Inside Edition investigates papoose board use in dentistry

For some kids a trip to the dentist can be a traumatic experience. But just imagine what it might be like strapped into a cocoon-like restraining device called a papoose board that is sometimes used to immobilize children at the dentist's office.

They're smiling today, but eight children say they were strapped into a papoose board while visiting the same dentist for routine work.

They're all patients of Dr. Edward Dove. Dr. Dove has a huge pediatric dentistry practice in Southern California and his commercials are specifically targeted to kids like a friendly Saturday cartoon show. But these kids' parents say their experience was nothing to smile about.

"He hit me on the head and said, ‘You better shut your mouth,' four-year-old Abigail Webb told INSIDE EDITION's Chief Investigative Correspondent Lisa Guerrero.

"He strapped me down on a papoose board and I started crying and he kept slapping my cheeks," said six-year-old Tyler Catalfamo, another patient of Dr. Dove.

Dr. Dove says he uses the papoose board properly, after sedating the youngsters.

Read the full story here at Inside Edition

 

When there is news about dentistry in the media, the American Dental Association issues a Red Alert.  Here is the ADA Red Alert issued after the “Inside Edition” story about the use of papoose boards aired April 26,2012. And the ABC Chris Como report about Florida’s children access to dental care; It’s in a “crisis”. Link to ADA Red Alert

Inside Edition and ABC World News Media Stories

"Inside Edition" airs segment on the use of papoose boards

"Inside Edition," a nationally-syndicated newsmagazine show aired a story April 26 about dentists' use of papoose boards during dental treatment. As a result of this rather sensational segment, parents of young children under your care may ask if you use a papoose board in your practice.

Who are on these committees and subcommittees making these guidelines? Who are they cozy with?

 

2011 Behavioral Management Guidelines

The link above contains the latest version, according to the American Academy of Pediatric Dentistry (AAPD). It’s written and revised by the AAPD Clinical Affairs Committee – Behavior Management Subcommittee. I want to know who is on this committees, don’t you?

In fact, I think it is extremely important to know who is on each of these committees and subcommittees. They are setting guidelines and standards that our federal and state government rely heavily on. Most of the time these guidelines are 100% relied upon.

We certainly demand to know who is making our laws and just who these lawmakers are all cozied up with, well, what’s the difference?! NONE!

I’ve found a helpful little website where you can check guidelines for various healthcare professions. It’s at the Agency for Healthcare Research and Quality (AHRQ). It’s the National Guideline Clearing House.

I’ve not tried it, but it appears you can compare guidelines, now isn’t that cool.  Well, if it works anyway.

You can check past guidelines going back to 1997, that seems handy: browse by Organization,Topic,Guidelines in progress, get expert commentaries and much more.

Of course in checking this place out I got fired up over reading all the guidelines for Behavioral Management (D9920). Various terms for it are used; Behavior Guidance, Behavior Management, Behavior Control. The latest term, “Guidance” sounds so much nicer doesn’t it.

I don’t care what they call it, it’s worse than a straight jacket. In a straight jacket you can at least have use of your legs, but not in the papoose board, rainbow wrap, blankets or whatever cuddly term is thrown at the damn thing.

Papoose Board Used On Child At Dentist

I recently discovered that these pictures show the latest attire a child needs to wear to the dentist.

There's just something about the Papoose Board that seems ... unfair, really really sneaky, a betrayal, and a ruthless display of dominance don't you think.

From reading the reports all over the web, I'm not the only one to feel this way. Some states such as Colorado have passed strict guidelines for the use of these for mentally and physically handicapped children and only as a last resort.

But many dentist are using them as standard procedures to get the job done as quickly and easily as possible. One dentist interviewed said it was more cost effect to tie up the child rather that another method or combination of behavior control.

Caution This Video May Be Very Distrubing:



On January 2, 2008, this particular Dental Office, Small Smiles, has now changed it's policies but basically denies they use them as much as they really do. See more here.

