Current through September 24, 2024
(1) Purpose - The purpose of this rule is to
recognize the unfortunate fact that pediatric and special needs patients may
need to be restrained in order to prevent injury and to protect the health and
safety of the patients, the dentist, and the dental staff. To achieve this it
will be important to build a trusting relationship between the dentist, the
dental staff and the patient. This will necessitate that the dentist
establishes communication with the patient and promote a positive attitude
towards oral and dental health in order to alleviate fear and anxiety and to
deliver quality dental care.
(2)
Training Requirement - Prior to administering restraint, the dentist must have
received formal training at a dental school or during an American Dental
Association accredited residency program in the methods of restraint described
in paragraph (4) of this rule.
(3)
Pre-Restraint Requirements
(a) Prior to
administering restraint, the dentist shall consider:
1. The need to diagnose and treat the
patient;
2. The safety of the
patient, dentist, and staff;
3. The
failure of other alternate behavioral methods;
4. The effect on the quality of dental
care;
5. The patient's emotional
development; and
6. The patient's
physical condition.
(b)
Prior to administering restraint, the dentist shall obtain written informed
consent from the parent or legal guardian and document such consent in the
dental record, unless the parent or legal guardian is restraining or
immobilizing the patient by use of the method described in subparagraph (4) (b)
of this rule.
(4)
Methods of Restraint
(a) The Hand-Over-Mouth
Exercise (HOME) Method
1. This method may be
used for a healthy child who is able to understand and cooperate but who
exhibits defiant, aggressive, or hysterical behavior during dental
treatment.
2. Use of this method
shall never obstruct the patient's airway nor be used:
(i) With patients whose age, disability, or
emotional immaturity prevent them from being able to understand and/or
cooperate;
(ii) When patients are
under the influence of medications which prevent them from being able to
understand and/or cooperate;
(iii)
When patients have an airway obstruction or when restraint will prevent the
patient from breathing; or,
(iv)
When the parent or legal guardian has not given written informed consent for
this method to be utilized.
(b) The Physical Restraint or Medical
Immobilization Method
1. This method may be
used to partially or completely immobilize the patient for required diagnosis
and/or treatment if the patient cannot cooperate due to lack of maturity,
mental or physical handicap, failure to cooperate after other behavior
managements techniques have failed and/or when the safety of the patient,
dentist, or dental staff would be at risk without using protective restraint.
This method should only be used to reduce or eliminate untoward movement,
protect the patient and staff from injury, and to assist in the delivery of
quality dental treatment. If restraint or immobilization is deemed necessary,
the least restrictive technique shall be used.
2. Use of this method shall not be used:
(i) With cooperative patients;
(ii) On patients who, due to their medical or
systemic condition, cannot be immobilized safely;
(iii) As punishment; or,
(iv) Solely for the convenience of the
dentist and/or dental staff.
(5) Dental hygienists and dental assistants
shall not use the methods described in paragraph (4) by themselves, but may
assist the dentist as necessary.
(6) The patient's record shall include:
(a) Written informed consent from parents or
legal guardians;
(b) Type of method
used;
(c) Reason for use of that
method;
(d) Duration of method
used; and,
(e) If restraint or
immobilization is used, type of restraint or immobilization used.
(7) Parents or legal guardians
must be informed in advance of what treatment the patient will receive and why
the use of restraints may be required. Parents or legal guardians shall be
informed of the office policy concerning parental presence, the benefits and
risks of parental presence, and of their opportunity to choose a different
practitioner for the child if they are not comfortable with the office
policy.
(8) Parents or legal
guardians may not be denied access to the patient during treatment in the
dental office unless the health and safety of the patient, parent or guardian,
or dental staff would be at risk. The parent or guardian shall be informed of
the reason they are denied access to the patient and both the incident of the
denial and the reason for the denial shall be documented in the patient's
dental record.
Authority: T.C.A. §§
4-5-202,
4-5-204, 63-5-105, and
63-5-108.
