Note from the author: The content is intended as knowledge-based and informative, neither an endorsement of or opposition to the method or information.
Our dental hygiene journey is marked by an arduous path of rigorous and comprehensive dental hygiene courses, a trek culminating in our well-earned licenses. The education provided within dental hygiene programs allows graduates to become great clinicians, educators, researchers, and beyond. However, I want to acknowledge a specific topic in dental hygiene that, in retrospect, would have greatly benefited from a more extensive depth of understanding: pediatric dental hygiene, which can be very different in terms of patient management and treatments than general dentistry.
Because dental caries is a chronic preventable disease that remains a public health problem among children, adolescents, and special needs patients, clinicians need to learn to treat this population with a patient-centered approach.1 Many patients within this population need special patient management devices such as a papoose board, a specialized restraining device designed to immobilize and secure a patient during dental procedures.2 The primary purpose of a papoose board is to prevent sudden movements of the body and head and ensure the child's safety and the success of the dental treatment.
The papoose board typically consists of a flat, padded surface with adjustable Velcro straps that secure the patient's wrists, ankles, and head, limiting their ability to move during dental procedures. The patient is positioned on the board and gently but securely strapped in place. This restraint helps keep the patient still and calm, reducing the risk of injury to both the patient and the clinician.
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Although the papoose board has been banned in certain countries, it is still used here in the US when absolutely necessary. Use a of a papoose board should be done compassionately and safely. As a clinician with 10 years of experience working with special needs and pediatric patients, I found that many parents or guardians prefer the use a papoose device to keep their child/individual safe. Some parents have even said that their child feels like they’re being given a “tight hug,” which in turn makes them calm.3
Considerations before use
Before using a papoose board, clinicians need to have a comprehensive dialogue with the patient's parents or guardians, explaining the necessity and rationale behind using such restraint. A comprehensive explanation of the advantages associated with the device is crucial to ensuring both the efficacy and safety of the dental procedure.
After getting parental/guardian consent, the subsequent pivotal step is selecting an appropriately sized papoose board. These devices vary in dimension and restraint strap configuration, typically encompassing wrist, body, head, and feet/ankle restraints strategically positioned to optimize patient safety and comfort.
The next procedural phase entails reclining the dental chair to achieve parallel alignment with the floor, serving as the foundational support for the papoose board placement. The patient is then positioned with extended legs onto the board, with any necessary assistance from parents or dental staff to ensure a relaxed and comfortable posture that includes optimal bodily alignment on the board and adequate head support with a headrest or pillow.
Next, the dental chair is reclined to align parallel with the floor, and the papoose board is positioned on it. The patient is then positioned on the device with their legs extended. Parents and dental staff may be needed to assist in calmly helping the patient become comfortable with the device, ensuring their body is comfortably resting on the board.
Securing the patient
The process of securing the patient onto the papoose board requires a systematic approach. Starting with the gentle placement of the patient's arms alongside their body, the next part is to secure the Velcro straps of the papoose board around the wrists. This is followed by fastening the body Velcro flaps, the feet/ankle flaps, and culminating, if necessary, by attaching the head strap. Prudent restraint tension—striking a balance between snugness and avoiding excessive tightness—will help ease discomfort and any potential circulatory complications.
Notably, all dental prophylaxis treatments, radiographic procedures, fluoride varnish applications, and pediatric dental examinations can be effectively conducted while the patient remains securely fastened to the papoose board. The clinician's vigilance and continuous monitoring are imperative throughout the duration of the appointment, as is collaborative teamwork.
The thought of using a papoose board, especially for a clinician newly navigating the pediatric or special needs realm, may initially evoke apprehension. However, after proper training in its implementation and witnessing its judicious application in various clinical scenarios, I found my confidence in its utility has grown significantly. The use of a papoose board should always be executed by trained dental professionals well-versed in pediatric dentistry committed to an ethical and compassionate approach that helps ensure the patient's comfort, well-being, and overall positive dental encounter.
References
- Claiborne DM, Poston R, Joufi A. Innovative collaborative service-learning experience among dental hygiene and nurse practitioner students: a pediatric oral health pilot study. J Dent Hygiene. 2020;94(3):29-36.
- Malik P, Ferraz dos Santos B, Girard F, Hovey R, Bedos C. Physical constraint in pediatric dentistry: the lived experience of parents. JDR Clin Trans Res. 2022;7(4):371-378. doi:10.1177/23800844211041952
- Chen HY, Yang H, Chi HJ, Chen HM. Physiologic and behavioral effects of papoose board on anxiety in dental patients with special needs. J Formos Med Assoc. 2014;113(2):94-101. doi:10.1016/j.jfma.2012.04.006