Even companies selling this things clearly state they are for use as a "Last Resort" and modifications are highly recommended prior to their use on a child at a dentist office according to the American Academy of Pediatric Dentistry.



There are laws to stop the restraint of our elderly what on earth makes anyone here think it's ok to do it to our CHILDREN is what I'm asking, and so far I've not gotten any answers.

"Imagine a visit to a dentist office where you walk back to your room and see a child strapped down, struggling for his life and the dentist, office personnel and the child's parents look up with a smile. (I didn't look back with any thing close to a smile!) I wanted to call Child Services!"

Dentist's now have a new little gadget called a "dam" they put in your mouth to make it easier to get in and work. It restricts air flow from your mouth and all you are left with is what you can manage to breath through your nose. You really have to put the whole picture together to understand the trauma of it all.



Now we adults can manage that, but a child has a bit more trouble. Especially when they have been thrown in the natures flight or fight emotion and screaming is more important that anything.

Please tell me how a child is supposed to communicate to a dentist tied down, hand, feet and body restrained and this contraption in their mouth supposed to tell a dentist that they are not numb, that they have hit a "hot" nerve or they are about to choke. I would say that any dentist that does this to a child really doesn't care about anything other than drilling some hole, real or not, and making some fast bucks.

Add to the crying hysterically from the event, the nose becomes clogged and now the child can't breath nor move, so it's not far from death for the children, as they see it for sure. They certainly have no trust with those around them cause they are clearly the enemy!

The restraints do not do the job alone, so if you think the dentist just gently wrapping your child in a loving blanket for comfort is what's happening you are dead wrong!

It's only a way of gathering up the flying arms and legs making it easier to use other physical force to hold the child still. The child can still thrash around. Sometimes the dentist will enlist the parents to assist but many time they will tell you that the parents distract the child so you are asked to leave.
While trying to stop the thrashing around (since they are fighting for their lives) they put their arm over their face to try to restrain the head further.

Sometimes they add HOM-Hand Over Mouth - which further panics the child. The child is sure something terrible is going to be done to him, they see this kind of action in cartoons on tv everyday and it never ends well.

Don't try and tell me that putting your hand over the mouth of a child tied up is ok, and that you can assure me through their thrashing about the dentist will not block the only air way they child has-his nose.


Guess how they get the child to open their mouths, they pinch their nose. So you have a child strapped down and no way to get air! How more cruel is that!


A dentist in Florida had been prosecuted because a child's arm was broken while trying to restrain a child, and yes, he was using a papoose board.

• How did this restraint mechanism come to be called a Papoose Board?
  

• How is it still acceptable for it to be called a Papoose Board?
  

• Native American's are insulted at the use of this name offended by the idea that this restraint technique be associated with a cultural tool used for swaddling Native American babies.
  

• I’m sure this is not what their elders intended it to be used for.
• Call it what it is…A restraining board. In this current usage it has nothing to do with a Papoose…which by the way is: A papoose (from the Algonquian papoos, meaning “child”) is an English loanword whose present meaning is “an American Indian child” (regardless of tribe). The word came originally from the Narragansett.
  

I admit the device would serve its purpose well for what it was designed for, pediatric life and limb saving, but there is no excuse to use it to work on a child's baby teeth.

Using the term Papoose is supposed to somehow sooth the real idea of the straight jacket for children in hopes that makes it more acceptable to use. Sorry, it's not working. It's a straight jacket for a child, period!

Dr. Frank Carberry has been a dentist for 40 years and has worked with children in Third World countries. He said he's treated children with major tooth decay without ever resorting to restraining devices.

"I've got five grandchildren,” he said. “I can't imagine the psychological trauma on that child.”

That's where I am. I never treated my children this way and would never allow anyone to tie up my child for dental care. The idea that I have a son and daughter in law, who are supposed to be well educated, would allow this to be done to my 5 year old grandchild has infuriated me.

