| (D) patients with non-emergent treatment needs in order
to accomplish full mouth or multiple quadrant dental rehabilitation;
or
(E) the dentist's convenience.
(11) Documentation. In addition to the record requirements
in §108.8 of this title (relating to Records of the Dentist),
the patient records shall include:
(A) indication for stabilization;
(B) type of stabilization;
(C) informed consent for protective stabilization;
(D) reason for parental exclusion during protective
stabilization (when applicable);
(E) the duration of application of stabilization;
(F) behavior evaluation/rating monitoring during stabilization;
(G) any adverse outcomes, such as bruising or skin
markings; and
(H) management implications and plans for future appointments.
(12) Patients with Special Health Care Needs.
(A) Children and adolescents with special health care
needs will at times require protective stabilization to facilitate
completion of necessary dental treatment. Aggressive, uncontrolled,
and impulsive behaviors along with involuntary movements may cause
harm to both the patient and dental personnel. Use of protective stabilization
reduces potential risks and provides safer management of patients
with special health care needs. When considering protective stabilization
during dental treatment for special health care needs patients, the
dentist in collaboration with the parent or guardian must consider
the importance of treatment and the safety consideration of the restraint.
(B) The dentist should be cautious when utilizing protective
stabilization on children and adolescents receiving multiple medications.
The propensity of adverse central nervous system or cardiac events
occurring may increase when protective stabilization is instituted
on patients receiving psychotropic or other medications.
(C) The dentist should consider utilizing alternative
behavioral approaches to reduce movement and resistance as well as
increasing cooperation when proving medically necessary dental care
for patients with special health care needs prior to implementing
protective stabilization, such as:
(i) distraction via counting, positional modeling,
and repetitive tasks and visits;
(ii) shaping;
(iii) modeling;
(iv) sensory integration;
(v) desensitization;
(vi) reinforcement; or
(vii) non-pharmacological behavior guidance approaches
by skill training in acceptable behaviors in the dental operatory.
(e) Deferred Treatment. Treatment deferral or discontinuance
shall be considered in cases when treatment is in progress and the
patient's behavior becomes hysterical or uncontrollable. In such cases,
the dentist shall halt the procedure, discuss the situation with the
parent or guardian, and either select another approach for treatment
or defer treatment based upon the dental needs of the patient. Upon
the decision to defer treatment, the dentist shall immediately complete
the necessary steps to bring the procedure to a safe conclusion before
ending the appointment. A recall schedule shall be recommended after
evaluation of the patient's risk, oral health needs, and behavior
abilities.
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| Source Note: The provisions of this §108.14 adopted to be effective June 11, 2014, 39 TexReg 4429; amended to be effective September 3, 2014, 39 TexReg 6856; amended to be effective June 12, 2019, 44 TexReg 2839 |
