Perspectives of Parents regarding the Appropriateness of Physical Restraint Alone or in Conjunction with Sedative Techniques for Managing Challenging Pediatric Dental Behaviour

Abstract

Purpose: A retrospective look at parents’ responses to having witnessed their children of varying levels of apprehension undergo sedative treatment visits across a 35 year period. Sedation visits with outcomes ranging from optimal or adequate, to inadequate and over-dosage, were assessed by both parents and their clinician. Methods: After witnessing their child’s visits, parents were asked if they would choose sedation for future visits under circumstances where outcomes cited need for persistent application of restraints vs more favorable outcomes. Post-treatment surveys of over 4,360 parents were conducted at the time of discharge after observing their children’s responses to oral sedation visits in a private practice setting. Variable dosing of Chloral hydrate-Hydroxyzine with and without Meperidine, and Midazolam with and without Meperidine were compared. Results: Not surprisingly, for parents where sedation was rated inadequate, 95% indicated they would likely opt for alternative modalities rather than subject their children to measures which ultimately necessitated persistent applications of restraint. Under circumstances where outcomes enabled treatment objectives to be accomplished without any form of restraint, parents correspondingly indicated they would have no reservation in accepting a pharmacological modality for future visits. Where transient application of physical restraint was needed to overcome minimally, moderately, or severely interfering behaviors, reactions were mixed among parents while clearly leaning in the direction of finding sedation desirable. Parents observing less than adequate success of sedation indicated they would consent to using sedation procedures for future visits only if it meant avoiding use of general anesthesia. Conclusion: Perceptions of parents where persistent application of restraints were needed found their use neither acceptable, appropriate nor desirable. There appears to be a trend in this direction amongst clinicians of today but in lieu of current practices which make little or no use of sedative modalities, this appears by no means universal.