I don't know when this practice started, nor who ever thought it was a great idea, but I know I certainly never would ever have considered torturing my children in this manor. I started my children early going to a dentist and not once, not one time did any dentist ever mention using any kind of restraint.

• A recent study among dentists showed that only 14% of them condone restraints such as these for dental care of children. It jumped to 20% if the child was pre-medicated.

• Also a study indexed at medline.com showed that adults who experienced HOM or any other kind of restraint for dental procedures were 50% more likely to never see a dentist again!

• In Europe, dentistry is now seeing that this type of treatment is uncalled for and abusive.

"Dr. Kevin J. Urbanek has a complete review of this abuse here. In summary he states: In summary, research exists that demonstrate physical restraints are both potentially harmful, and are being increasing rejected by both practitioners and patient guardians. Alternatives such as medications are currently being explored and should be strongly considered instead of using physical restraints."

What needs to be studies is the long term affect on the children who suffered this kind of trauma!

The American Academy of Pediatric Dentistry warns that stabilization devices like papoose boards have potential to seriously harm patients and should only be used in extreme cases where a patient is a danger to himself or his care givers.

One study from the AAPD showed that younger more inexperienced parents would more likely to consent to the use of the PB. (Papoose Board) Where parents 35 years of age and above were much less likely.

Dentists are far too often using the "danger to himself or his care givers" as an excuse to exspediate the procedure. Dentist are not taking in to consideration as to the real urgency of the procedure. Just the cost savings of a quick treatment.

Some dentists use the argument they clearly informed the child or child's parents and the child or child's parent/parents agreed to putting on the restraint. Come on, No child thought they would be tied up and tortured when they agreed to this!

• Parents who agree to this all I can ask is: Where is your damn brain!

Filling 4 year molars on a 5 year old child does not constitute Extreme Case, as in my case.

The only extreme case here is the mental status of a parent who would allow this.

Long Term Damage:

Deaths:

• A few children have died from being strapped to one of these boards because the dentist could not see the lethal allergic reaction the child had to the lidocane. Here's one story.

• One woman says, "now I suffer from mild-moderate claustrophobia. I'm not saying this is always the wrong choice, but I wouldn't wish this upon anyone."

• Other children report nightmares, not wanting close contact such as hugs, and one child refuses to sleep with a blanket to cover him.

One little girl told her mother that she dreams every night she is in a coffin and wakes up gasping for air. This has disrupted the entire family to the point they have had to seek professional care with biofeedback to help the child over come these fears.

More than one child has ended up with broken arms and limbs from fighting the restraints.

Many children and been brought into full blown Asthma attacks and seizures due to the trauma of papoose board and pediwrap boards. Your dentist office is NOT equipped to handle this kinds of emergencies.

Read the story of this poor child in Charlotte, NC

• Are those fillings this important to you, are you willing to kill, mame and mentally damage your child over a filling, cap or other nonemergency dental work??

• Find yourself a qualified Dentist, or keep them at home!

Here's another story of Dentist who have lost licenses from this practice.

Here a mother explains the trauma her child experienced:

"At 2 1/2 years old, I took my son to the dentist for the first time. All he had done was a brushing and teeth counting. He hated it! He kicked and screamed, and begged to get up. About 3 months later he had a horrible accident in which he fell and pushed his four front top teeth up into his gumline. He ended up having to have the left front tooth pulled. In order for the dentist to do this she had to place him in a papoose board and strap him down. He freaked out! He screamed like he was on fire, he threw up, he gagged, and he hyperventilated to the point of almost passing out."

You know what really burns my butt, it's these parents worried about the violence on TV, cartoons and children's classic fairy tales, but would take their children to the torture chamber, aka, poorly qualified Dentist!

A Report from California:

A trip to the dentist probably doesn't rank high on anyone's to-do list. Now, imagine if your dentist skimps on appropriate amounts of anesthesia before submitting you to painful procedures.

