Nathan J E
Department of Pediatric Dentistry, Northwestern University, Chicago, IL.
ASDC J Dent Child. 1989 Jul-Aug;56(4):293-301.
The findings of a 1988 survey of 616 pediatric dentists' attitudes and utilization of non-pharmacologic and pharmacologic strategies for treating the difficult pediatric patient are described. Wide variations appear to exist with regard to the use of restraints and aversive techniques, parent presence in the operatory, use of sedation, and general anesthesia. Variables including practice location, caries prevalence, patient populations, individual training experiences and skills, and liability costs clearly have an impact on pediatric dentists perception of the appropriateness of various modalities and their choice of application. There appear to be more concerns regarding the issue of informed consent, the appropriateness of hand-over-mouth, particularly HOMAR, and the use and overuse of sedation and general anesthesia. In the area of risk management, although many report high proficiency and comfort levels in their ability to recognize and manage in-office medical emergencies, others using various forms of in-office sedation, however, report having minimal emergency and monitoring equipment or training.
本文描述了1988年对616名儿科牙医治疗难处理的儿科患者时的态度以及非药物和药物治疗策略使用情况的调查结果。在使用约束和厌恶技术、家长在诊疗室的陪伴情况、镇静剂的使用以及全身麻醉方面，似乎存在很大差异。包括执业地点、龋齿患病率、患者群体、个人培训经历和技能以及责任成本等变量，显然会影响儿科牙医对各种治疗方式适当性的认知及其应用选择。对于知情同意问题、手捂嘴尤其是手捂嘴厌恶疗法（HOMAR）的适当性，以及镇静剂和全身麻醉的使用与过度使用，似乎存在更多担忧。在风险管理领域，尽管许多人报告称自己在识别和处理诊所内医疗紧急情况方面能力很强且得心应手，但其他使用各种形式诊所内镇静的人则报告称，他们的急救和监测设备或培训很少。
