Biomedical and structural factors impact oral health for people with intellectual and developmental disabilities (IDD). The onset of age prevalent chronic diseases and conditions can result in new cognitive or physical disabilities leaving individuals with IDD to contend with ageism as well as ableism and further exclusion from the oral health care systems. Environments and attitudes that inform how health care systems are built and maintained significantly impact quality of life and outcomes, more than the fact of being disabled or old. Understanding and easing the transitions that lay ahead of individuals aging with IDD will come from an inter-professional inclusive approach.