Helping Adults with Intellectual and Developmental Disabilities Cooperate During Dental Exams

Many adults with intellectual and developmental disabilities receive dental care only with sedation, anesthesia, or restraint—even for routine exams. A recent study explored whether a telehealth coaching model could help these adults cooperate without such measures. The findings offer practical guidance for behavior analysts working with caregivers and dental teams to make oral healthcare more accessible and less stressful.

What is the research question being asked and why does it matter?

Many adults with intellectual and developmental disabilities (IDD) get routine dental exams only with sedation, general anesthesia, or physical restraint—often called SAS. SAS can cost more, take longer to schedule, and carry medical risks. It can also lead caregivers to avoid dental visits altogether because the process feels overwhelming.

The main question: can a telehealth model, where a behavior analyst coaches the caregiver at home, help adults with IDD cooperate during routine dental exams without SAS? A second question: can a quick “mock dental exam” at home predict how the person will do with a dentist in a clinic?

This matters because it could help teams avoid SAS when it isn’t needed—and plan ahead when extra support is.

What did the researchers do to answer that question?

The team worked with adults with IDD who had a caregiver-reported history of needing SAS during routine dental care. Caregivers were trained over video using behavior skills training and mailed basic dental tools to practice at home. The researchers used a step-by-step checklist of common exam actions: sitting, opening mouth, toothbrush, mirror, floss, and bite block.

First, caregivers did mock dental exams at home with coaching from the behavior analyst. Separately, dentists at a university-affiliated clinic did baseline exams with remote coaching as needed. The main measure was the percent of exam steps completed, with clear rules for what counted as “completed.”

If a person didn’t complete enough steps, the team tried behavioral supports in order from simpler to more complex:

• Tell-show-do
• Brief breaks between steps
• Praise
• Access to preferred items during the exam (noncontingent reinforcement)
• Longer breaks
• Earning extra reinforcers after steps (contingent reinforcement)
• Graduated exposure, where exam steps slowly increased over time

When the person met a high cooperation goal at home, they returned to the clinic dentist for a post-intervention exam. The dentist used the same support plan with coaching. Some participants then went to a community dentist who received written instructions but no coaching, to see if skills carried over.

How you can use this in your day-to-day clinical practice

Question the assumption that SAS is always needed. In this study, about three out of four adults completed the clinic exam steps during baseline—even though caregivers reported a history of SAS use. A “screen first” approach may prevent unnecessary SAS referrals. Help families and dental teams try a planned, dignity-focused routine exam with supports before jumping to sedation or restraint.

Use a caregiver-led mock dental exam as a screening tool. In most cases, how the person did at home matched how they did with the clinic dentist. You can save families time and stress by checking cooperation at home first, especially for basic steps like sitting, wearing a bib, opening their mouth, and tolerating a mirror. If the person completes most steps at home, you can approach the dental visit with more confidence and a clearer plan.

Keep the mock exam short, clear, and choice-based. Use simple language (“Do you want to start?”) and watch for signs the person wants to pause or stop. In this model, sessions had clear rules for backing up, putting tools down, waiting for calm, and ending if behavior became dangerous. Plan responses ahead of time so caregivers don’t feel stuck pushing through. The goal is cooperation—not “getting through it no matter what.”

If baseline cooperation is low, try simple supports first. Many people only needed low-effort changes. The first level looked like dental best practices: tell-show-do, praise, and brief breaks. Next came noncontingent reinforcement—letting the person hold or use a preferred item during the exam. Coach caregivers and dentists to set up comfort supports before demands start, rather than only rewarding after the person “toughs it out.”

Be ready: what works with a coached clinic dentist may not carry over to a community dentist. People who needed intervention often didn’t cooperate with the community dentist, and the community dentist didn’t reliably follow the written plan. Don’t assume generalization will happen just because you send a handout. If a learner needed NCR, longer breaks, or graduated exposure, your plan should include active training with the dental team—not just caregiver training.

Treat dentist training as part of the intervention for complex cases. The best clinic outcomes happened when the dentist watched a short video of what worked and had live coaching during the appointment. You may not be able to coach live through an earpiece, but you can offer a brief pre-visit huddle, share a one-page step plan in plain language, and get agreement on key actions: when breaks happen, what reinforcers are allowed, and how to respond to refusal without rushing to restraint.

Plan for time and caregiver capacity. Families who needed intervention spent much more time in training sessions, and a few withdrew because home practice was hard to maintain. Some learners required very long timelines and still didn’t meet goals. Screen for caregiver time, physical ability to run mock exams, and the learner’s medical or motor limits that may affect oral access. Offer options like shorter practice sessions, different positioning, or using another trusted support person.

Be clear about what this model covers. The steps focused on routine exams—not fillings, extractions, or other painful procedures. Don’t promise that success with a routine exam will automatically mean success with invasive work. Use routine-exam cooperation as a first milestone, then reassess and plan separately for higher-risk procedures.

Use these findings to support informed choice and reduce harm. Some adults with IDD may be receiving SAS without a fresh check of what they can do with basic supports. Help caregivers ask for a trial of routine care with accommodations. Help dentists feel confident using simple behavioral strategies. Include medical providers in decisions about sedation—and treat refusal and distress as important data, not something to override.

Works Cited

Nguyen, J. T., Tsami, L., Lerman, D. C., Harrison, T. C., & Walker, E. J. (2025). An interdisciplinary telehealth model to increase the comfort and cooperation of adults with intellectual and developmental disabilities during routine dental exams. Behavior Analysis in Practice. https://doi.org/10.1007/s40617-025-01139-9