Betty* had a diagnosis of a severe Learning Disability and Autism, staff at her supported living accommodation noticed that two of her teeth had become loose and took her to the dentist, the dentist had concerns that leaving these teeth intact could pose a risk of Betty swallowing these and choking.

The dentist proposed that Betty had all her teeth removed under general anaesthetic, as she had advanced gum disease with little possibility for any future improvement. The dentist assessed Betty’s capacity and found that she lacked capacity in this area. As Betty has no family or friends, it was decided that a referral should be made to the IMCA service.

How we helped

An Independent Mental Capacity Advocate (IMCA) consulted with the dentist (who was the decision maker) and tried to establish how they had followed the best interests checklist. The IMCA then visited Betty twice over a period of two months and used various formats of communication to encourage Betty to participate in discussion around the treatment (this included the use of verbal communication, picture cards and gestures).

However, Betty was not able to verbalise or indicate that she expressed a view via any other means. The IMCA also consulted the staff at Betty’s supported living accommodation and viewed relevant documentation including, daily notes, care plans and nutrition charts.

From this it became apparent that staff had concerns around the level of restriction the proposed treatment posed and the consequences that proceeding with treatment would have on her quality of life, as Betty went out for lunch every day visiting different cafés, pubs and restaurants in the area.

There was also no indication that Betty was in pain or having any changes to her appetite over the last two months. Betty’s two loose teeth had also naturally come out with no difficulties or consequences.

The IMCA relayed this information back to the decision maker (dentist) highlighting the need to explore all possible options which led to a best interests meeting being held. During the meeting, the IMCA conveyed their findings from the visit and the benefits and burdens of each option were weighed up.

In consultation with the IMCA and Betty’s support workers, the decision maker was able to come to the conclusion that the proposal to perform a full clearance of all remaining teeth under General Anaesthetic was not time and decision specific, and was not required at this time.

It was decided Betty should continue with routine maintenance with support from staff and have regular reviews from the dentist. Additionally, the IMCA compiled a report of their findings which was submitted to the decision maker.    


Improved Health and Wellbeing - Betty avoided having invasive treatment to her teeth and gums and instead would now benefit from more routine maintenance and regular visits to the dentist.
Freedom from discrimination - Despite professionals believing that having all Betty’s teeth removed were in her best interests, when Betty’s care givers and support workers were interviewed and the IMCA found out more details about Betty’s social life they were able to ascertain and act on her views and wishes.
Sustained quality of life - Betty is still able to enjoy going out for lunch every day and eat a variety of foods whilst benefitting from regular trips to the dentist.

*Names have been changed to protect the identity of the people we support