Pediatric dentistry often faces the challenge of treating children who may be uncooperative or have difficulty sitting still during dental procedures. The hand over mouth technique is one of the methods employed to manage such situations. It is a form of positive restraint that aims to gain the child’s attention and cooperation, allowing the dentist to complete necessary dental work. However, its use requires careful consideration and proper training to ensure it is implemented in an appropriate and ethical manner.
Definition and Procedure of the Hand over Mouth Technique
What It Is
The hand over mouth technique involves the dentist or dental assistant placing a gloved hand gently over the child’s mouth.This is not a forceful covering that restricts breathing but rather a light touch that serves to interrupt any excessive crying, screaming, or uncooperative behavior. For example, if a child is thrashing about and yelling loudly, making it impossible for the dentist to perform a simple examination, the hand can be placed over the mouth to signal the child to calm down.
How It’s Done
Preparation: The dental team should first explain to the child and the accompanying parent or guardian about the technique in a simple and reassuring way. This helps to build trust and understanding. For instance, saying, “If you get too excited and we can’t help you, we might need to use a special way to help you calm down a bit.”
Execution: When the need arises, the gloved hand is placed over the child’s mouth, with the fingers resting lightly on the cheeks and the palm covering the mouth area. The pressure applied is minimal, just enough to muffle the sound and get the child’s attention. The dental professional may also use a calm and firm voice to communicate with the child, such as “Let’s take a deep breath and calm down so we can make your teeth better.”
Indications for Using the Hand over Mouth Technique
Uncooperative Behavior
Excessive Crying and Screaming: When a child’s crying and screaming are so intense that it disrupts the dental procedure and prevents the dentist from accurately assessing or treating the teeth. For example, a young child might be extremely fearful and cry uncontrollably at the sight of dental instruments, making it impossible for the dentist to even start an examination.
Physical Resistance: If the child is physically resisting the dental chair, moving their head or body in a way that poses a risk of injury to themselves or the dental team. For instance, a child might be trying to jump out of the chair during a filling procedure.
Safety Concerns
To Prevent Swallowing or Aspiration: In cases where the child is at risk of swallowing or aspirating small dental instruments or debris. If a child is thrashing around and there is a loose filling material or a small instrument in the mouth, the hand over mouth technique can be used to quickly gain control and prevent a dangerous situation.
Protecting the Oral Tissues: When the child’s uncooperative behavior might lead to accidental biting of the dentist’s fingers or damage to their own oral tissues. For example, if a child is flailing and might bite down on a dental mirror or cause self-inflicted cuts in the gums.
Benefits of the Hand over Mouth Technique
Quick Behavior Modification
It can rapidly change the child’s behavior from uncooperative to more compliant. By interrupting the outburst of crying or resistance, the child is forced to pause and listen to the dentist’s instructions. This can save valuable treatment time and reduce stress for both the child and the dental team. For example, a child who was screaming and refusing to open their mouth might calm down and allow the dentist to complete a simple cleaning after the technique is used.
Enhanced Safety
As mentioned earlier, it helps prevent potential accidents such as swallowing or aspiration of foreign objects and protects the oral tissues from damage. This ensures that the dental procedure can be carried out without endangering the child’s health. For instance, in a situation where a child has a loose crown and is moving erratically, the technique can prevent the crown from being swallowed.
Facilitates Treatment Completion
Allows the dentist to finish necessary dental work that might otherwise be postponed or abandoned due to the child’s behavior. This is important for maintaining the oral health of the child and preventing the progression of dental diseases.For example, a cavity that needs to be filled can be treated promptly, reducing the risk of further decay and potential pain for the child.
Limitations and Risks of the Hand over Mouth Technique
Psychological Impact
Fear and Trauma: There is a concern that the technique might cause fear or psychological trauma to the child. If not used properly, the child may associate the dental visit with a negative and intrusive experience. For example, a child might develop a long-term aversion to dental visits after a particularly rough encounter where the technique was used.
Trust Issues: It could also lead to trust issues between the child and the dental team. If the child feels that their cries and protests were not heard or respected, they may be less likely to cooperate in future dental appointments.
Physical Risks
Breathing Obstruction: Although the intention is not to block breathing, if the technique is misapplied or the child has an underlying respiratory condition, there is a small risk of accidentally obstructing the airway. For example, a child with asthma might have a more difficult time breathing if the hand is placed too firmly over the mouth.
Soft Tissue Injury: Incorrect placement or excessive pressure could potentially cause soft tissue injury to the child’s face or mouth. For instance, if the fingers press too hard on the cheeks, it could leave marks or cause bruising.
Ethical Considerations in Using the Hand over Mouth Technique
Informed Consent
Parent or Guardian Agreement: The dental team must obtain informed consent from the parent or guardian before using the technique. This involves explaining the purpose, benefits, and potential risks in detail. For example, showing the parent how the technique will be used and discussing any concerns they might have.
Documentation: Proper documentation of the consent process and the use of the technique during the dental visit is essential. This helps to protect both the dental team and the patient in case of any future disputes or questions.
Training and Competence
Staff Training: Only trained dental professionals who are competent in using the technique should apply it. Training should include understanding the proper way to place the hand, how to communicate with the child during the process, and how to recognize signs of distress or discomfort. For example, a dental assistant should receive hands-on training and role-playing scenarios to practice using the technique.
Regular Review: The dental practice should have a system in place to regularly review and update the training and protocols regarding the use of the technique. This ensures that the latest best practices are being followed.
Conclusion
The hand over mouth technique in pediatric dentistry is a valuable behavior management tool when used appropriately and with caution. It can help overcome uncooperative behavior and ensure the safety and successful completion of dental procedures. However, its use must be carefully weighed against the potential risks and ethical considerations. Dental professionals need to be well-trained, obtain proper consent, and continuously monitor the child’s well-being during its application. By doing so, they can strike a balance between providing effective dental care and safeguarding the child’s physical and psychological health. Parents and guardians also play an important role in understanding and supporting the use of such techniques when necessary, as they are partners in ensuring the oral health of their children. With proper implementation and communication, the hand over mouth technique can be a useful addition to the pediatric dentist’s toolkit in creating a positive dental experience for children, even in challenging situations.
