To discriminate against a person means to treat them differently or less favourably for some reason. The GDC's Standards for the Dental Team 1.6 states that, "You must treat patients fairly as individuals and without discrimination", highlighting that this could be on the grounds of "…age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, sexual orientation," as well as "…nationality, special needs, health, lifestyle or any other consideration."

The guidance is also clear about dental professionals needing to "consider patients' disabilities and make reasonable adjustments to allow them to receive care which meets their needs." It goes on to say that if for any reason you're not able to make these adjustments, you should consider referring the patient to a colleague who's able to treat them according to their needs requirements.

Anticipating care needs and complaints

Dental professionals should be aware of the issues that can arise around discrimination so they can put in place measures to address them. This is obviously in the patients' best interests, but if patients think that adequate provisions haven't been made to assist them in obtaining appropriate dental care due to their disability, they're more likely to complain, either to the dental practice or to a third party such as the NHS or the GDC.

However, the good news is that it's often possible to avoid patients complaining if certain protocols are put in place. It is also important that every member of the dental team is aware of these so patients are provided with accurate information which will assist them in receiving dental care.

Members of the dental team might want to ask patients how they can assist or support them while they are at the practice. You may wish to consider having longer appointment times if appropriate.

Identifying issues

As the GDC's guidance points out, there are all sorts of issues that, if not considered carefully, could give rise to a potential complaint based on discrimination.

Mobility issues

Wheelchair users and people with mobility issues may find it difficult to access some dental practices. It may not be feasible to completely adapt a building to ensure it's fully accessible, but it's often possible to make some changes, like ensuring there are ramps and that at least one surgery is on the ground floor.

Assistance dogs

These are widely used in the UK and offer emotional support as well as independence to over 7,000 people. Although it most commonly refers to guide or hearing dogs for blind or deaf people, assistance dogs are also trained to support people with conditions such as autism.

The Equality Act 2010 and the Disability Discrimination Act 1995 in Northern Ireland require access be made available to medical treatment facilities for assistance dogs. There is therefore a legal duty to make sure reasonable adjustments are made so people with a disability are able to access services.

Hearing loss

Patients with hearing loss may find it difficult to fully understand the information you're giving them. You might want to consider having an induction loop in the practice for those with hearing aids, and providing information in writing can be helpful in ensuring patients have the opportunity to read it and ask questions.

If appropriate, removing your mask and facing a patient so they can lip read can also be helpful, as can turning off background noise such as a radio. You might like to consider learning some basic signs in British Sign Language or Makaton.

Sight loss

For partially sighted patients, consider offering to provide written information like medical history forms in a large print format, or use a digital device if appropriate so the font size can be increased. Carefully read any written information out loud so that the patient is kept fully informed.

Ensure that edges of steps or other trip hazards are clearly marked. As with all areas of dentistry, good communication is key, so ask patients what they would find helpful and how they would like to receive information.

Obesity

This has become a major public health concern in the UK, and obese patients may exceed the safe limit of a dental chair. Using equipment outside the limits and recommendations of the manufacture may invalidate your public and employee liability insurance and could potentially lead to injury of the dental professional or patient.

However, dental professionals might rightly be concerned that refusing to treat a patient in these circumstances could amount to discrimination. In these instances, you will need to have a referral pathway so patients can be treated safely. This might mean referral to a specialist unit, and the local NHS team should be able to advise on this.

It's important to be as tactful as possible when explaining the position to obese patients. Obesity UK has produced a guide for healthcare professionals that provides helpful advice on talking to patients, and the DDU's own advice on making adjustments for patients who are obese is available on our main website.

Communication issues

Some disabilities make communication difficult, so consider allowing patients to be accompanied by someone to help with this if needed. When treating patients with cognitive impairments such as dementia, introduce yourself, explain simply and clearly what you are doing and involve others as appropriate.

Autism is a developmental disability that affects how a person communicates with other people. People with autism may experience their surroundings in a different way and may be more sensitive than others to things like the noise of the handpieces or the light. While it may not be possible to alter these, the patient might be able to tell you what can help them manage these types of situations. There is some useful information for dentists on the National Autistic Society's website.

Although it is not a disability, if patients don't speak or understand English, it may be necessary to use a professional interpreter or a translation service. Dental professionals need to be aware that there are potential problems with using a family member to interpret, as there is no guarantee they are able to interpret correctly. However, it might be necessary to arrange a sign language interpreter for a patient who is deaf or hard of hearing.

It is important to make details of any assessment you have carried out to assist patients with disabilities, including what adjustments have been made. As well as providing a reliable record of the visit for you, this can help when preparing for future appointments and means patients don't have to repeat the same information at every visit.