Patients with Disabilities

Dental care for people with disabilities is often straightforward¹ and can usually take place in a routine dental setting. The first step is to adapt the appointment to the person, with local anaesthesia where needed. If these approaches are insufficient or unsuitable, conscious sedation or general anaesthesia may be considered. General anaesthesia is usually not the first choice, but it can be chosen directly when the alternatives are unsuitable or not feasible².

Treatment is provided by our clinic in Antalya, Turkey; on this page, "we" means that clinic. Under a Turkish regulation, treatment with sedation or general anaesthesia must not take place in an individual dental practice or a polyclinic³. Ask us where it would take place, who would provide it and how accessible our premises are. We answer in writing. Whether the rule applies to premises licensed before 6 October 2022 is a legal question this page does not resolve; the section on facilities below gives details.

This page is for people considering travel from abroad, including family members and carers helping with that decision. Treatment with a dentist or hospital service where you live remains an option.

Guidelines recommend considering less restrictive approaches before higher-risk options such as general anaesthesia². These include communication suited to the person, support to help them tolerate treatment, and local anaesthesia where needed. Sedation and general anaesthesia are not compulsory steps that everyone must try in sequence. The approach is chosen individually. Sedation guidance also recommends considering approaches without medication as alternatives or additions to sedation⁴.

An adapted appointment

Guidelines describe the following adjustments:

• More time or support. A longer appointment or an additional team member may help.
• A quieter time. An appointment can be arranged when the waiting room is less busy⁵, such as early in the day.
• A familiarisation visit. A short visit without treatment⁶ can introduce the rooms and team.
• Communication suited to the person. The dentist should explain things in a way the person understands. Someone with a hearing or visual impairment may need signs or other non-verbal communication. A carer can help if the person wishes. Difficulty communicating should not be taken to mean that someone has an intellectual disability⁵.
• Moving to the dental chair. A wheelchair user may need equipment and assistance for a transfer⁶. A published care standard describes equipment including hoists, wheelchair recliners and positioning supports⁷. This does not establish that a particular clinic has them.

Ask which adjustments are available at our clinic before arranging the appointment.

Becoming familiar with treatment gradually

For someone who finds dental treatment difficult, approaches that help them tolerate care can be used instead of, or alongside, sedation. One is gradual desensitisation⁷: becoming familiar with the surroundings and procedures in small steps.

Light, sound and touch

A systematic review examined dental environments with adapted light, sound and touch. It found a small reduction in physical signs of anxiety in people aged 6 to 21 with intellectual or developmental disabilities⁸, without a clear difference in behaviour that interfered with treatment. The evidence came from four small studies with 16 to 22 participants each⁸. Most had design limitations that could distort the results, described as a high risk of bias. Only simple procedures such as examinations, cleaning and fluoride application were studied, so the findings may not apply to adults over 24 or to treatment such as fillings or extractions.

Conscious sedation

Conscious sedation uses medication to reduce anxiety; it is not sleep⁹. Communication with the person is maintained during treatment. If they do not speak, their usual means of communication should remain possible. Sedation alone does not relieve pain, so local anaesthesia is still used where needed.

Sedation guidance explains that the plan may need adapting for a person with a disability. Some people may be unable to tolerate measurements or an examination inside the mouth beforehand. Non-verbal communication and a team member dedicated to providing sedation⁴ may be needed.

A sedative can also be given into the nose, for example intranasal midazolam. This is different from inhaling nitrous oxide through the nose. The cited sedation standard describes increasing use of this route, particularly for people with disabilities. However, the dose cannot be adjusted in small increments. The standard therefore recommends it only when techniques allowing gradual dose adjustment are unsuitable⁹.

General anaesthesia

General anaesthesia uses medication to place the person in a deep sleep. The BSDH guideline covers people aged 16 and over² receiving dental care for additional needs. For many patients in those services, it describes general anaesthesia as the only way to tolerate even simple treatment. The guideline explains that much of its advice rests on the working group's shared judgement because research evidence is limited.

Because of its risks, general anaesthesia should not usually be the first choice². It can be chosen directly if local anaesthesia, psychological support or sedation is unsuitable or cannot be used. It should be used only when a substantial expected benefit outweighs the risks, and not routinely just to carry out an examination. For children, the AAPD also states that sedation or general anaesthesia may be recommended⁵ when approaches without medication are ineffective.

