ADH ad hoc committee report: the use of restraints in the delivery of dental care for the handicapped—legal, ethical, and medical considerations

Fenton, Sanford J.; Fenton, Loring I.; Kimmelman, Benedict B.; Shellhart, W. Craig; Sheff, Michael C.; Scott, Jurate P.; Staggers, Julie Ann; Portugal, Brian V.

doi:10.1111/j.1754-4505.1987.tb00661.x

Cited by 17 publications

(11 citation statements)

References 9 publications

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“…If dentists are not permitted to employ appropriate use of restraint, surely many people with special needs will either not receive necessary care or may be subject to needless general anesthesia at a much greater risk to their well being. Certainly, sedation or general anesthesia are not reasonable means of delivering daily oral hygiene, recall exams, or minor restorative treatment 59 . Ethically, the dental profession has an obligation to provide care to all segments of the population who seek it, including the developmentally disabled, aged, and institutionalized 49,59 .…”

Section: Discussionmentioning

confidence: 99%

“… Physical or chemical restraint is a valid treatment modality for the noncompliant developmentally disabled patient. When using restraints, the least restrictive alternative should be employed. Physical or chemical restraint should not be used solely for the convenience of the dentist or as punishment for an uncooperative patient. The restraint must cause no physical injury and the least possible physical discomfort. The reason for use of the restraint, the type of restraint used, and the length of time administered must be documented in the treatment record 59 …”

Section: Policies Position Papers Guidelines and Published Recommementioning

confidence: 99%

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Consent,restraint,and people with special needs:a review

Romer¹

2009

Special Care in Dentistry

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Dentists providing treatment to individuals with developmental disabilities are often faced with unique medical/legal issues. Obtaining informed consent when a patient does not have capacity can be an involved process. Issues regarding therapeutic aides used for immobilization (i.e., restraint) during treatment may further complicate the situation. This area is controversial and has even resulted in legal difficulties for some dentists. Several topics related to the use of restraint are addressed in this article. A review of the literature and applicable laws pertaining to consent issues for people with special needs is presented and appropriate use of medical immobilization is discussed. Existing guidelines are reviewed. Informed consent and the use of restraint should be incorporated into overall guidelines for the use of anesthesia, sedation, and alternative behavior management techniques in providing dental care to patients with special needs.

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Section: Discussionmentioning

confidence: 99%

Section: Policies Position Papers Guidelines and Published Recommementioning

confidence: 99%

Consent,restraint,and people with special needs:a review

Romer¹

2009

Special Care in Dentistry

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“…Several authors suggest that the majority of people with special needs can receive routine dental care in the conventional dental office, presenting minimal or no behavior management difficulties for the dentist. 1,6,7 However, there are still many people with special needs who present with unique and complex characteristics that challenge the dental practitioner' s traditional approach to care. There are those people with special needs who have cognitive or physical impairments that complicate basic communication with the dental team.…”

Section: U N D E R S T a N D I N G B A S I C B E H A V I O R A L S U mentioning

confidence: 99%

“…The discipline of special care dentistry involves providing care to patients who present with a complex variety of cooperative, cognitive, and physical abilities in the least restrictive manner. 1 There is a perceived hierarchy of methodology or treatment strategies available to dentistry to assist patients in their attempt to cope with clinical oral health treatment. 2,3 These techniques range from tell-show-do, to medical stabilization, to general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Understanding basic behavioral support techniques as an alternative to sedation and anesthesia

Lyons

2009

Special Care in Dentistry

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Patients with special needs often present a challenge for the dental care team. The exacting and surgical nature of dental procedures requires significant patient cooperation to ensure the safe delivery of care. Some individuals who have special care needs have difficulty cooperating during treatment, thus creating a potentially harmful situation. Modern dentistry, particularly pediatric dentistry, provides the dental team with a variety of strategies designed to enable the team to safely provide comprehensive care in the least restrictive manner. These techniques range from tell‐show‐do, to medical stabilization, to general anesthesia. The effective use of noninvasive, nonpharmacologic behavioral guidance/support techniques cannot only avoid the need for sedation or general anesthesia, they can teach the patient to develop coping skills that may enable them to receive comprehensive care in a traditional dental setting over a lifetime. Unfortunately, many providers are inadequately trained in behavioral support strategies. This paper presents a review of noninvasive, nonpharmacologic behavioral support techniques with discussion regarding their application to persons with special care needs.

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“…Guidelines for the use of restraint in healthcare settings have been formulated by four sources (Fenton & Fenton 1987; Health Care Financing Administration 1989;Marks 1992; Bosek 1993; British Society for Disability and Oral Health 2004). These guidelines share four common features.…”

Section: Guidelines For the Use Of Restraint In Dentistrymentioning

confidence: 99%

Restrictive Behaviour Management Procedures with People with Intellectual Disabilities who Require Dental Treatment

Newton

2009

Research Intellect Disabil

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Background Dental disease is more common among people with intellectual disabilities than in the general population. Improvements in oral health require individuals to engage in daily oral hygiene and regular visits to a dental practitioner; both may be challenging for the individual with intellectual impairment. Materials and Methods A review of policies relating to behaviour management and physical restraint for individuals with intellectual disabilities and challenging behaviours was undertaken. Published studies of behaviour management in individuals with intellectual disabilities attending for dental treatment were reviewed. Reference to studies of children with average IQ and other populations were made where appropriate. Results There is little published evidence regarding behaviour management for people with intellectual disabilities who require dental treatment. Current policies place great emphasis on pharmacological management and restrictive behaviour management techniques. There is a paucity of studies which have employed a functional analysis framework. There are few incentives for dentists to implement positive approaches to behaviour management as current systems of payment reward the completion of numbers of treatments and thus there is an incentive to complete treatments quickly rather than to spend time with patients. Conclusions There is a need for research addressing the behaviour management of individuals with intellectual disabilities who require dental treatment, particularly the efficacy of non-restrictive techniques and the provision of incentives that reward the use of positive behaviour management among dentists. The use of restrictive techniques should be carefully monitored for compliance with best practice guidelines.

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ADH ad hoc committee report: the use of restraints in the delivery of dental care for the handicapped—legal, ethical, and medical considerations

Cited by 17 publications

References 9 publications

Consent,restraint,and people with special needs:a review

Consent,restraint,and people with special needs:a review

Understanding basic behavioral support techniques as an alternative to sedation and anesthesia

Restrictive Behaviour Management Procedures with People with Intellectual Disabilities who Require Dental Treatment

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