A 23-year-old patient with Down syndrome comes in with his caregiver. Most teeth have deep decay and many broken teeth; his last dental visit was 5 years ago. How should you proceed?

Before deciding on a treatment plan or jumping to a neglect report, the appropriate first step for any new patient — especially one with an extensive, unclear history — is a comprehensive examination to fully understand the current oral condition and gather the information needed to make any further decisions (treatment planning or, if truly warranted after full assessment, a report).