Patients with Disabilities

Dental care for people with disabilities is often straightforward and possible in an ordinary dental setting¹. The first step is to adapt the appointment to the person. Local anaesthetic can be used where needed. If these approaches are unsuitable or insufficient, conscious sedation or general anaesthesia may be considered. General anaesthesia is usually not the first choice, but it can be chosen directly when other approaches are unsuitable or cannot be used².

A Turkish regulation states that treatment under sedation or general anaesthesia must not take place in an individual dental practice or a polyclinic³. Whether the rule applies to facilities licensed before 6 October 2022 is a legal question this page does not resolve; the section on treatment settings below gives details. Before booking, ask any clinic you are considering where treatment would take place, who would provide it and what access arrangements are available.

This page is for English-speaking people living in Turkey, including people arranging their own care and parents, relatives or carers supporting someone else.

A Turkish regulation issued in 2022 defines four types of private dental facility³: an individual dental practice, a polyclinic, an oral and dental health centre, and a hospital. Under this regulation:

• Examinations and treatment under sedation or general anaesthesia must not take place in an individual practice or a polyclinic³.
• Centres and hospitals must have a general anaesthesia intervention unit and an observation unit. A centre must employ an anaesthesiology specialist full-time or part-time; a hospital must employ one full-time³.
• Dentists from an individual practice or polyclinic 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 responsibility³.

Facilities licensed before 6 October 2022 remain subject to the requirements in force when they were licensed for premises, equipment and staffing³. Whether the sedation prohibition also applies to those facilities is a legal question this page does not resolve. The articles reviewed also do not specify who provides sedation in a centre.

These rules do not establish that a particular facility complies with them. Ask about the facility type, its licensing date, and where and by whom sedation or general anaesthesia would be provided. You can request these details in writing from any facility you are considering.

Access to the building

The same regulation requires polyclinics, centres and hospitals to have at least one toilet suitable for people with disabilities³. A polyclinic above ground level needs a lift suitable for wheelchair transport. This also applies if suitable care cannot be provided on its ground floor. A stairlift or lifting platform may be used where there is no lift. There are also lift requirements for centres and hospitals.

In polyclinics and centres, stairs, landings, ramps and door widths must accommodate wheelchair access³. The regulation does not set out equally detailed access requirements for individual practices. The licensing-date caveat above also applies to these premises requirements.

Turkey's law on disability prohibits discrimination on grounds of disability and requires reasonable accommodation⁴. This means changes and measures needed in an individual case that do not impose a disproportionate burden.

Before the appointment, ask about the entrance, lift, toilet and treatment room, as well as help with transferring to the dental chair.

In Turkey, medical treatment requires the patient's consent⁵. Who gives consent depends on the person's age and legal circumstances.

• Children. For a minor, a parent or guardian gives consent⁵.
• Adults. An adult who has the capacity to make the decision and whose legal capacity has not been restricted by a court decides for themselves⁶. Disability alone does not remove that right.
• Adults whose legal capacity has been restricted by a court. Under the Turkish Patient Rights Regulation, the legal representative gives consent⁵.

The regulation describes decision-making capacity in terms of reasonably understanding and weighing the proposed treatment and the consequences of refusal. Even where a legal representative's consent is sufficient, the person should be heard and involved as far as they can understand. Healthcare facilities must make the arrangements needed to provide suitable information and obtain consent⁵. Turkey's disability law also recognises freedom to make one's own decisions⁴.

Scottish sedation guidance recommends involving people in discussions even when they cannot legally give consent. It also recommends confirming that the person is willing to proceed⁷. Ask which documents are needed if a legal representative will be involved.

Refusing treatment, court decisions and emergencies

• Except where a legal obligation applies, treatment may be refused⁵. The consequences are explained and documented in writing.
• If a legal representative refuses medically necessary treatment for someone under parental authority or legal representation, treatment requires a court decision⁵.
• In specified emergencies, treatment does not depend on obtaining consent⁵. These include life-threatening situations where the person is unconscious and consent cannot be obtained, and situations threatening the loss of an organ or its function. Relatives or the legal representative are informed beforehand where possible, or afterwards. Routine dental treatment is not such an emergency.
• If the person cannot express their wishes, previously expressed treatment wishes are taken into account⁵.

Scottish guidance recommends starting the sedation consent process at a separate appointment before treatment, unless exceptional circumstances apply⁷. It also states that a person who has already received a sedative cannot give valid consent to treatment. Ask for explanations in a form you understand and request a copy of the consent documents.

Answers will vary between facilities. Ask for the details that matter to you in writing.

1. Is the facility an individual practice, a polyclinic, a centre or a hospital? When was it licensed?
2. If sedation or general anaesthesia is needed, where will it take place and who will provide it?
3. Are the entrance, lift, toilet and treatment room suitable for wheelchair access? What transfer support is available? Can treatment take place in the person's own wheelchair?
4. Can a longer appointment, a quieter time or a familiarisation appointment be arranged?
5. What communication support is available, such as pictures, easy-read information, written explanations or sign language? Can explanations and documents be provided in English?
6. Can a companion be present during treatment, at the start of general anaesthesia and in recovery?
7. Is clinical holding used? If so, how is consent obtained, and what training does the team have?
8. Which consent or legal representation documents are needed? Is a translation required?
9. Who assesses health risks before sedation or general anaesthesia? Who gives fasting and medicine instructions, and in what form?
10. Can latex-free materials be used?
11. Who can be contacted outside normal hours? Who provides follow-up? Can a carer be shown how to help with brushing?
12. Which dentist will provide treatment, and what training and experience do they have in this area?
13. Can the treatment plan, possible changes to it and the materials used be documented in writing?

Under Turkey's Patient Rights Regulation, you may inspect your health record and obtain a copy⁵. Ask for a record of the treatment, any sedation or anaesthesia, medicines given and the agreed follow-up plan.

Is this a separate dental specialty in Turkey?

Turkish law defines nine dental specialties⁸. Dental care for people with disabilities is not a separate specialty on that list, so there is no separate Turkish specialty title for it. Paediatric dentistry is one of the recognised specialties. The law permits dentists to examine and treat the teeth, gums and related tissues of the mouth and jaws. Ask the treating dentist about their relevant training and experience.