A Turkish regulation issued in 2022³ distinguishes individual dental practices, polyclinics, oral and dental health centres, and hospitals. Under that regulation:

• Examinations and treatment with sedation or general anaesthesia must not take place in an individual practice or a polyclinic³.
• Centres and hospitals must have a general anaesthesia procedure unit and an observation unit. A centre must employ a doctor qualified in anaesthesia and resuscitation on a full-time or part-time basis; a hospital must employ one full-time.
• Dentists from individual practices or polyclinics may treat their patients in a facility with a general anaesthesia unit, including a private healthcare facility outside this regulation. Written notification to the provincial health directorate is required. Both facilities keep records and share responsibility.

Facilities licensed before 6 October 2022³ remain subject to the rules in force at licensing for premises, equipment and staffing. Whether the sedation prohibition also applies to those facilities is a legal question this page does not resolve. The provisions cited here also do not establish who provides sedation in a centre. These rules do not prove that any particular facility complies with them.

Ask us what type of facility our clinic is, when it was licensed, and where and by whom sedation or general anaesthesia would be provided. We answer in writing.

Access to the building

Under the same regulation, polyclinics, centres and hospitals must have at least one toilet suitable for people with disabilities. A polyclinic above ground level needs a lift suitable for transporting a wheelchair user. This also applies if it cannot adequately provide care for people with disabilities on the ground floor. A stairlift or lifting platform can be used where there is no lift. Centres and hospitals also have lift requirements. In polyclinics and centres, stairs, landings, ramps and door widths must be suitable for wheelchair access³.

The regulation does not give equally detailed access requirements for individual practices. Here too, facilities licensed before its commencement remain subject to the requirements in force when they were licensed.

Turkey's disability law prohibits discrimination on grounds of disability and requires reasonable accommodation¹⁰: changes needed in an individual case that do not impose a disproportionate burden.

Before your appointment, ask about the entrance, lift, toilet and treatment room at our clinic.

Medical treatment in Turkey requires the patient's consent¹¹. Who gives it depends on the person's age and legal circumstances:

• Children. A parent or guardian gives consent for a minor.
• Adults. An adult who can exercise judgement and whose legal capacity has not been restricted by a court makes their own decision¹². Disability alone does not remove that right.
• Adults with a court-appointed representative. Where a court has restricted legal capacity, the Turkish patient rights regulation provides for consent from the legal representative¹¹, such as a parent or court-appointed guardian.

The regulation describes decision-making capacity in terms of being able to understand and reasonably weigh the proposed treatment and the consequences of refusing it. Even when a representative's consent is sufficient, the person should be heard and involved as far as they can understand. Healthcare facilities must make the necessary arrangements to provide accessible information and obtain consent¹¹. Turkey's disability law also recognises the freedom to make one's own decisions¹⁰.

Sedation guidance recommends involving people in discussions even when they cannot legally give consent. It also recommends confirming that the person is willing to proceed⁴.

If a representative or power of attorney was appointed where you live

Bring any documents authorising someone to make healthcare decisions. This page does not establish how an appointment or power of attorney from your country is recognised in Turkey. Ask before travelling which documents the clinic requires and whether translations are needed. If recognition is uncertain, obtain legal advice before the trip.

Refusal, court decisions and emergencies

• Except where a legal obligation applies, treatment can be refused. The consequences are explained and the refusal is documented in writing. You can say no to a proposed plan or ask to stop.
• If a legal representative refuses medically necessary treatment, the patient under parental responsibility or legal representation may be treated only with a court decision¹¹.
• In certain emergencies, treatment does not depend on consent¹¹. These include circumstances where consent cannot be obtained, the person is unconscious and their life is at risk, or an organ or its function is threatened. Relatives or the legal representative are informed beforehand where possible, or afterwards. Routine dental care is not such an emergency.
• If someone cannot express their wishes, previously expressed wishes about treatment are taken into account.

Sedation guidance recommends that, except in unusual circumstances, the consent process should begin at a separate appointment before treatment⁴. It also states that someone who has already received sedative medication cannot give valid consent to treatment. Ask beforehand which consent documents are needed.

