[Groping in the dark: pain that goes unheard 1].

Even with pharmalogical support, it is always very difficult to carry out dental check-ups on a deaf-blind man with profound intellectual disabilities. The man cannot communicate pain. Further diagnostic measures and treatment are impossible while using only oral sedation. When caries and calculus are diagnosed, the man is treated under general anaesthesia. In this treatment session severe periodontal disease and peri-apical problems are also diagnosed. The legal representative of the patient is unavailable for consultation on changes to the pre-prepared preliminary treatment plan during the treatment session. This creates a dilemma for the dental treatment section signteam. This case study will be presented during the conference 'State of the art' on 17 March 2017, by the Society for the Promotion of Dental Health Care for People with Disabilities (VBTGG). This case can be read before the conference exclusively by the readers of the Dutch Journal of Dentistry (NTvT). The chosen treatment will be published in the edition of April 2017.