Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

September 10, 2018

Using restraints in treating difficult children

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In my practice, I very much enjoyed seeing children—even children who were difficult to treat. Part of the reason for that was that the pediatric dentist on my side of town was someone I felt was mean and who would put ugly stainless steel crowns on front teeth, so I didn’t want to refer to him. But a big part of it was because I enjoyed the challenge of trying to understand each child and how to get them through the care that they needed.

One issue in providing dental treatment to children is the use of physical restraints. Sometimes it is needed, and I want to address two aspects of that restraint.

The first aspect is the use of a mouth prop to keep their mouth open anytime I was drilling on their teeth. When I was in dental school doing my rotation in the pediatric dentistry clinic, before I took my turn as the operator I did a turn as an assistant. My fellow dental student was doing a small, routine filling on a baby tooth when our patient bit down unexpectedly, poking the drill through to the pulp of his tooth. We had to call the instructor over and upgrade the treatment to a pulpotomy (the baby-tooth equivalent of a root canal treatment) and stainless steel crown. My partner got a lecture about using a mouth prop and I vowed in that moment that this would never happen to one of my patients—I would always use some type of mouth restraint.

I ended up routinely using a Molt mouth gag on all my child patients when I was using a drill on a back tooth. I never, during dental school or my 20+ years of private practice, had an accident like my dental school partner.

a scissors-like device with rubber prongs on one end to hold the mouth open and a ratchet to hold the position

The Molt mouth gag

But there was a very small minority of child patients that we would run into maybe once every couple of years that would need even more restraint to treat them safely. In spite of all the psychology we could use on them, they would thrash around with their arms and legs, making safe treatment impossible. When this would occur, I would excuse myself to the reception room and ask the parent for permission to physically restrain their child. They always gave permission, and we would proceed to wrap them in a papoose and complete the treatment.

a 6-year-old child wrapped tightly in a blanket, restraining his arms and legs

The Papoose Board

This technique has been criticized by some as being mean and traumatic to the child. That isn’t my experience at all. These were strong-willed children who refused to cooperate and were determined to make it impossible to fix their teeth; and without general anesthesia it would have been completely impossible to treat them. Once they fully realized that the treatment was going to go forward whether or not they chose to cooperate, they would completely calm down. I cannot remember an instance when that didn’t happen. Sometimes, having become physically worn out from their earlier resistance, they would actually fall asleep as the treatment proceeded.

Once treatment was done, we would unwrap them, congratulate them on finally settling down, give them their choice of toys from the prize box, and part friends.

– Dr. David Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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