Restrictive Behaviour Management Procedures with People with Intellectual Disabilities who Require Dental Treatment

Abstract

Background Dental disease is more common among people with intellectual disabilities than in the general population. Improvements in oral health require individuals to engage in daily oral hygiene and regular visits to a dental practitioner; both may be challenging for the individual with intellectual impairment. Materials and Methods A review of policies relating to behaviour management and physical restraint for individuals with intellectual disabilities and challenging behaviours was undertaken. Published studies of behaviour management in individuals with intellectual disabilities attending for dental treatment were reviewed. Reference to studies of children with average IQ and other populations were made where appropriate. Results There is little published evidence regarding behaviour management for people with intellectual disabilities who require dental treatment. Current policies place great emphasis on pharmacological management and restrictive behaviour management techniques. There is a paucity of studies which have employed a functional analysis framework. There are few incentives for dentists to implement positive approaches to behaviour management as current systems of payment reward the completion of numbers of treatments and thus there is an incentive to complete treatments quickly rather than to spend time with patients. Conclusions There is a need for research addressing the behaviour management of individuals with intellectual disabilities who require dental treatment, particularly the efficacy of non-restrictive techniques and the provision of incentives that reward the use of positive behaviour management among dentists. The use of restrictive techniques should be carefully monitored for compliance with best practice guidelines.

Knowledge and practice of behavioral management principles among dentists treating adults with learning disabilities

“…Dentists treating patients who have learning disabilities may find the delivery of care difficult because the patient is not cooperative or behaves in a way that interferes with treatment. Most dentists develop ways to deal with these behaviors, using what is termed “behavior management” or “behavioral management techniques.” 3 These may be either formally learned during undergraduate or graduate training, by observing other dentists, or through trial and error. The use of pharmacological and physical interventions in the dental treatment of people with learning difficulties is established and potentially widespread in dentistry 3 .…”

“…Most dentists develop ways to deal with these behaviors, using what is termed “behavior management” or “behavioral management techniques.” 3 These may be either formally learned during undergraduate or graduate training, by observing other dentists, or through trial and error. The use of pharmacological and physical interventions in the dental treatment of people with learning difficulties is established and potentially widespread in dentistry 3 . The use of nonpharmacological behavioral management techniques is also becoming established as an important facet of managing individuals with learning disabilities 3 .…”

“…The use of pharmacological and physical interventions in the dental treatment of people with learning difficulties is established and potentially widespread in dentistry 3 . The use of nonpharmacological behavioral management techniques is also becoming established as an important facet of managing individuals with learning disabilities 3 . These nonpharmacological behavioral management techniques are advocated because they acknowledge the independence, right to dignity, respect, and involvement of adults with learning disabilities (AWLD) in the consent process 3,4 .…”

“…The use of nonpharmacological behavioral management techniques is also becoming established as an important facet of managing individuals with learning disabilities 3 . These nonpharmacological behavioral management techniques are advocated because they acknowledge the independence, right to dignity, respect, and involvement of adults with learning disabilities (AWLD) in the consent process 3,4 . Most AWLD live in community settings and, hence, are more likely to be seen by general dentists in the U.K 5 .…”

“…Little is known in the U.K. about the level of skills and education in behavior management principles among dentists treating individuals with learning disabilities. Some studies 3 , 6‐10 have reported the use of various behavioral management techniques. For example, authors have reported the use of contingent escape, 6 in vivo desensitization, 7 video modeling, 7 distraction, 8 contingent distraction, 9 and cognitive behavior therapy 10 for managing pediatric patients and AWLD.…”