ethical or not?

[MickeyMouse45]

I work as a dental receptionist. Recently, a family brought a two year old child for dental check-up. when I asked the kid to sit on a chair, he started crying. So I told the father to sit on a chair and hold his kid so this way the kid will be comfortable knowing he is with his father. But the kid continued crying. dental assistant was sick on that day, so I was assisting the dentist. Dentist came in and told the kid's mom to hold kid hands and told father to hold kid's legs and told me to hold head tightly so he can do prophy/polishing. I felt horrible and my hands started to shake. Kid continued crying and even got louder when heard the machine sound. The parents were okay with this whole situation as they believe with cleaning, his son's teeth will become healthier. long story short, dentist finished prophy in 5 minutes, put fluoride, give him tooth brush kit and family went home happily.

1. are dentists allow to do prophy on small kids?
2. is there any benefits of child prophy/polishing on deciduous teeth?
3. should parents bring under 3 yrs old kid for dental checkup when the kid does not have any cavity or problem?

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[DocMon16]

1. Yes dentists are allowed to see children even if they aren't a pediatric dentist.
2. Yes there are huge benefits of doing a cleaning/prophy on primary teeth - kids need to keep them as long as they need for space maintenance so keeping them clean and healthy is just as important as your permanent dentition.
3. Under the AAPD guidelines - children should be seen at the age of 1 yr old or when the first tooth erupts.

Hope that helps - I could go into a lot more details but those are the basics.

 

[oralcare123]

Everything was done within legal and ethical limits. What would you think about papoose board, if you have seen one

 

[ncide]

4-year-old dies after anesthesia used in dental procedure

General anesthesia carries risk, especially for children. This is why you want to emphasize preventative care early on for children.

 

[Hannah Banana]

I work as a dental receptionist. Recently, a family brought a two year old child for dental check-up. when I asked the kid to sit on a chair, he started crying. So I told the father to sit on a chair and hold his kid so this way the kid will be comfortable knowing he is with his father. But the kid continued crying. dental assistant was sick on that day, so I was assisting the dentist. Dentist came in and told the kid's mom to hold kid hands and told father to hold kid's legs and told me to hold head tightly so he can do prophy/polishing. I felt horrible and my hands started to shake. Kid continued crying and even got louder when heard the machine sound. The parents were okay with this whole situation as they believe with cleaning, his son's teeth will become healthier. long story short, dentist finished prophy in 5 minutes, put fluoride, give him tooth brush kit and family went home happily.

1. are dentists allow to do prophy on small kids?
2. is there any benefits of child prophy/polishing on deciduous teeth?
3. should parents bring under 3 yrs old kid for dental checkup when the kid does not have any cavity or problem?

We discussed this at my school and we agreed that it's ok to "restrain" kids BUT it should be done by parents. Dentist and staff shouldn't hold any part of the patient's body down because that is considered battery.

 

[Hannah Faulkner]

It is ethical and done under legal parameters. If the doctor aim to manage situation on this specific situation it will only end up wasting time of his and others waiting outside.

 

[MickeyMouse45]

thank you!!

 

[periopocket]

Totally ethical - I use to volunteer at a practice for patients with special needs and we had to papoose all the little buggers to avoid violent acts - dentistry is a dangerous game sometimes gotta protect ourselves and the patients for their own good.

Edit: some of the little buggers use to attempt to punch the dentist in the nuts during procedures.

Sent from my iPhone using SDN mobile

 

[StudentDentistsRock]

4-year-old dies after anesthesia used in dental procedure

General anesthesia carries risk, especially for children. This is why you want to emphasize preventative care early on for children.

Holy guac n' toc. This scared the pre-dent bjeepers out of me. I don't want to do oral surgery (ortho, general practitioner), but the thought of giving anesthetic scares me really bad.

 

[Roy Williams]

Holy guac n' toc. This scared the pre-dent bjeepers out of me. I don't want to do oral surgery (ortho, general practitioner), but the thought of giving anesthetic scares me really bad.

It probably scares you because you've had zero training and only have heard stories. After spending a large portion of time studying and training, it will be much more manageable and realistic. As a dentist, you will have to administer anesthetics for certain procedures.

 

[oralcare123]

We discussed this at my school and we agreed that it's ok to "restrain" kids BUT it should be done by parents. Dentist and staff shouldn't hold any part of the patient's body down because that is considered battery.

It is not

 

[Hannah Banana]

No offense, but it doesn't really matter what you discussed and agreed upon at your school between dental students, it matters what the American Academy of Pediatric Dentists has published as guidelines for the profession through research. No it should not just be done by the parents, and no it is absolutely not considered battery. When informed consent is obtained the child may be restrained by a parent, the dentist, an assistant, or with a papoose board. Below is an article from the AAPD about protective stabilization of children.

