[Groping in the dark: unheard pain 2]

For a very severely mentally disabled, deaf and blind man, it was always very difficult to carry out dental check-ups, diagnosis and treatment, even with pharmacologic support. The man cannot communicate pain. When caries and calculus were diagnosed, the man was treated under general anaesthesia. During this treatment session he was also found to have severe periodontal disease and peri-apical problems. The legal representative of the patient was unavailable for consultation on changes to the pre-prepared preliminary treatment plan. This created a dilemma for the dental treatment team. This case study was presented during the conference 'State of the art' on March 17, 2017, that was organised by the Society for the Promotion of Dental Health Care for People with Disabilities (VBTGG). In this second part of the case, the treatment that was ultimately chosen is described, considered and discussed.