Understanding Protective Stabilization
AAPD National Spokesperson Dr. Dennis McTigue provides important information for parents and caregivers to understand about the use of protective stabilization.
Because every child is unique, caring for their little teeth requires much more than a “one-size-fits-all” approach. In fact, pediatric dentists are trained in a significant variety of approaches to help a child complete needed dental treatment. And their recommendations for treatment are based on a number of individual considerations, including a child’s health history, special health care needs, dental needs, type of treatment required, potential consequences of no treatment, emotional and intellectual development, as well as parental preferences.
One technique in a pediatric dentist’s toolbox to provide optimal oral care is called protective stabilization. Below, Dr. Dennis McTigue, professor of pediatric dentistry at Ohio State University College of Dentistry, provides important information for parents and caregivers to understand about this advanced behavior guidance technique.
What is protective stabilization?
Protective stabilization is a method to immobilize or reduce the ability of a patient to move his or her arms, legs, body or head freely. There are a variety of forms and levels. For instance, if a pediatric dentist uses active immobilization, she might ask the parent to hold the child in their lap and use their arms to hug and stabilize the child. If a pediatric dentist uses passive stabilization, she might use a “wrap” or “blanket” to stabilize the child’s arms and legs, similar to the way a car seat stabilizes a child in a moving vehicle. Because every child is different, a wide range of choices exist and pediatric dentists always choose the least restrictive method that is appropriate and best for each patient.
When does a pediatric dentist use protective stabilization and why?
A pediatric dentist considers protective stabilization only when less restrictive interventions are not effective, such as in the following instances:
- The child requires immediate diagnosis and/or urgent limited treatment and cannot cooperate due to emotional maturity or medical and physical conditions;
- Emergency care is needed and uncontrolled movements risk the safety of the child, staff, dentist, or parent without the use of protective stabilization;
- A previously cooperative child quickly becomes uncooperative during the appointment in order to protect his/her safety and help to expedite completion of treatment;
- A child is sedated and becomes uncooperative during treatment;
- A child with special health care needs who may experience uncontrolled movements that would be harmful or significantly interfere with the quality of care.
What are my rights as a parent or caregiver?
Parents and caregivers play an important role in their child’s dental health and have the right to know what treatment their child is recommended to receive and why. Additionally, parents have the right to support or deny any treatment approach suggested for their child. Beyond a signature on a consent form, parents and caregivers should expect that consent consists of a thorough discussion of the procedure. The dentist should discuss the benefits and risks of the recommended treatment, as well as other options, such as treatment deferral, sedation and general anesthesia. If possible, this conversation should be had on a different day than the procedure. Of course, a pediatric dentist will also consider your child’s wishes and feelings when addressing the issue of consent. But it is important that parents and caregivers are active partners in choosing the treatment that is best for their child.
Are all dentist trained to practice protective stabilization?
Training beyond dental school is essential to ensure appropriate, safe and effective use of protective stabilization. All pediatric dentists have the two-three years of training beyond dental school, which includes formal training in advance techniques like protective stabilization.
If your child does not see a pediatric dentist, you should ask about what type of training the dentist has received. AAPD recommends advanced training through an accredited post-doctoral program such as an advanced education in general dentistry, general practice or pediatric dentistry residency program or an extensive and focused continuing education course.
What else should parents and caregivers know?
Protective stabilization is not used as a convenient method to provide routine care to an uncooperative child. As in a hospital’s emergency room, it’s reserved for those times when urgent care must be provided and, then, only with the full understanding and consent of the parents.
Finally, it’s important to establish a Dental Home for your child, ideally by age one but it is never too late. Regular trips to the pediatric dentists will be associated with fun flavors of toothpaste, a new toothbrush and stickers – making caring for their little teeth easy for both parents and the child.
Partnering together, parents and pediatric dentists can ensure the best care of little teeth that is tailored for each child’s unique needs for a healthy, happy smile.
Dennis J. McTigue, D.D.S
Dr. Dennis J. McTigue is a professor of pediatric dentistry at Ohio State University College of Dentistry. He received his dental education and pediatric dentistry training at the University of Iowa. He then taught at the Louisiana State University School of Dentistry in New Orleans for eight years prior to moving to Columbus, Ohio, to chair the department of pediatric dentistry at Ohio State University. He is a past president of the American Academy of Pediatric Dentistry, of the American Board of Pediatric Dentistry and of the Academy of Dentistry for the Handicapped. His research interests involve dental injuries to children and guidance of child behavior in the dental office. He is co-editor of the textbook “Pediatric Dentistry; Infancy through Adolescence,” now in its fifth edition. He has maintained a private practice in pediatric dentistry for over 35 years.