Special Considerations in Special Care Dentistry:
Supports and Health-related Protections
Special Care in Dentistry
John Morgan, DDS
Tufts University School of Dental Medicine, 2008
Note: The following information has been adapted from Massachusetts DMR regulation 115 CMR 5.12.
What are “supports?”
According to Massachusetts DMR regulation 115 CMR 5.12, the term supports refers to:
In dentistry, supports needed to achieve proper body positions, balance, or alignment, and health-related protections, are not emergency restraint. Supports may be used only to:
Devices providing such support include but are not limited to:
Health-related protections are methods and strategies ordered by a physician or other authorized clinician if absolutely necessary during a specific medical or dental procedure or for the individual’s protection during the time that a condition undergoing treatment pursuant to that clinician’s orders exists. These devices shall not be considered a type of restraint.
(a) With the authorization and supervision of a qualified practitioner;
(b) In accordance with principles of good body alignment, concern for circulation, and allowance for change of position.
Emergency shall mean that a reasonable person would perceive one or more of the following:
(a) the present occurrence of serious self-injurious behavior;
(b) the present occurrence of serious physical assault;
(c) the imminent threat of serious self-injurious behavior or behavior which is likely to lead to self injury, where the individual has the present ability to effect such behavior and has engaged in any action which indicates a present intention or inclination to carry out such behavior immediately.
(d) The imminent threat of serious physical assault, where the individual has the present ability to effect such assault and has engaged in any act which indicates a present intention or inclination to carry out such assault immediately. The occurrence or imminent threat of property damage is not an emergency unless such damage is also likely to lead to the serious self-injury of the individual or to the serious harm of those present.
Support needed to achieve proper body position, balance, or alignment means a limitation of movement necessary for the individual to achieve proper body position, balance, or alignment. It is not a form of emergency restraint and may not be used for the convenience of staff.
Transportation restraint shall mean limitation of movement necessary for the safety of the individual during transportation. It is not a form of emergency restraint and may not be used for the convenience of staff.
(a) Use Permitted Only in Emergency. Emergency restraint – whether physical, mechanical, or chemical – may be used only in cases of emergency.
(b) Least restrictive alternative. Emergency restraint may be used only after the failure of less restrictive alternatives or after a determination, based upon professional judgment, that such alternatives would be ineffective under the circumstances.
(c) Duration of emergency restraint. Emergency restraint may be used only for the period of time necessary to accomplish its purpose, but in no event may physical or mechanical restraint be used beyond the periods.
(d) Duration of transportation restraint. Transportation restraint may be used only for the period of time necessary to accomplish its purpose and only during transportation.
(e) PRN orders prohibited. No “P.R.N.” or “as required’ authorization of restraint may be written.
(a) Authorization for use. An individual may be given chemical restraint only on the order of an authorized physician who has determined that such chemical restraint is the least restrictive, most appropriate alternative available. Such an order may not be implemented unless:
1 - the authorized physician giving the order is or was present at any time during the course of the emergency justifying the use of the restraint; or
2 - prior to issuing the order, the authorized physician has a telephone consultation with a physician, registered nurse or nurse practitioner, or certified physician assistant who is or was present at the tie and site of the emergency and who has personally examined the individual.
(b) Chemical Relaxation for Medical or Dental Treatment. Sedatives or anti-anxiety medication prescribed by a qualified practitioner for the sole purpose of relaxing or calming an individual so that he or she may receive medical or dental treatment is not a restraint. Administration of such medication shall be deemed incidental to the treatment, and, except in a medical emergency, requires the consent of the individual or guardian. Providers should incorporate into an individual’s ISP objectives that assist the individual to learn how to cope with medical treatments and that lead to the decrease or elimination of medication for chemical relaxation incidental to treatment.
See the Mass. DMR
regulations link above for more detailed