Protective Stabilization for Children as Part of Advanced Behavior Management Technique in Dentistry: UAE United Arab Emirates Dentists’ and Parents’ Acceptance

Abstract

Background: Behavior Management Techniques (BMTs), used by Pediatric Dentists (PDs) and some General Dental Practitioners (GDPs) for managing children’s dental care, are divided into two categories: “basic behavior techniques” and “advanced behavior techniques.” One method of the latter is Pediatric Protective Stabilization (PPS), which is the physical limitation of a patient’s movement by a person or restrictive equipment, materials, or devices for a finite period to provide an examination, diagnosis, and/or treatment safely. Examples of PPS are Hand-Over-Mouth Exercise (HOME), Papoose board (PB), clinical holding (CH), and Lap-toLap examination (LLE).

Aim: To evaluate the acceptance of dentists and parents regarding the use of four types of PPS as a BMT during children’s dental treatment in the UAE.

Materials and Methods: A cross-sectional survey-based study sampling dentists (GDPs and PDs) (n=125) and parents (n=126) was obtained between the 1 st of March 2021 and 1 st of January 2022, using Microsoft Forms® to conduct two online surveys to examine the parental acceptance and dentist’s acceptance of one type of advanced BMT, which is protective stabilization. The dentists’ survey was circulated to online UAE dentists’ associations, societies, and clubs. In contrast, the parents’ survey was distributed on social media, among parents’ groups, and children attending dental institutions and facilities like Dubai Dental ii Hospital (DDH) and other UAE dental clinics. The questionnaires were divided into demographic questions (i.e., age, gender, nationality, etc.) and acceptance of various BMT methods. In addition, parents and dentists were asked to rate their acceptance level on each randomly displayed PPS type using a Likert rating scale. Both questionnaires demonstrated the four PPSs using photos and a worded explanation. All data analyses were performed using IBM-SPSS for Windows version 28.0. The Chi-squared test or Fisher’s exact test was used to investigate the association of categorical data. In addition, the Kolmogorov-Smirnov test was used to test the normality of continuous variables and Mann Whitney test to compare the means between the two groups. Quantitative data were analyzed and expressed in mean ± SD, and the significance level was set at (P-value ≤ 0.05 level).

Results: 66.7% of the parents stated that their children had never received the PPS techniques in the study sample. In addition, 54% of the parents stated that they prefer their child to receive PPS over general anaesthesia. On the other hand, 53% of the dentists felt they need to use PPS. Furthermore, 67.2% of the dentists felt the need to obtain consent from the parents before resorting to PPS. In general, 54% of the parents were against the use of PPS with their children’s dental treatment if it was not an emergency, compared to 28.8% of the dentists (p < 0.001). Furthermore, 59.6% (31/125) of the dentists believe the benefits of protective stabilization outweigh its risk. PPS techniques were categorized as per their acceptance. CH technique was found to be accepted by only 18.3% of the parents, in comparison to 56% of dentists, making it their method of choice in the event of a non-pharmacological protective stabilization (p < 0.001). HOME technique found acceptance for only 9.5% of the parents, in comparison to 8.8% for the dentists (p ≤ 0.427). The LLE technique was the most accepted technique by the parents 44.4%, compared to 41.6% for the dentists (p ≤ 0.344). PB board was the least accepted PPS technique for the parents, 6.3%, compared to 4% for the dentists (p ≤ 0.344).

Conclusion: PB was the least accepted PPS technique for both the parents and dentists. The LLE technique ranked as the most favorable BMT for the parents, followed by CH; Whereas for the dental practitioner, CH ranked as the most favorable, followed by the LLE technique. Almost half of the GDPs and PDs would obtain consent before carrying out PPS techniques, which is below the required international recommendations of 100%. Parents' and dentists’ demographic data did not play a role in the acceptance rate of PPS techniques.