Archives for July 2010

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	Creation of dental phobias Inadequate relaxation resulting in poor pain  management Difficulty in treating a lengthy, complicated case	Aspiration May affect the developing brain (autism/ADHD) Death
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.