Modules

5.4 Advanced Behavior Guidance Techniques—Continued


Protective Stabilization

Protective stabilization should be used only when absolutely necessary to protect the child and oral health staff during oral health procedures. There are no universal guidelines for this technique that apply to all settings. Before employing any kind of protective stabilization, it may help to consult available guidelines on federally funded care, the state’s department of mental health, and the state’s Dental Practice Act. AAPD's Guideline on Behavior Guidance for the Pediatric Patient may also be useful. The least restrictive protective stabilization technique that enables the oral health staff to provide care safely should be chosen. Protective stabilization should not cause physical injury or undue discomfort. Some children actually feel more secure if supportive techniques are used to stabilize them in the dental chair, especially if the chair is too large for them.

Description:
Partial or complete immobilization of the child is sometimes necessary to protect the child and the oral health staff from injury while providing care. Protective stabilization can be performed by an oral health professional (e.g., dentist, dental hygienist) or a parent with or without the aid of a stabilization device.

Common examples of protective stabilization devices include mouth props, PediWraps®, Papoose Boards®, and supportive seat belts. An oral health professional, dental office staff, or a parent can also gently hold the child’s hands, arms, or legs.

The decision to use protective stabilization should also take into consideration the following: (1) alternative behavior guidance techniques that could be used instead, (2) the child’s oral health needs, (3) the effect of this technique on the quality of oral health care, (4) the child’s emotional and cognitive developmental levels, (6) the child’s medical and physical condition, (7) the oral health professional’s comfort with, and skill in, using these techniques, and (8) the parent’s understanding and acceptance of their use.

Objectives:
  1. Reduce or eliminate sudden, uncontrolled, or aggressive movement of the child’s head, jaw, body, or appendages
  2. Provide stability for the child in the dental chair
  3. Protect the child and oral health staff from injury
  4. Facilitate delivery of quality oral health procedures
Indications:
  1. A child who requires immediate diagnosis and/or limited oral health procedures and cannot cooperate
  2. A situation where the safety of the child and/or the oral health staff would be at risk without the use of protective stabilization
Contraindications:
  1. A cooperative child
  2. A child who cannot be stabilized safely owing to physical or medical conditions

An oral health professional performing protective stabilization with or without a stabilization device must obtain and document in the child’s record written informed consent from a parent. Protective stabilization performed by a parent does not require written informed consent before the procedures are used. The child’s record should include (1) informed consent, (2) type of stabilization used, (3) indication for stabilization, and (4) duration of stabilization.