To the OP here are a few articles you may want to read. Basically,what the dentist did was ethical, although perhaps he could have tried harder to communicate with the child and attempt to make him feel more at ease.

http://www.aapd.org/media/Policies_Guidelines/G_Protective1.pdf
http://www.aapd.org/media/Policies_Guidelines/G_Periodicity7.pdf
http://www.aapd.org/media/Policies_Guidelines/G_CariesRiskAssessment7.pdf

It is not

"The family or caregivers must be utilized to prepare uncooperative patients for treatment according to their needs and desires, and to interpret for the dentist what the patients desires are.
No consensus exists among the states regarding the definition of restraint or what constitutes the use of restraints. The astute practitioner should consult with the state dental board before establishing an office policy."
Source: Behavior Management » Paul Burtner » College of Dentistry » University of Florida

Where do you draw the line?
Source: Controversial dental restraint used on kids sparks debate

"AAPD indications for physical restraint include the following:

1. The patient requires immediate diagnosis and/or limited treatment and cannot cooperate because of lack of maturity or mental or physical disability.
2. The safety of the patient, staff, dentist, or parent would be at risk without restraint.
3. The sedated patient requires limited stabilization to help decrease untoward movement.

AAPD contraindications for physical restraint are as follows:

1. The nonsedated patient is cooperative.
2. The patient cannot be immobilized safely because of associated medical or physical conditions.
3. The nonsedated patient with nonemergent treatment requires lengthy appointments.
4. The patient has experienced previous physical or psychological trauma from physical restraint, unless no other alternatives are available."

Source: Why Is Physical Restraint Still Acceptable for Dentistry?

My personal opinion: There is no consensus regarding this issue (of course I know the benefits of doing it) and that is why each school might teach their students differently. To cover our own asses, holding children' arms and legs down by the dentist and staff is not recommendable because it might lead to law suit (or maybe not). That's why, if you must, it's better to be done by parents or caregivers.
My childhood dentist physically restrained me to extract my primary teeth. Luckily, my mom was right next to me and helped holding me down. Can you imagine what would it be like to be held down by people who you don't know (dentist and staff) as a kid with no parents or care givers nearby?
Please understand from the patients' point of view to decrease the chance of giving them dental phobia.

 

[MickeyMouse45]

I believe general dentist should not do polishing on 2 yr old kid. polishing only smoothen the enamel surface. it's not like kid will end up loosing all teeth or have major dental issue if polishing was not done at the age of 2. Such crying kids should be sent to pediatric dental office.
I understand that general dentists do not want to loose $40 for child prophylaxis from medicaid.

Holding kid's hands, legs, head, and teeth tightly portray bad image of dentistry.

 

[oralcare123]

You hold an idealistic image of how dentistry suppose to be. Wait until you start practicing.
Whatever is not forbidden by law is permitted.
Good luck convincing parents to treat child under general anesthesia. Doing prophy under GA is an overkill. Yes, restraining does not look good, but is necessary. One parent often is unable to keep child from moving violently
Your assistant does not enjoy the stress or possible injury coming from little children
Personally, I took my kid to a pediatric dentist to use NO on him, but majority of parents want fast and cheap. They don't give ...about possible phobia and so should you, unless you want to be paying off your loans until the next century

"The family or caregivers must be utilized to prepare uncooperative patients for treatment according to their needs and desires, and to interpret for the dentist what the patients desires are.
No consensus exists among the states regarding the definition of restraint or what constitutes the use of restraints. The astute practitioner should consult with the state dental board before establishing an office policy."
Source: Behavior Management » Paul Burtner » College of Dentistry » University of Florida

Where do you draw the line?
Source: Controversial dental restraint used on kids sparks debate

"AAPD indications for physical restraint include the following:

1. The patient requires immediate diagnosis and/or limited treatment and cannot cooperate because of lack of maturity or mental or physical disability.
2. The safety of the patient, staff, dentist, or parent would be at risk without restraint.
3. The sedated patient requires limited stabilization to help decrease untoward movement.

AAPD contraindications for physical restraint are as follows:

1. The nonsedated patient is cooperative.
2. The patient cannot be immobilized safely because of associated medical or physical conditions.
3. The nonsedated patient with nonemergent treatment requires lengthy appointments.
4. The patient has experienced previous physical or psychological trauma from physical restraint, unless no other alternatives are available."

Source: Why Is Physical Restraint Still Acceptable for Dentistry?

My personal opinion: There is no consensus regarding this issue (of course I know the benefits of doing it) and that is why each school might teach their students differently. To cover our own asses, holding children' arms and legs down by the dentist and staff is not recommendable because it might lead to law suit (or maybe not). That's why, if you must, it's better to be done by parents or caregivers.
My childhood dentist physically restrained me to extract my primary teeth. Luckily, my mom was right next to me and helped holding me down. Can you imagine what would it be like to be held down by people who you don't know (dentist and staff) as a kid with no parents or care givers nearby?
Please understand from the patients' point of view to decrease the chance of giving them dental phobia.

 

[oralcare123]

I believe general dentist should not do polishing on 2 yr old kid. polishing only smoothen the enamel surface. it's not like kid will end up loosing all teeth or have major dental issue if polishing was not done at the age of 2. Such crying kids should be sent to pediatric dental office.
I understand that general dentists do not want to loose $40 for child prophylaxis from medicaid.

