Students' perception of protective stabilization of pediatric dental patients: a qualitative study

Protective stabilization (PS) has been utilized to safely perform examinations, make diagnoses and/or provide limited treatment of short duration to uncooperative children. The literature supports PS as an alternative technique when behavior management strategies are not sufficient to enable oral care. The use of PS in pediatric dentistry can be traumatic for patients, parents and the medical team and has sometimes been described as being non-compliant with standards of care. Semi-structured qualitative interviews on dental students’ perception of PS were conducted in the pediatric department of dentistry at the University Hospital of Toulouse, France. A thematic analysis of the transcript of interviews was provided using the NViVo software. This analysis identified four main themes. The students described their first experience with physical restraint in pediatric dentistry and wondered about the definition of PS. The students’ perception of PS showed that this procedure has a psychological impact and is disturbing. There is a lack of information on PS in dental curricula and didactic and clinical education which requires attention. Finally, the students took into consideration the role of PS in future practice. Dental students’ perception of PS provides justification for the development and improvement of theoretical and clinical education in behavior guidance techniques for pediatric dental patients, in accordance with national and international guidelines.

Physical restraint; Pediatric dentistry; Qualitative study; Student; Dental care; Child

[1] Davidovich E, Pessov Y, Baniel A, Ram D. Levels of stress among general practitioners, students and specialists in pediatric dentistry during dental treatment. Journal of Clinical Pediatric Dentistry. 2015; 39: 419–422.

[2] Clinical Affairs Committee-Behavior Management Subcommittee, American Academy of Pediatric Dentistry. Guideline on behavior guidance for the pediatric dental patient. Pediatric Dentistry. 2015; 37: 57–70.

[3] Nazzal H, El Shahawy OI, Al-Jundi S, Hussein I, Tahmassebi JF. The use of behaviour management techniques amongst paediatric dentists working in the Arabian region: a cross-sectional survey study. European Archives of Paediatric Dentistry. 2021; 22: 375–385.

[4] Guideline on protective stabilization for pediatric dental patients. Pediatric Dentistry. 2016; 38: 199–203.

[5] American Academy of Pediatric Dentistry. Use of protective stabilization for pediatric dental patients. the reference manual of pediatric dentistry. American Academy of Pediatric Dentistry: Chicago, Ill. 2021; 325–331.

[6] Weaver JM. Why is physical restraint still acceptable for dentistry? Anesthesia Progress. 2010; 57: 43–44.

[7] Chavis SE, Wu E, Munz SM. Considerations for protective stabilization in community general dental practice for adult patients with special healthcare needs: a scoping review. Compendium of Continuing Education in Dentistry. 2021; 42: 134–138.

[8] Malik P, Ferraz dos Santos B, Girard F, Hovey R, Bedos C. Physical constraint in pediatric dentistry: the lived experience of parents. JDR Clinical & Translational Research. 2022; 7: 371–378.

[9] Perlman SP, Wong A, Waldman HB, Friedman C, Webb J, Rader R, et al. From restraint to medical immobilization/protective stabilization. Dental Clinics of North America. 2022; 66: 261–275.

[10] Ilha MC, Feldens CA, Razera J, Vivian AG, de Rosa Barros Coelho EM, Kramer PF. Protective stabilization in pediatric dentistry: a qualitative study on the perceptions of mothers, psychologists, and pediatric dentists. International Journal of Paediatric Dentistry. 2021; 31: 647–656.

[11] Martinez Mier EA, Walsh CR, Farah CC, Vinson LA, Soto-Rojas AE, Jones JE. Acceptance of behavior guidance techniques used in pediatric dentistry by parents from diverse backgrounds. Clinical Pediatrics. 2019; 58: 977–984.

[12] Marty M, Marquet A, Valéra MC. Perception of protective stabilization by pediatric dentists: a qualitative study. JDR Clinical & Translational Research. 2021; 6: 402–408.

[13] Lombart B, De Stefano C, Dupont D, Nadji L, Galinski M. Caregivers blinded by the care: a qualitative study of physical restraint in pediatric care. Nursing Ethics. 2020; 27: 230–246.

[14] Salehi Z, Joolaee S, Hajibabaee F, Ghezeljeh TN. The challenges of using physical restraint in intensive care units in Iran: a qualitative study. Journal of the Intensive Care Society. 2021; 22: 34–40.

[15] Al-Jobair AM, Al-Mutairi MA. Saudi dental students’ perceptions of pediatric behavior guidance techniques. BMC Medical Education. 2015; 15: 120.

[16] Chai HH, Gao SS, Chen KJ, Duangthip D, Lo ECM, Chu CH. A concise review on qualitative research in dentistry. International Journal of Environmental Research and Public Health. 2021; 18: 942.

[17] Pyo J, Lee W, Choi EY, Jang SG, Ock M. Qualitative research in healthcare: necessity and characteristics. Journal of Preventive Medicine and Public Health. 2023; 56: 12–20.

[18] Bimstein E, Azari AF, Riley JL. Predoctoral and postdoctoral students’ perspectives about pediatric dental behavior guidance. Journal of Dental Education. 2011; 75: 616–625.

[19] Bimstein E, Azari AF, Sotto JJ, Riley JL. Students’ perceptions about pediatric dental behavior guidance in an undergraduate four-year dental curriculum. Journal of Dental Education. 2009; 73: 1366–1371.

[20] Nutter DP. How do we protect a child’s psychological health during procedures that use protective stabilization? Journal of the California Dental Association. 2022; 50: 453–463.

[21] Juntgen LM, Sanders BJ, Walker LA, Jones JE, Weddell JA, Tomlin AM, et al. Factors influencing behavior guidance: a survey of practicing pediatric dentists. Pediatric Dentistry. 2013; 35: 539–545.