DDU members occasionally come to us for advice about whether they can treat patients whose weight is at the limit of what a standard dental chair can safely support. At the same time, they are worried that refusing to treat a patient in these circumstances might constitute discrimination.
It is not surprising that more practices are encountering this dilemma, as obesity has become a major public health concern in the UK. According to NHS Digital statistics from 2018, the majority of adults in the UK were overweight or obese - 67% of men and 60% of women, including 26% of men and 29% of women who were obese.
Patient safety
Dental professionals are right to be concerned about the health and safety aspects of treating patients who are obese. They have both a duty of care to all patients and a legal obligation under the Health and Safety at Work Act 1974 to operate in a safe environment.
Using any equipment outside the limits and recommendations of the manufacturer may invalidate your public and employee liability insurance, and you may find you have no recourse against either the manufacturer or the patient for any breakage or failure. Under the Unfair Contractual Terms Act 1977, liability cannot be avoided, even if the patient is informed of and voluntarily accepts the risk.
In short, you would be justified in referring patients to a specialist unit for treatment if they cannot be treated safely in the practice.
Obesity and equality rights
Dental professionals must also be aware of their legal obligations when it comes to accommodating obese patients and ensuring they have access to dental care.
Obesity is associated with a range of health concerns that might be considered disabling, including joint damage, cardiovascular disease, type 2 diabetes and cancer.
Under the Equality Act 2010 and its statutory Code of Practice, service providers are expected to make 'reasonable adjustments' to ensure that people with disabilities are 'provided access to a service as close as it is reasonably possible to get to the standard normally offered to the public at large' - they must be at a 'substantial disadvantage' and this can be addressed by providing a 'reasonable alternative'.
Making reasonable adjustments
Of course, what's reasonable will vary according to the type of service your practice provides, your size and resources and the effect of the disability on current and future patients.
- For example, a specialist bariatric dental chair might easily be considered an excessive burden on a small dental practice but might be an appropriate purchase for larger practices with more patients. Although it's worth bearing in mind that if the cost of the chair comes down in future, it might be considered reasonable for smaller practices to buy.
It makes sense to document proof of the assessment you have carried out to accommodate patients with disabilities and what reasonable adjustments have been made. This will mean you can demonstrate compliance with the legislation if asked to do so.
Referring obese patients
Dental professionals who believe a patient cannot be treated safely in the practice will still need to make sure the patient has access to 'a reasonable alternative' for their dental care. This usually means referral to a specialist unit.
Your local NHS team or health board should be able to advise you about what can be provided and what is available, and it is ultimately their responsibility to make sure suitable arrangements are in place for patients in their area to receive necessary dental treatment. This will often be in a hospital setting.
Communication and language
Sensitivity and tact are vital when explaining the position to obese patients and it's important that all members of the practice team, including receptionists, are aware of how best to broach this potentially difficult topic.
ObesityUK has produced a guide for healthcare professionals on talking to patients about obesity, with a focus on the language used and how this can help support patients.
Choosing a private setting to discuss the situation can avoid embarrassment and a potential breach of patient confidentiality.
This page was correct at publication on 20/02/2024. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.