Our Stories: Making dental care more accessible for PWIDs and their families

Making dental care more accessible for PWIDs and their families


As a special care dentist with Tzu Chi Free Clinic’s Dental Service and the National Dental Centre Singapore, Dr David Lim, 36, serves a handful of adults with intellectual disability.

Dental screening CASA-MODAL in Aug 2019 in MINDSville@Napiri

He was shocked by the degree of dental disease some of them suffered from, comparable or at times worse than some cases in third-world countries. Complicating matters further, not much was known about the state of oral health for Persons with Intellectual Disability (PWIDs) in Singapore.

Compelled to do more, Dr Lim began taking leave to conduct dental screenings for this vulnerable group on a voluntary basis in 2018.

In order to garner more support and resources, he pitched his idea to a national youth organisation offering grants to young change-makers and met many like-minded youths.

Dr David Lim 60 Stories (4)
Dr Lim started the CASA-MODAL initiative in 2018 with two of his oral health therapy students in a mixed-disability day centre

Things took off in 2019 when he got Tzu Chi’s support to roll out the CASA-MODAL (Clean And Screen All Mouths Of Disability And Long-term care facilities) initiative.

CASA-MODAL is a monthly dental screening and health education programme for residents in nursing homes and institutions caring for Persons with Disabilities (PWDs). The programme focuses on screening and preventing dental complications caused by failure to detect oral problems in time, which could affect the overall health of the PWD or elderly individual.

To date, CASA-MODAL has served clients in a number of MINDS facilities, including MINDSville@Napiri, Jurong Training & Development Centre, Woodlands Employment Development Centre (WEDC) and Faber Training & Development Centre. Dr Lim and the CASA-MODAL team hope to extend their services to all of MINDS’ adult facilities by the end of 2023.

Portable screening centre set up for CASA-MODAL

Making Oral Healthcare Accessible

Unlike the general population, PWIDs have very different dental needs, and habits like basic daily brushing can be challenging, says Dr Lim.

It is especially hard to wean them off lifelong habits. For example, some PWIDs may be used to having a hot cup of Milo after brushing their teeth before bed, or have caregivers who continually reward them with sweet treats. Compounding the issue, PWIDs may also have medical conditions that predispose them to dental issues.

With each PWID having a different level of ability and understanding, a generic oral care (e.g. brushing, flossing, using appropriate items like mouthwash, mouth gel, etc.) approach is limited in its effectiveness, Dr Lim asserts.

Besides teaching caregivers the hand-over-hand technique, he also provides special brushes to aid PWIDs who face challenges with manual dexterity.

Teaching oral care techniques at CASA-MODAL screening in WEDC.

In his line of work, Dr Lim also meets patients who are fearful of going to the dentist.

Dr Lim recalls the case of a boy with intellectual disability who used to panic every time he reached the clinic. He would struggle to get out of the dental chair and run away to the carpark to hide behind his father’s van. As a result, the team had to feed him an oral sedative to help him relax before leading him onto the dental chair for his regular cleaning, filling or even tooth extractions.

In another instance, he treated a boy with swollen and overgrown gum inflammation that covered half of his tooth surface. Conditions like these are sometimes side-effects from the medication clients take for other medical conditions. The swelling finally came down after many sessions.

Speaking to Dr Lim, the passion is evident in his voice. “Being a dentist, we always want things to turn (out well). … Working with this group, we learn to take life with a bit of unpredictability, (and) try to work with what we have.”


Since the CASA-MODAL initiative started, Dr Lim has seen over 500 clients with disabilities. If additional treatment is found to be required during the screening process, patients are referred to nearby dental clinics for treatment.

Supporting the development of dental care capabilities in MINDS Developmental Disabilities Medical Clinic (or MINDS Clinic) and widening the network of dental care providers PWIDs and their families can access through MINDS Clinic, Dr Lim believes that oral care for PWDs should be an integral part of mainstream public health services and made more accessible.

Collating the data over the last four years to track the dental health of PWIDs, Dr Lim says they have barely covered the “tip of the iceberg.” The COVID-19 pandemic also hindered their progress considerably because of the additional restrictions to enter residential care facilities.

Despite the challenges of the job, Dr Lim remains committed.

“In terms of dental needs, we’re serving a group which appears to have the most severe needs in Singapore”, he explains.

Dr Lim treasures the rapport built with his patients with intellectual disability during follow-ups. Unlike average dental reviews where patients visit their dentist every 6 months, the reviews PWIDs have are more frequent to cater to different needs. With the higher frequency of these visits, Dr Lim shares that he has the opportunity to grow with his patients and their caregivers.

“They’re upfront, lively and our interaction is sincere. We spent a lot more time to understand their background, form close relationships with them and their family, and in turn, that allows us to treat them better,” he says.

“In a way, it makes work feel less like work.”

Home-based Dental Visit for PWID

As MINDS celebrates its 60th anniversary, we would like to encourage more people to step forward and advocate for more inclusion in society.

MINDS Clinic offers medical screenings, consultations, examinations, and referrals to appropriate medical professionals to PWIDs and their families. Learn more about MINDS Clinic or make an appointment here. MINDS Clinic is part of MINDS Hub – a one-stop location for PWIDs, their families and caregivers to access resources and information to enhance their quality of life. Read about MINDS Hub here.

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NOTICE OF THE 59TH ANNUAL GENERAL MEETING OF MINDS: NOTICE is hereby given that the 59th Annual General Meeting (AGM) of the Movement for the Intellectually Disabled of Singapore (MINDS) will be held by way of electronic means as follows: Date: Saturday , 18 September 2020 Time: 9:30am (Registration starts at 8:30am) Venue: Online via ZOOM MINDS members will be receiving an email on the notice of AGM and are strongly encouraged to register your attendance to facilitate the verification process on the day of the AGM. For enquiries regardingthe AGM, members may email to agm@minds.org.sg or call 849607358