Background <p>Children with intellectual disabilities often have unmet oral health needs. Challenging behaviours during dental procedures create uncertainty for dentists about the appropriate approach to adopt. Tailored strategies, including cognitive–behavioural approaches, sedation, or physical restraint, are often required.</p> Aim <p>To explore the experiences and perceptions of dentists treating children with intellectual disabilities, including the use of pharmacological or physical restraint and any ethical dilemmas involved.</p> Design <p>Four focus groups of French dentists (overall <i>n</i> = 20) with experience of treating children with intellectual disabilities were assembled and discussions undertaken. Thematic content analysis identified the underlying themes.</p> Results <p>Participants described the characteristics of their practice, the difficulties and rewards they encountered, and their motivation in working with this population. They described the different strategies used to overcome challenging behaviours. Participants demonstrated a commitment to care, prioritising beneficence over autonomy in difficult situations, but were aware of compromising on ideals in these situations.</p> Conclusion <p>This study describes the complexity of dental care for children with intellectual disabilities. The ethical tensions surrounding the use of restraint and pharmacological techniques were significant, as these practices conflict with the principle of autonomy. This moral complexity highlights the need for deeper understanding and discussion regarding the ethical implications of dental care in such contexts.</p>