That's just one of the things California Attorney General Bill Lockyer is alleging in criminal complaints against 20 dentists throughout the state. He's charging them with defrauding the state Medi-Cal System of $4.5 million, health benefits and workers' compensation fraud, conspiracy, grand theft, child abuse, elder abuse, assault and intentional infliction of great bodily injury. (due to using these restraints sweetly called Papoose Boards)

Here is another mother's experience using these typed of dentist, her child busted a blood vessel:

I have a 3 year old and when he went in for a cleaning, the experience was good- probably 4 stars-the nurses were kind but I felt like the Doctor was a little cold. We had to bring my son back for a root canal because of a dead tooth and the experience was traumatic, horrifically scary for my son and we will not go back. The Doctor did not discuss the possibility of any type of sedative with us for this procedure nor did he tell us in advance that my son would be placed on a board and basically placed in a straight jacket. While that may be necessary to complete the procedure, letting parents know what to expect is critical to a good experience. During the procedure, my son, who was so scared that he literally popped blood vessels in his face and neck was told in a firm voice by the dentist "You are yelling at me. You can't yell at me any more. I can't do my job when you are yelling." While certainly, yelling is going to be difficult to deal with, as a doctor who sees patients this young and chooses to perform these types of procedures on them, a certain amount of empathy is required to be considered a good dentist. If my children were older, I'm sure the visits would all be good ones. However, my fellow is 3 and I am disgusted.


Another outraged mom:

My son had 2 cavities. I took him to my dentist and as soon as he got in the room the strapped him to a papoose board and 4 ppl worked on his mouth. No one tried to comfort him. They just held him down with the papoose board which looks basically like a strait jacket. It made his arms and legs immobile and his head was between two boards. When we left he was hysterical. HIs lips were bruised. I did not sign any consent form for them to do this. I decided I was not taking him back to get the other cavity filled there ever. This is 2009, and is ridiculous! Clearly it was not for the comfort or safety of my child, it was for the convenience of the dentist.

Here is a quote from a parent on a message board that pretty much sums up my feelings and anger on this issue:

"A cavity is not worth a lifelong traumatic memory like this. If I found out the dentist covered my daughter's mouth and told her to shut-up ...I'd give him the beating of his life right then and there and then warn him if he called the police he'd get 100 times worse when I got out of jail."

Have any of these Pro Papoose Board Supports even considered the
psychological safety of the patient!

Another recount from a mom: (DS=Dear Son)

I'd only been that dentist once before. DS has Medicaid and I thought it seemed like a lot of work, too, but I told them to do whatever was needed right then so he wouldn't have to go through it again. He also didn't give DS any sedation other than the shot in his gums and he cried so hard he threw up blood. I was crying too, and the dentist said, "This is typical of a child his age to cry, he can't feel anything, he's just afraid of the noises." Uh, hello? DS was afraid because he was strapped down, had a drill in his mouth, blood going down his throat, and some stranger telling him not to cry. I was so mad at myself for letting this happen, and even madder at the dentist. I had called all the dentists who accept Medicaid in my area and none offered anesthesia/sedation. I thought he'd be drowsy from the shot (he wasn't) and I wasn't expecting all that to happen - torture! Argh! Sorry, this turned into a long rant here....

updated: 1-15-2008

This may be one reason some dentist resort to papoose board instead of other types of sedation for persons under 13 years of age. Permits, Education, More Training. Below is from the Kentucky Board of Dentistry.

• Dental Anesthesia Permits
  Any dentist who wants to administer general
  anesthesia, I.V. conscious sedation, or oral
  sedation for patients under the age of 13, must
  first secure a permit from the Board. To
  receive a permit, an application with supporting
  documentation of education and experience
  must be submitted along with the permit
  application fee. An office inspection must also
  be done before anesthesia can be performed in
  a dental office. A permit will not be issued for
  any of the above types of permits until all
  requirements have been met. Until a permit is
  issued, anesthesia cannot be administered.
  University of Louisville is requesting your
  participation