Restraint Of Pediatric And Special Needs Patients

(1) Purpose - The purpose of this rule is to recognize the unfortunate fact that pediatric and special needs patients may need to be restrained in order to prevent injury and to protect the health and safety of the patients, the dentist, and the dental staff. To achieve this it will be important to build a trusting relationship between the dentist, the dental staff and the patient. This will necessitate that the dentist establishes communication with the patient and promote a positive attitude towards oral and dental health in order to alleviate fear and anxiety and to deliver quality dental care. (2) Training Requirement - Prior to administering restraint, the dentist must have received formal training at a dental school or during an American Dental Association accredited residency program in the methods of restraint described in paragraph (4) of this rule. (3) Pre-Restraint Requirements (a) Prior to administering restraint, the dentist shall consider: 1. The need to diagnose and treat the patient; 2. The safety of the patient, dentist, and staff; 3. The failure of other alternate behavioral methods; GENERAL RULES CHAPTER 0460-01 4. The effect on the quality of dental care; 5. The patient’s emotional development; and 6. The patient’s physical condition. (b) Prior to administering restraint, the dentist shall obtain written informed consent from the parent or legal guardian and document such consent in the dental record, unless the parent or legal guardian is restraining or immobilizing the patient by use of the method described in subparagraph (4)(b) of this rule. (4) Methods of Restraint (a) The Hand-Over-Mouth Exercise (HOME) Method 1. This method may be used for a healthy child who is able to understand and cooperate but who exhibits defiant, aggressive, or hysterical behavior during dental treatment. 2. Use of this method shall never obstruct the patient’s airway nor be used: (i) With patients whose age, disability, or emotional immaturity prevent them from being able to understand and/or cooperate; (ii) When patients are under the influence of medications which prevent them from being able to understand and/or cooperate; (iii) When patients have an airway obstruction or when restraint will prevent the patient from breathing; or, (iv) When the parent or legal guardian has not given written informed consent for this method to be utilized. (b) The Physical Restraint or Medical Immobilization Method 1. This method may be used to partially or completely immobilize the patient for required diagnosis and/or treatment if the patient cannot cooperate due to lack of maturity, mental or physical handicap, failure to cooperate after other behavior managements techniques have failed and/or when the safety of the patient, dentist, or dental staff would be at risk without using protective restraint. This method should only be used to reduce or eliminate untoward movement, protect the patient and staff from injury, and to assist in the delivery of quality dental treatment. If restraint or immobilization is deemed necessary, the least restrictive technique shall be used. 2. Use of this method shall not be used: (i) With cooperative patients; (ii) On patients who, due to their medical or systemic condition, cannot be immobilized safely; (iii) As punishment; or, (iv) Solely for the convenience of the dentist and/or dental staff. GENERAL RULES CHAPTER 0460-01 (5) Dental hygienists and dental assistants shall not use the methods described in paragraph (4) by themselves, but may assist the dentist as necessary. (6) The patient’s record shall include: (a) Written informed consent from parents or legal guardians; (b) Type of method used; (c) Reason for use of that method; (d) Duration of method used; and, (e) If restraint or immobilization is used, type of restraint or immobilization used. (7) Parents or legal guardians must be informed in advance of what treatment the patient will receive and why the use of restraints may be required. Parents or legal guardians shall be informed of the office policy concerning parental presence, the benefits and risks of parental presence, and of their opportunity to choose a different practitioner for the child if they are not comfortable with the office policy. (8) Parents or legal guardians may not be denied access to the patient during treatment in the dental office unless the health and safety of the patient, parent or guardian, or dental staff would be at risk. The parent or guardian shall be informed of the reason they are denied access to the patient and both the incident of the denial and the reason for the denial shall be documented in the patient’s dental record.