protective stabilization C D A J O U R N A L , V O L 5 0 , Nº 8
Pain, Psyche and Protective Stabilization Paul S. Casamassimo, DDS, MS; Beau Meyer, DDS, MPH; and Janice A. Townsend, DDS, MS
abstract Background: Protective stabilization (PS) and its subset of medical immobilization (MI) with a passive device have been part of advanced behavior guidance in pediatric dentistry for decades, yet they remain controversial. Inadequate evidence on risks and benefits, ambiguous indications and newer societal and professional skepticism make application of these techniques the subject of continuing debate. PS and MI are often the treatments of last resort and can be effective and safe. Conclusions: Clinical, psychological and logistic considerations should guide clinicians when these techniques are among behavior guidance choices. Like other forms of advanced behavior guidance, PS and MI affect children and family, and their application is also shaped by the community and care system. Practical implications: Professional guidelines provide general directions for use of PS and MI, and these should be refined by the clinician’s recognition of the limitations and possible effects of use. Finally, in the absence of a clear evidence-based pathway, application of a logic algorithm can both maximize the benefit of PS and MI and minimize negative outcomes. Keywords: Behavior, pediatric dentistry, safety, medical immobilization, protective stabilization
AUTHORS Paul S. Casamassimo, DDS, MS, is a professor emeritus at The Ohio State University College of Dentistry and an attending dentist at Nationwide Children’s Hospital in Columbus, Ohio. Conflict of Interest Disclosure: None reported.
Janice A. Townsend, DDS, MS, is the chief of pediatric dentistry at Nationwide Children’s Hospital and the chair of the division of pediatric dentistry at The Ohio State University College of Dentistry. Conflict of Interest Disclosure: None reported.
Beau Meyer, DDS, MPH, is an assistant professor at The Ohio State University College of Dentistry, division of pediatric dentistry and is on the medical staff at Nationwide Children’s Hospital in Columbus, Ohio. Conflict of Interest Disclosure: None reported.
Editor’s Note: This article is a companion to “How Do We Protect a Child’s Psychological Health During Procedures That Use Protective Stabilization?” on page 453.
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he use of protective stabilization (PS) must consider the overall health and safety of the pediatric patient as the highest priority. Consideration of important ethical and pragmatic consequences is integral to proper application of PS. Paying attention to pain management, maintaining patient safety, providing quality dental care and protecting the developing psyche are assumed in every application of PS and essential to the decision-making process when choosing to use PS. The umbrella of PS includes active stabilization by the parent or dental team as well as passive stabilization with an
immobilization device that we will refer to as medical immobilization (MI). While most PS in pediatric dentistry is limited to hand guarding and head stability, the term immediately conjures up the image of a papoose board. It should escape no one that MI remains controversial. Unlike the hand-over-mouth technique (HOM), MI remains in our guidelines and in the acceptable practice of pediatric dentistry, as it does in medical care. MI has been reshaped by societal, safety and ethical shifts as well as advances in other pharmacologic forms of behavior guidance. Its place in our therapeutic toolkit has admittedly narrowed, yet MI remains an indicated behavior guidance AUGUST 2 0 2 2
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