Faculty of Dentistry, McGill University, Montréal, QC, Canada.
Division of Dentistry, Montréal Children's Hospital, Montréal, QC, Canada.
JDR Clin Trans Res. 2022 Oct;7(4):371-378. doi: 10.1177/23800844211041952. Epub 2021 Oct 10.
The use of physical constraint in pediatric dentistry is highly controversial. Papoose boards in particular, which envelop and immobilize children during treatment procedures, have been described as barbaric devices even though their goal is to protect the patient. In this debate, the voice of parents is important but still missing in the scientific literature.
To understand how parents or caregivers experienced physical constraint and the use of the papoose board on their children during regular dental treatment.
We conducted qualitative research rooted in interpretive phenomenology. Accordingly, we performed in-depth individual interviews with a purposive sample of 7 parents or caregivers. The interviews took place in Montréal, Canada, after the children had been treated with a papoose board for nonemergency dental treatments. The discussions were audio recorded, transcribed, and thematically analyzed.
Two perspectives emerged among participants. Some explained that the papoose board calmed their children, helped the dentist to complete the procedures, and made their experience less stressful. For others, the papoose board was a horrible and traumatizing experience, leading to feelings of guilt toward their children. They expressed anger toward the dentists for not allowing them enough time to decide and for imposing use of the device.
Our study raises serious ethical concerns about this practice. We believe that using a papoose board should remain an extraordinary measure and, more generally, that dental professionals should reflect on the place of children and their families in clinical encounters.
The findings of this study should encourage policy makers, dental professionals and ethicists to consider the following points: 1) the traumatizing experiences described by parents raise serious ethical concerns about the use of papoose boards; 2) the dental profession should reflect on the place of children and their families in the clinical encounter and grapple with the importance of consent and how to ensure consent in encounters involving children and their parents.
在儿童牙科中使用身体约束是极具争议的。特别是襁褓式固定器，它在治疗过程中包裹和固定儿童，尽管其目的是保护患者，但仍被描述为野蛮的装置。在这场争论中，父母的声音很重要，但在科学文献中仍然缺失。
了解父母或照顾者在常规牙科治疗中如何看待对孩子使用身体约束和襁褓式固定器。
我们进行了扎根于解释现象学的定性研究。因此，我们对 7 名父母或照顾者进行了有针对性的深入个人访谈。访谈在加拿大蒙特利尔进行，访谈对象的孩子在接受非紧急牙科治疗时使用了襁褓式固定器。讨论内容被录音、转录并进行了主题分析。
参与者中有两种观点。一些人解释说，襁褓式固定器使他们的孩子平静下来，帮助牙医完成治疗过程，使他们的体验压力更小。对于另一些人来说，襁褓式固定器是一种可怕的、创伤性的经历，导致他们对孩子感到内疚。他们对牙医不允许他们有足够的时间做出决定并强制使用该设备感到愤怒。
我们的研究对这种做法提出了严重的伦理问题。我们认为，使用襁褓式固定器应仍然是一种特殊措施，更广泛地说，牙科专业人员应反思儿童及其家庭在临床接触中的地位。
这项研究的结果应该鼓励政策制定者、牙科专业人员和伦理学家考虑以下几点：1）父母描述的创伤经历对襁褓式固定器的使用提出了严重的伦理问题；2）牙科专业人员应反思儿童及其家庭在临床接触中的地位，并思考同意的重要性以及如何确保在涉及儿童及其父母的接触中获得同意。
