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Title General Dentists Can Safely Treat Special Needs Patients in Office
Clinical Question For dental professionals treating special needs patients, does protective stabilization compared to alternative behavioral techniques result in reduction in morbidity/safety/ability to treat the patient?
Clinical Bottom Line Utilization of alternative behavioral techniques on special needs patients can reduce barriers and increase their ability to tolerate care in an office setting to receiving dental treatment. This is supported by a crossover interventional trial, clinical practice guideline, and a literature review.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24530242Chen/2012 19 disabled participantsCrossover intervention trial
Key resultsNineteen disabled patients were recruited to receive the papoose board as a mode of deep touch pressure application. Measurements designed to monitor sympathetic and parasympathetic nervous system (SNS and PsNS) activation were used (i.e., skin conductance level, heart rate variability). Results indicated that parasympathetic nervous system stimulation occurred when deep tissue pressure through use of a papoose board was employed (p=0.013-0.045). This indicates a reduction in anxiety for the patient.
#2) 19152561Glassman/2009n/aClinical Practice Guideline
Key resultsThis is a consensus statement from the Special Care Dentistry Association (SCDA) intended to provide guidelines for decision-making in treatment of patients with special needs (PSNs). It was agreed that the use of physical supports which limit mobility and require little to no medication can provide safer and more accessible care to PSNs. These techniques are less expensive than general sedation but may not be reimbursed adequately by insurance.
#3) 19152567Lyons/2009n/aLiterature Review
Key resultsTreatment of patients with special needs should fall into the hands of general dentists, although most dentists believe they do not have the training or expertise to treat this population. With basic behavioral support techniques (voice control, nonverbal communication, tell-show-do, positive reinforcement, distraction, caregiver presence/absence, etc.), the general dentist can treat PSNs without pharmacological interventions or physical restraints. In more combative patients, medical immobilization may become necessary to avoid escape extinction (reinforcement of escape behavior to avoid needed treatment). It is emphasized that the use of medical immobilization does not preclude or eliminate the need for behavioral support.
Evidence Search special[All Fields] AND care[All Fields] AND ("dentistry"[MeSH Terms] OR "dentistry"[All Fields]) AND alternative[All Fields] AND ("behaviour"[All Fields] OR "behavior"[MeSH Terms] OR "behavior"[All Fields]) AND ("methods"[Subheading] OR "methods"[All Fields] OR "techniques"[All Fields] OR "methods"[MeSH Terms] OR "techniques"[All Fields]) and special[All Fields] AND ("health services needs and demand"[MeSH Terms] OR ("health"[All Fields] AND "services"[All Fields] AND "needs"[All Fields] AND "demand"[All Fields]) OR "health services needs and demand"[All Fields] OR "needs"[All Fields]) AND ("dentistry"[MeSH Terms] OR "dentistry"[All Fields]) AND papoose[All Fields] AND board[All Fields]
Comments on
The Evidence
Little literature exists comparing treatment modalities for patients with special needs (PSNs). The Chen study is one of few clinical trials. It appears to have been well designed but was published in an open access journal and clearly lacked adequate editing, making it difficult to discern the significance of many of the results. The consensus statement from the SCDA was well written and organized and provides practice guidelines for decision-making around appropriate treatment of PSNs. There is a need for increased research and documentation of treatment modalities and approaches that need to be incorporated into guidelines for patient care for people with special needs.
Applicability This is applicable to dental professionals considering other forms of behavioral modalities without using pharmacologic approaches treating special needs. This evidence suggests that use of a papoose board aids in patient management, is cost effective and results in fewer side effects than pharmacological interventions. In addition, using social support in providing oral health interventions outside the dental office can reduce barriers and increase their ability to tolerate care in an office setting to receiving dental treatment. Alternative behavioral interventions may reduce or eliminate the need for sedation or anesthesia in order to best support the individual’s ability to receive dental treatment. Training of general dentists, in dental school or through continuing education, is also needed to give dentists the confidence to provide care to PSNs.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords Special needs patients, alternative behavioral techniques, papoose board
ID# 3389
Date of submission: 09/26/2019spacer
E-mail joann.leclaire@cuanschutz.edu
Author JoAnn Panem LeClaire, RDH, MS
Co-author(s) Ethelyn Thomason Larsen, DMD and Sheila Stille, DMD, MAGD, FACD
Co-author(s) e-mail ethelyn.thomasonlarsen@cuanschutz.edu, sheila.stille@cuanschutz.edu
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