LEARNING DISABILITY PRACTICEApril 2009 | Volume 12 | Number 326
Feature
26
Rob Mirow explains how a solution-focused approach was used
to help a man with challenging behaviour to cope with a fear of
dental treatment and safely have his teeth extracted
Helping an individual to overcome
a fear of dental surgery
My first encounter with tom (not his real name), a
63-year-old man with a moderate learning disability,
was in therapy. tom had endured years of physical,
emotional and financial abuse at the hands of his
brother. What tom had learnt from his family
was that his feelings would often be disregarded.
Likewise, at his day centre, no one had managed
to find out why he fluctuated between being loud,
angry and abusive, and bursting into tears.
During counselling sessions, tom was able to
form an authentic relationship in which he could be
attended to and heard. therapy enabled him to deal
with many of the horrors he had been subjected to.
towards the end of therapy he had gained a real
sense of the injustice he had suffered and began to
demand that people treat him with the respect and
the care he so desperately needed and expected. But
tom developed a hyperviligence to any perceived
negative incongruence towards valuing him as a
person. if he suspected he was not valued in any
way by someone, he immediately displayed verbal
aggression towards that person. tom is big, with
a loud voice, and can change instantly from being
gentle and humorous to intimidating and angry,
uttering verbal obscenities and displaying physical
aggression towards others. in less than a year tom
had two failed residential placements due to bouts
of escalating aggression.
throughout this period tom's care team
was aware of the pain that his rotten teeth were
causing him and of the need for their removal. it
is well documented that pain can add to emotional
disturbance and behaviours that challenge (royal
College of Psychiatrists et al 2007).
Decaying teeth and infected gums cannot only be
painful but can cause further health problems. for
example, the bacteria that flourish in gum disease
can enter the bloodstream and lead to clogged
arteries, damaged heart valves and strokes. the same
bacteria can travel to the lungs, causing respiratory
infections (British Dental Health foundation 2009).
Fear of the dentist
tom hated going to the dentist and hospitals. He
refused to discuss or explore the possibility of
going into hospital and what was involved. if he
was questioned further his anxiety surfaced and
his behaviour became challenging. Consistently, he
would respond by stating his `simple request': `i need
to have my teeth out and have some plastic ones.'
We felt that as professionals we had a duty to
discuss tom's `best interests' and the problems
involved in how to support him in achieving this
Tom had rotten and painful teeth, disliked dentists
and hated hospitals, yet he wanted his teeth
removed and dentures fitted. The use of solution-
focused therapy and a skilled and dedicated
team accompanied Tom on a challenging journey
towards better dental health and improved quality
of life. This article highlights how important it can
be to avoid imposing ideas on clients but to allow
their wisdom and insight to reveal solutions to
deep-seated problems.
Keywords
Dental health, hospital liaison nurse,
solution-focused therapy
summary
If someone is in pain this can add to emotional
disturbance and behaviours that challenge

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