Management of the difficult child: a survey of pediatric dentists' use of restraints, sedation and general anesthesia.

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.