No one likes the idea of seeing a child being restrained. Especially not at the dental office. But on the same hand, if a child is admitted to a hospital, has thousands of dollars spent to knock them out with potentially risky gas, and is in need of a procedure that takes only minutes to perform, which care is the right one?
Notorious press has given the papoose board a bad name. Granted, its utilization can be abused, especially as seen in the story that was profiled on ABC’s 20/20. General anesthesia isn’t without its opponents as well, especially when a child dies.
With that somber note hanging in the air, you may want to revisit David After Dentist and pick yourself up with a little sedation dentistry humor. Even if you don’t agree that his dad should have ever posted the video on YouTube, it’s still so freakin’ funny.
Children who can’t be cooperative still need a means of getting their dentistry done, so pedodontists must make choices that sometimes include the use of papoose boards or general anesthesia. For entertainment’s sake, let’s just call this polarizing dilemma by another name: Hugs vs. Drugs.
| Hugs | Drugs | |
| Familiar name | Papoose board restraint | “Knocked out with the mask” |
| Kinder-sounding euphemism | Protective stabilization | Inhalation anesthesia |
| Risks |
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| Benefits | Can be used quickly and inexpensively without much training | Instantaneous and complete patient control |
| Perception | Brute force and inhumane treatment seen in Medicare clinics | Clean, modern care paid for by inscos and private payer |
There have been accusations from both sides: allegations of “nest feathering” by morally outraged dental anesthesiologists, abuses of public funds to pay for unnecessary procedures, the ultimatums given that any child restraint is considered grounds for lawsuits, equating papoose boards with third-world dental care, or offering general anesthesia for simple extractions when a combination of restraint and other sedation would be less expensive and as effective.
As a dental professional, it is your responsibility to make well-informed choices about sedation and restraint methods. For instance, individuals with autism or cerebral palsy may find that restraints are not only necessary, but even welcomed when compared to the use of drugs that can do more harm than the good that the dentistry is trying to achieve. Restraints may not be a better choice for toddlers whose biggest problem is a helicopter parent or two who are freaked out about the psychological trauma of having an irreparable tooth pulled. If a parent freaks, most likely so will the child, so it may be your choice to pander to the whiny world of children who are more in charge than their parents. After all, it’s no big deal to go under GA for a five-minute ear tube procedure with the ENT, right? That’s expected.
No matter what you decide to do, as long as you’re doing it from a level of comfort with your ability, and most importantly, from a sense of compassion, you should be able to confidently make the call for each patient, no matter where it falls on this line.
But sometimes, you just want to throw up your hands and say “AHHHHH I QUIT!” because you don’t know how to manage a patient. That’s when it’s awesome to have someone in your contact list who you trust to make this call.
And then pass the buck to them, because referring out can be very, very gratifying at times.
Valuable info. Lucky me I found your site by accident, I bookmarked it.
This is a really hot button issue for a lot of people, as I’m sure you already knew. However, it would seem to me that in many cases, the papoose board would be a preferable thing to general anesthesia for a child who may or may not come back up. In any case, I think that it’s a choice that needs to be made on a case by case basis, with sedation and local anesthesia used in conjunction with the papoose board to create a safe, sane situation for everyone involved. If the child needs the procedure and general anesthesia is too dangerous, then a papoose board is obviously a good choice. However, if the dental situation is not an emergency, then I think that waiting till the child is old enough to not need the papoose board should also be looked at as a viable option.
Donald from Tooth Extraction Pain How Long
Very interesting article and appreciated that it is coming from someone from the dental field.
This is definitely a very hot topic and the healthcare field really needs to do a better job at finding a national standard procedure on when to use a papoose or any type of physical or chemical restraint. There are so many gaps of information that is not documented on when a physical restraint is used and it saddens me to see that there is even less documented when it comes to the care of children. I sure hope those people in pediatric medicine keep their promise of ‘doing no harm’ to ALL of their patients. And remember doing no harm involves no harm both physically and mentally.
my autistic son was given the SCIP maneuver today. What is this – how safe is this procedure
My almost-3-year-old son will be getting an injured tooth extracted next week. (By the way, I found this Mom’s Guide to be a helpful tooth resource for us.) My son is not cooperative AT ALL and we briefly considered the papoose for this procedure. He is extremely fearful of the dentist (nice intro to dental care- having a tooth injury last fall!) and he will not allow the dentist or hygienist to do more than a quick peek in his mouth. I think if he was older and we could explain this to him in a way he could understand we would be more likely to use the papoose. But we’re setting his dental foundation here, so this time we’re opting for light sedation, done in a board certified pediatric dental office.