be anxious during dental examinations and treatment. It may help if the dentist uses the person’s own toothbrush to examine their mouth. People who are very anxious or have involuntary body movements may need sedation or a general anaesthetic.

After the visit

If there are further appointments or follow up, make sure you explain this clearly to the person with intellectual disability and check that they understand.

If there are things to do at home, eg rinsing for a day with a mouth wash, make sure the dentist explains or demonstrates this to the person. And, if the person has more than one carer, make sure they all know what to do.

Finding a public dental clinic

To locate your local public dental clinic, look in the White Pages under Dental Clinics or search for “dental” at www.health.nsw.gov.au/services/index.asp
Phone NSW Health (02) 9391 9000 or TTY (02) 9391 9900

Special Care Unit at Westmead Centre for Oral Health
Phone (02) 9845 7424 and 9845 7423 Emergency treatment (02) 9845 7363

Special Care Dentistry Department at Sydney Dental Hospital, Surry Hills
Phone (02) 9293 3200

You might be interested in these fact sheets

Dental care - information about kinds of dental problems, good dental care at home and what the dentist can do to prevent dental problems.
Consent to medical treatment
Getting the most out of Medicare
Going to the doctor – tips and tricks
Helping the doctor understand the person
Personal health records

This fact sheet was written in July 2009.

The fact sheet contains general information only and does not take into account individual circumstances. It should not be relied on for medical advice. We encourage you to look at the information in this fact sheet carefully with your health professional to decide whether the information is right for you.