Medical Stabilization

Documentation

Document restraint usage and consent process Amount of time used Effectiveness Adverse effects How treatment/restraint was tolerated Which restraint used and why

Arm and Leg Tubes

Stabilizers elbow or knee to prevent from bending Often using in conjunction with papoose board Fastened by velcro

Head Stabilizers

AKA head holder Prevents side to side and up/down head movements Provides stability Supports patient's head for clinician Be sure ears are comfortable Cannot be used alone, has to be paired with PB or RW.

Summary

Also, talk with the patient's caregiver and/or family and ask how tooth brushing is going at home to get a feel for the patient and to form an idea of what to expect. It is important to obtain proper consents prior to rendering dental treatment. With all adaptations or MIPS you must be cognizant of a patients rights, even if the legal guardian consents. As a provider you must be sensitive to a patients physical and emotional status at all times and each patient must be evaluated at every appointment for care (some days are better than others).

Anxiety Medications:

Benzodiazepines More common than barbiturates Treats anxiety, insomnia, agitation, muscle spasms, alcohol withdrawal Taken at least 1 hour before procedures Oral administration (most common) Hypnotic Benzodiazepines: Brotizolam Estazolam Flunitrazepam Flurazepam Loprazolam Lormetazepam Midazolam Nimetazepam Nitrazepam Temazepam (Restoril or Normison) Triazolam (Halcion) Anxiolytic Benzodiazepines: Alprazolam (Xanax) Bromazepam Chlordiazepoxide Clonazepam Diazepam (Valium) Lorazepam (Ativan, Temesta, Tavor) Oxazepam Prazepam Clorazepate Barbiturates: Amobarbital Aprobarbital (Elixir) Phenobarbital Secobarbital Barbital

Patients in Wheelchairs

Can be treated in wheelchair (WC) WC can often be reclined If needed, complete a WC transfer Hoyer lift 2- person transfer 1- person transfer (not recommended) 2-Person WC transfer: Determine patient's needs - never assume Prepare operatory - clear the areas, make dental chair accessible Prepare WC - lock the chair, position parallel to dental chair Two person transfer - first clinician stand behind patient and place arms under patient's upper arm, second clinician place hands under the lower thighs and initiate lift Position the patient

Foam Mouth Prop

Home use Thick, dense foam Re-usable until worn out Allows for easier brushing and flossing at home

Molt Mouth Prop

If a patient's mouth is too large for LRMP a molt mouth prop is often used. Sometimes a molt mouth prop is used initially, then replaced by a rubber mouth prop. Molt mouth props have rubber tubes that surround the metal. ONLY placed on Posterior teeth.

Poseys

Limits hand and arm movements Ensures safe delivery of dental treatment (grabbing at instruments) Only used when patients are uncooperative and cannot maintain safe hand position "bracelets"

Papoose Boards

Limits movement of torso and extremities Reduces risk of injury to patient and provider Keeps uncooperative and anxious patients safe Must provide adequate ventilation Lay dental chair supine - place board on top Two types: rainbow wrap and papoose board Leg wrap (unwrap first) Torso wrap Shoulder wrap Arm straps underneath wrap (Velcro away from skin) Can have head wrap if needed

Restraint

Manual method, physical/mechanical device, equipment, material that is attached/adjacent to the patient's body Prevents individuals from removing device easily and restricts freedom of movement Can be physical, mechanical, chemical (or combination) Only used to ensure patient safety and comfort Used to provide safety to providers Provide least restrictive environment Lowest potential to cause injury Only used to deliver adequate dental services Decreases patient anxiety Too loose of a fit can cause rubbing, irritation, or trauma Prevents injury during appointment Well tolerated by patient Short duration of use Limits movement Provides physical control so that dental services can be completed safely Should be comfortable When to use: Patient displays challenging/uncooperative behavior in dental settings Patients with increased anxiety and fear Only for patient comfort and safety

Mechanical Restraints

Mechanical device used dental treatment to assist in patient safety and comfort Assists patient in maintaining adequate positioning during procedure Papoose board Mouth prop Vac-Pac Seat belts/straps Poseys Head stabilizers/holders Arm/leg tubes

Rainbow Wrap

Mesh-like material allows for more ventilation No shoulder wrap Arm straps underneath wrap (Velcro out) Leg wrap 2 torso wraps Better for heavier weighted individuals

Physical Restraints

Provider/caregiver physically supporting a patient's body Head holds 2nd assistant needed Head cradle Support head from moving Physical holds Patients with abrupt, random body movements Hand guarding Passive

Vac-Pac

Provides support to patients Allows patients to sit comfortably in chair Sit patient in position that dental services can be delivered

How to use a mouth prop

Pull down the lower lip gently Insert mouth prop Be sure mouth prop is rested against posterior teeth Hold against the maxillary arch

Rubber Mouth Prop

Rubber mouth props come in three sizes: Small (pink or purple colored in our clinic) Medium (blue colored in out clinic) Large (green colored) Often referred to as a "tooth pillow"

Chemical Restraints

Sedation Nitrous Oxide Conscious Anxiolytic Medications Reduce patient anxiety General Anesthesia- full mouth rehabilitation or extreme cases Operating rooms/hospital

Documentation Example

Time in: 1:00 pm Time out: 1:45 pm HH updated: yes Vitals: 120/80, 80 BPM, pulse Ox 99. Adapts Consent: yes, Anxio: yes ADAPTATIONS: anxio: lorazepam 1 mg taken one hour prior. APB due to body movements, HH due to side to side and lifting. Molt mouth prop used to place MRMP. MRMP used to render prophy. No water, high aspiration risk. Behavior: Pt tolerated treatment well, some body movements and frequent head movements. Responded well to show-tell-do, counting to 10 and verbal positive reinforcement. 35 YOF with profound intellectual disability and history of TBI presents for an adult prophy with hand scaling, polish, floss, and OHI. No water, high aspiration risk.

Mouth Props

Used to provide comfort to patients Assists patients in keeping their mouths open during dental treatment Reduces risk for injury of patients and provider Can be used without a handle Helps alleviate jaw pain during dental procedures Professional Use: Molt Rubber Home Use: Foam If a patient is uncooperative or not willing to open for MP placement, toothbrushing is performed to encourage opening

Medical Stabilization

Utilizing adaptations, such as restraints, to ensure patient safety and comfort during treatment