Dental Work

We have a client who needs extensive dental work. It is believed that some challenging behaviors are related to his dental health condition. This person does not communicate through speech. Although this man was able to sit for procedures on a previous visit, during his most recent appointment he became impatient and uncooperative in the middle of the procedure, which led us to restrain him for medical purposes. Because he is on a lot of behavior meds, the dentist didn’t feel it was safe to give him a sedative. Can you suggest a way to restrain this client safely so he can get the dental care he needs?

Let’s back up. Physically restraining this man in order to complete dental work can cause significant psychological trauma. How would you or I wish to be supported if we became fearful during a dental procedure? We would ask the dentist to stop and expect our wishes to be respected. If we were experiencing pain, we might ask for more anesthesia and expect it to be given. If we were fearful or if the vibrations, smells, tastes, pressure or other sensory phenomena of dental work became intolerable we might ask for a break. Since this man cannot speak we must accept his behavior as communication. Because he has tolerated dental procedures in the past, his behavior suggests distress, either pain or fear, that the person needs to be supported through.

If you anticipate this man needing future dental work and regular dental care, how likely is it that he will cooperate with the procedures once you use physical force to subdue his resistance? What damage will be done to this person’s trust and your relationship in general if we disregard his fear or pain and overcome his resistance with force?

In addition to the risk of psychological trauma, physically holding this man’s head and body still for procedures involving power tools seems dangerous. It is easy to imagine a drill spinning at thousands of revolutions per minute in the mouth of a struggling person causing trauma to nearby teeth and gums. Trying to hold a struggling person’s head still also poses substantial risk of cervical spine injury.

We suggest you convene a meeting of the team, including his dentist and psychiatrist, and come up with a comprehensive plan for supporting this gentleman to receive the needed dental care. Since one of the barriers to using pharmacological support during the procedures is the large array of psychiatric or neurological drugs this man is taking, we suggest the physicians discuss the issue. Together they can assess the risk of drug interactions or evaluate the need for this array of drugs, and come up with a plan for adjusting the medications, at least long enough to accomplish the major dental treatments.

Good luck. Thanks for shaking the Magic 8 Ball.