Carers' behaviour is thought to contribute to the development and maintenance of challenging behaviour in people with learning disabilities (Emerson et al. 1995; Hastings & Remington 1994). The present study sought to investigate the effectiveness of a behavioural intervention in the management of such problem behaviours by means of a long-term follow-up single case study. This study describes the prevalence and management of the severe challenging behaviours of a 55-year-old man, (Paul), with severe learning disabilities. The functional assessment showed a significant decrease in challenging behaviour after implementation of guidelines. However, effective dental treatment produced a further reduction in challenging behaviour, posing many implications for healthcare assessment and practice. The results of this single case study are discussed in the context of relocation practices, holistic assessment and service provision.