Holding kid's hands, legs, head, and teeth tightly portray bad image of dentistry.

Polishing is done to remove plaque, not to smooth the enamel, and it is necessary for caries prophylaxis

 

[Hannah Banana]

You hold an idealistic image of how dentistry suppose to be. Wait until you start practicing.
Whatever is not forbidden by law is permitted.
Good luck convincing parents to treat child under general anesthesia. Doing prophy under GA is an overkill. Yes, restraining does not look good, but is necessary. One parent often is unable to keep child from moving violently
Your assistant does not enjoy the stress or possible injury coming from little children
Personally, I took my kid to a pediatric dentist to use NO on him, but majority of parents want fast and cheap. They don't give ...about possible phobia and so should you, unless you want to be paying off your loans until the next century

Well I guess you're protected from legal issues if the parents know about everything and agree to it.

 

[fdu83]

I believe general dentist should not do polishing on 2 yr old kid. polishing only smoothen the enamel surface. it's not like kid will end up loosing all teeth or have major dental issue if polishing was not done at the age of 2. Such crying kids should be sent to pediatric dental office.
I understand that general dentists do not want to loose $40 for child prophylaxis from medicaid.

Holding kid's hands, legs, head, and teeth tightly portray bad image of dentistry.

I'm a general dentist with over 35 years of experience treating children. General dentists should absolutely treat young children, even if they are crying. There are not enough pediatric specialists to treat every child in the USA, and there are fewer who will accept Medicaid. Many of us do this everyday. Small children cry in unfamiliar circumstances. We use restraint if we have to, but only after exhausting other behavioral management techniques. Children aren't harmed by crying a bit. Often once they realize that nothing "bad" happened they are easier to manage in subsequent visits.

Take a seat, and don't be so judgmental.

 

[setdoc7]

Restraint is a well known practice in both dentistry and medicine. When done legally with informed consent, it allows the delivery of healthcare which might otherwise not happen....to the detriment of the patient's health. Without restraint, uncooperative children and adults would receive no care at all, which would be unfortunate. Not every patient understands what is happening, why they are there, and what the risks of non treatment are. Young children cannot be "reasoned with".
Now, the larger question is really the efficacy of prophylaxis. Lot's of articles have been written about this. Why do we still do it?

 

[WheatLom]

if you see the board the kid could get strapped to, this is the best case scenario. That board would traumatize me and I love going to the dentist

 

[Kazanjian]

Better than taking them to OR.

 

[DrJeff]

Reality check #1 here. As a dentist, you are treating disease processes that the vast majority of the time are brought on by either the patient or patients parent's/caregivers lack of action to prevent. As a practicing general dentist, I'm not sure which public perception, 100% false myth I'm more tired of hearing after 20+ years of working on patients..... "I have soft teeth..." or "my wisdom teeth caused crowding of my front teeth..." People want to make excuses for their own in-actions. If you're treating a pediatric or special needs patients where restraint might be a valid option, you're treating THEIR disease process, not some haphazard thing that magically appeared on it's own one day!

Reality check #2 - in treating/managing the disease processes that patients bring upon themselves, you, as the dentist, as one of the most important things that you do, need to maintain the safety of the work environment for yourself, your staff and the patient. Sometimes, more often with pediatric or some special needs patients, maintaining that safety may require some form of immobilization. You are using sharp objects, often that are spinning rapidly, while working. Trying to work on a "moving target" increases the level of risk for the procedure, and you as the dentist, are in control of all of what's going on in the operatory at that time, and you want to make sure that those risks are at a minimum, and sometimes, that 100% requires the ethical use of restraints to accomplish this. A restraint, the overwhelming majority of the time, when properly used, has far less risks associated with it that general anesthesia does if one has to take a patient to the operating room to treat their dental disease processes

Reality check #3 - if a restraint is used, it's often far more "traumatic" on the parent that the patient, and very often the words and body language that a parent uses both before and during a procedure being done on their child makes our job as dentists, more challenging when it comes to minimizing associated risks. It is getting tougher and tougher these days to not have parents in the operatory for a host of reasons, I can honestly say that the chances of you, as the dentist, having a less fidgety, quiet, compliant child to work on, are far greater when the parents aren't there, than when they are. Anecdotally, I see this magnified if the patient/parent is of lower socio-economic status, as by far and away, parents in that demographic, at least in my own experience, are far more likely to blurt out something like "hear comes the shot" and increase the anxiety level of the child

While it's always a good thing to evaluate the ethics of how we practice, I do find it interesting that especially in the dental school setting, where there is often far less actual, real world experience weighing into one's formulation of opinions of what is proper or not, that some may be so quick to feel the need to ethically discredit a procedure because it makes them feel uneasy, when they really have never been in an actual clinical situation where it is needed. It's one thing to "read about it in a book" it's another thing to then try what you read on a patient, and it's often another thing if what you read in the book actually works for you on a patient as the book says it should.....