Special Care Dentistry is the specialty providing care for patients with complex needs who cannot be treated in a general dental practice. These needs can vary, however those seen within the specialty commonly include people with severe learning disabilities, autism, challenging behaviours, dementia, or significant medical conditions that increase the risk of dental treatment. Teams providing Special Care Dentistry need to consider a wide range of factors, including medical and dental, psychological, and social factors when planning dental care and often need to use sedation or general anaesthesia to be able to provide appropriate dental treatment.

Many patients seen within the specialty have cognitive impairments. Many, but not all, lack the mental capacity to consent for dental care.  The best interests standard is used in these situations to guide treatment decisions. It is often difficult to quantify risks or benefits associated with dental treatment, especially when sedation or anaesthesia is needed. In addition, pain is a key driver of intervention, yet other psychosocial factors related to dental care and its outcomes can often be less comprehensively considered in bests interest decision making.

Andrew's presentation will summarise the challenges encountered in Special Care Dentistry and will explore these through two case studies that relate to different ethical challenges encountered in Special Care Dentistry. The role of the dentist in determining best interests, and the appropriateness of this, will be explored in relation to the cases presented.