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Authors: John Morgan, Bonnie F. Zimble

Behavior Management: The Patient Care Experience

for Patients with Disabilities:

Health-related Protection

Special Care in Dentistry
John Morgan, DDS
Tufts University School of Dental Medicine, 2008


Study Questions
 

1.     Define health-related protection.

2.     Under what conditions is health-related protection employed?

3.     For what purposes should it not be used?

4.     What are some examples of health-related protection?

Health-related protection refers to the limitation of movement, ordered by a physician or authorized clinician, if absolutely necessary, during a specific dental procedure. 

Health-related protection is NOT a form of emergency restraint and may not be used for the convenience of the staff.  Immobilization using a papoose board is one example of  health-related protection (other examples are provided below). The procedure is controversial and should be discussed on an individual case basis with the faculty members in the clinics, the patient, family and caregivers. This topic is covered in greater detail in the Special Considerations module in this series. 

The use of health-related protection is an area of intense debate.  A committee from the Academy of Dentistry for Persons with Disabilities (http://www.scdaonline.org) was formed to study the legal, ethical, and medical considerations on the use of stabilization in the delivery of dental care for special needs patients.  The committee concluded that although there is  

“…no consensus among the states on the definition of stabilization, the current national view is that health related protection should only be used when absolutely necessary, and it shall not be used as punishment or for the convenience of the staff.  Use of health related protection is an acceptable dental practice when appropriately used for behavior control of patients with developmentally disabling conditions.”

Examples of health-related protection 

  • A caregiver or family member seated in the dental chair, immobilizing the child or patient with his or her body

  • Head, arm and/or leg immobilization

  • Mouth props

  • Pedi-Wrap blanket, Papoose or Pedi-Board

  • Sedation and general anesthesia

Click here to visit the Specialized Care web site and see images of health-related protection and other documents related to its use.

Immobilization is NOT used as a punishment!
It must be emphasized to the patient and parent or caregiver that immobilization not used as a punishment for patient behavior. Rather, immobilization is employed to assist the patient to control his movement.  This point needs to be discussed during the informed consent process.