Before you travel

• Fitness to travel. Ask your own doctor whether the trip and flight are appropriate for the person. This page cannot establish fitness to travel.
• Records. Bring the information listed under preparing for the appointment, including a current medicine list with doses and recent findings. Consumer guidance recommends making sure the treating dentist knows about existing conditions and risks, and checking which previous records are needed¹³.
• Your dentist at home. Discuss the plan before travelling and ask who can provide follow-up. If you do not have a regular dentist, arrange one before the trip.
• An escort. Plan who will travel with the person. The BSDH guideline² recommends an adult escort after general anaesthesia, and the IACSD standard⁹ after sedation other than nitrous oxide inhalation sedation, as explained above.
• Language. Ask whether explanations, consent forms, the treatment plan and care instructions are available in English or another language the person understands, and whether an interpreter is needed. Clarify how communication and unplanned follow-up treatment will be arranged.

The return flight

The team providing sedation or general anaesthesia should advise when the person may fly afterwards. Dental treatment itself may require a separate waiting period; the longer restriction determines the flight date.

A narrative review published in 2023 suggests waiting about a week after most dental procedures¹⁴. This assumes no pain, swelling or bleeding at the treated site¹⁴. The review was not a systematic assessment of the evidence, and the authors note that research is limited and comes mainly from military aviation. Treat this as a starting point for discussion with the treating dentist, not as clearance to fly.

Records to take home

Before leaving, ask for a written record of the treatment, any sedation or general anaesthesia, the medicines given and the recommended review interval. Consumer guidance recommends documenting the complete treatment and the materials used¹³.

Under Turkey's health tourism regulation, international patients are entitled to an itemised bill¹⁵. On request, they also receive free copies of records concerning materials, investigations and imaging¹⁵. The patient rights regulation also provides for access to the patient record and a copy¹¹.

If a problem develops after you return

Before agreeing to treatment, ask for the clinic's written terms for problems that arise after your return. Clarify who will assess the problem, where any further care would take place and who would pay for treatment, travel and accommodation. Ask your dentist at home what follow-up they can provide. For urgent symptoms, seek care where you are without waiting for a reply from the clinic.

Your health service or insurer

Before booking, ask the health service or insurer in the country where you live what, if anything, it covers for planned dental treatment in Turkey, including sedation or general anaesthesia. Check the rules for follow-up and complications after treatment abroad. If you have private, supplementary or travel insurance, ask the provider how planned treatment affects cover. Do not assume reimbursement; obtain the answer before committing.

Answers vary between facilities. You can put these questions to us; we answer in writing.

1. Is your facility an individual practice, a polyclinic, a centre or a hospital? When was it licensed?
2. If sedation or general anaesthesia is needed, where would it take place and who would provide it?
3. Are the entrance, lift, toilet and treatment room suitable for wheelchair users? What help is available for transferring to the dental chair? Can treatment take place in the person's own wheelchair?
4. Can you arrange a longer appointment, a quiet time or a familiarisation visit without treatment?
5. What communication support is available, such as pictures, easy-read information, written explanations or sign language? Can it be provided in a language the person understands?
6. Can a companion be present in the treatment room, when general anaesthesia begins and in the recovery area?
7. Do you use clinical holding? If so, how is consent obtained and what training does the team have?
8. Which consent or legal representation documents do you need, and do they need translating?
9. Who assesses the person's health risks before sedation or general anaesthesia? Who gives fasting and medicine instructions, and how?
10. Can latex-free materials be used?
11. Whom can I contact outside opening hours after treatment? How is follow-up arranged? Can you show the carer how to help with brushing?
12. Which dentist will provide treatment, and what training and experience do they have in caring for people with similar needs?
13. Will I receive a complete written estimate and treatment contract before treatment? Consumer guidance recommends having a written contract before treatment begins¹³.
14. What would I pay if the examination changes the proposed treatment or if I decide not to proceed?

Is there a separate dental qualification for this care?

Turkey's dental disciplines are defined in law. There are nine recognised dental specialties¹⁶, and dental care for people with disabilities is not a separate one. There is therefore no separate recognised title for this field in Turkey. Paediatric dentistry is one of the recognised disciplines. The same law allows dentists to examine and treat teeth, gums and related tissues of the mouth and jaws. Ask about the individual dentist's training and experience rather than assuming a particular qualification.

For further practical questions about arranging care away from home, see dental treatment abroad.