Experiences with sedation and restraint during dental treatment in Romania.

In August, 1995 dental treatment was provided in an orphanage in Romania. This treatment took place over three weeks using three different dentists. Two dental nurses served for full the duration. For the last two weeks the team was joined by a dental health educator. All have given accounts of their time in Romania. The patients had various degrees of handicap but generally co-operation for treatment was poor. Most patients needed pre-operative sedation of oral valium. A papoose board was used for restraint. All the contributors agree that this was extremely helpful in controlling the patients. Dental treatment was mostly-restricted to extractions. A parallel preventive programme was run by the dental health educator. The team encountered bureaucratic problems which were overcome. All 220 children in the orphanage were screened and treated. Local children and adults were also given dental treatment when time allowed. The team wish to express gratitude to all who helped and supported them. They plan a future mission in 1997. In 1994, a dental team had previously travelled to Romania and carried out treatment of handicapped children using sedation & restraint. The principal difference between 1994 and 1995 was the introduction of the papoose board as the method of restraint. The papoose board is a temporary restraint device for use during medical or dental procedures. It is a set of canvas flaps with velcro fasteners on a board. A head strap and wrist straps are important accessories. Pre-operative sedation was given to the children 2-3 hours in advance of dental treatment. This usually was 10-20 mg oral valium. The child was then led into the dental surgery by hand and placed on the papoose board, which was already situated on the reclined dental chair. Before the child realised what was happening the wrist straps and leg straps were in place. Within seconds the other straps were closed and the child was totally restrained and ready for dental treatment. Dental treatment was then carried out using local anaesthesia. Care has to be taken that the restraint does not impair the patient's breathing, circulation, cause over-heating or positional injuries. A dental health education programme was run in parallel with the treatment service. The individual accounts of experiences follow. Firstly, the joint account of Dental Nurses Catherine Treacey and Karen Vaughan from the Dublin Dental Hospital, who were working for the full three weeks. Then follow the accounts of the dentists. On week 1 by Anne O'Neill, who works with the Eastern Health Board in the Dun Laoghaire area, week 2 by Robert Gorby, a dentist in private practice in Carlow, and week 3 by Brendan Fanning who works part-time for the Eastern Health Board, in Wicklow and part-time in practice in Ashford, Co. Wicklow. The final account is of the dental health education programme by Miriam Henshaw, Health Educator who works for the Eastern Health Board in the Wicklow area.