Does protective stabilization of children during dental treatment break ethical boundaries? A narrative literature review

Abstract

Aim: Protective stabilization, a method for immobilizing or reducing the ability of a patient to freely move his or her body, raises ethical concerns that should be discussed. This narrative literature review aimed to discuss the bioethical aspects involved in the use of protective stabilization in normally developed children who exhibit behavior management problems in dental care. Methods: A critical review of full papers retrieved from PubMed, LILACS, SCIELO, BBO, supplemented by specialist books, the Brazilian Civil and Criminal Codes, the Brazilian Code of Dental Ethics, and institutional guidelines. Results: The literature indicates that the decision to use protective stabilization in normal children during dental treatment can be based on bioethical principlism, according to the principles of beneficence, non-maleficence, autonomy, and justice. The fears and limitations of a child must be respected and aversive physical impositions should be avoided. When a child does not cooperate with dental treatment, protective stabilization may be indicated with the written consent of parents and for specific procedures of short-duration, such as dental emergencies. Other options for managing the child's behavior in these cases are postponing care or indicating pharmacologic methods. The continuous use of protective stabilization is not justified in elective treatments. Conclusion: The use of protective stabilization in pediatric dentistry breaks ethical boundaries if the dentist is not trained in the application of the method, does not analyze the risks, benefits, and potential harm of the method, insists on its use for several appointments and for non-emergency procedures, does not respect the parents’ opinion and the child’s autonomy (even though in construction), and does not consider local law.