(a) Parent or Guardian. In this section the term "parent or guardian" refers to one of the following:
  (1) the natural or biological father or mother of a child with full parental legal rights;
  (2) a custodial parent who in the case of divorce has been awarded legal custody of a child;
  (3) a person appointed by a court to be the legal guardian of a minor child; or
  (4) a foster parent - a non-custodial parent caring for a child without parental support or protection who was placed by local welfare services or a court order.
(b) Applicability. This section applies to the use of protective stabilization when treating pediatric and special needs patients.
  (1) For purposes of this section a "knee-to-knee examination" during which the dentist and the patient's parent or guardian put knees together to create a "dental chair" is not considered protective stabilization. A knee-to-knee exam does not use any apparatus or equipment to restrain the patient and does not involve the use of dental personnel other than the treating dentist.
  (2) Although a mouth prop may be used as an immobilization device, the use of a mouth prop in a compliant child is not considered protective stabilization for purposes of this section.
(c) Purpose. Infants, children, adolescents, and patients with special health care needs may require protective stabilization to prevent injury and protect the health and safety of the patient, practitioner, and staff, and to safely expedite emergency treatment for a pre-cooperative child, uncooperative child, or patient with special health care needs if it is deemed necessary for the long-term health of the patient. The goals of protective stabilization as a part of individualized patient behavior guidance are to establish communication throughout dental care; alleviate fear and anxiety; deliver quality dental care; build a trusting relationship between the patient, parent or guardian and the dental professionals; and promote the patient's positive attitude toward dental care. Protective stabilization is an advanced behavior guidance technique in dentistry that can be used for treatment involving pediatric and special needs patients.
(d) Protective Stabilization.
  (1) Protective stabilization is the physical limitation of a patient's movement by a person, restrictive equipment, materials or devices for a finite period of time. Two types of protective stabilization are:
    (A) active immobilization, which involves the physical limitation of movement by another person, such as the parent or guardian, dentist, or dental auxiliary; and
    (B) passive immobilization, which utilizes a restraining device.
  (2) Protective stabilization shall not be used as a means of discipline, convenience, or retaliation. Protective stabilization shall not be used for "routine," non-emergent treatment needs or in order to accomplish full mouth or multiple quadrant dental rehabilitation. Protective stabilization shall cause no serious consequences, such as physical or psychological harm, loss of dignity, or violation of the patient's rights. It is the responsibility of the treating dentist and the dental team to guard against these aforementioned outcomes.
  (3) Training Requirements. A dentist utilizing protective stabilization shall have completed advanced training either through:
    (A) an accredited post-doctoral program or pediatric dentistry residency program that provides clinical and didactic education in advanced behavior management techniques; or
    (B) an extensive and focused continuing education course of no less than 8 hours in advanced behavior management that includes both didactic and clinical education pertaining to Protective Stabilization.
  (4) Practitioner Supervision. The dentist shall not delegate the use of protective stabilization to the dental staff, but they may assist the dentist as necessary.
  (5) Informed Consent.
    (A) Protective stabilization requires written informed consent from the parent or guardian which should be obtained separately from consent for other procedures to ensure parent awareness of the procedure and utilization of protective stabilization. Written informed consent should be documented in the patient's records.
    (B) Informed consent shall include an explanation, by the treating dentist, of the benefits and risks of protective stabilization, alternative behavior guidance techniques, and a clear explanation of the anticipated protective stabilization techniques to be used, including the possible use of restraining devices, and a statement that a parent or guardian may revoke informed consent for protective stabilization at any time.
    (C) If possible, the treating dentist should obtain informed consent for protective stabilization on a day separate from the treatment requiring protective stabilization.
    (D) If the patient's behavior during treatment requires a change in the protective stabilization, separate informed consent must be obtained and documented.
    (E) When providing dental care for adolescents or adults with mild intellectual disabilities, patient assent for protective stabilization should also be considered. Informed consent should take into account the patient's feelings towards the use of protective stabilization. A conditional comprehensive explanation of the technique to be used and the reasons for application should be provided.
    (F) A parent or guardian may revoke informed consent for protective stabilization at any time if they believe the patient may be experiencing physical or psychological trauma due to immobilization.
  (6) Parental or Guardian Presence. The treating dentist should consider allowing parental or guardian presence in the operatory or direct visual observation of the patient during use of protective stabilization unless the health and safety of the patient, parent, guardian, or dental staff would be at risk. If parents or guardians are denied access, they must be informed of the reason with documentation of the explanation in the patient's chart.
  (7) Pre-Stabilization Considerations. Prior to utilizing protective stabilization, the dentist shall consider the following:
    (A) alternative behavior management methods;
    (B) the dental needs of the patient and the urgency of the treatment;
    (C) the effect on the quality of dental care during stabilization;
    (D) the patient's comprehensive, up-to-date medical history;
    (E) the patient's physical condition, such as neuromuscular or skeletal disorders; and
    (F) the patient's emotional development.
  (8) Equipment. The restraining devices used for dental procedures should include the following characteristics:
    (A) ease of use;
    (B) appropriately sized for the patient;
    (C) soft and contoured to minimize potential injury to the patient while maintaining blood flow and respiration;
    (D) specifically designed for protective stabilization; and
    (E) ability to be disinfected.
  (9) Indications. Protective stabilization is indicated when:
    (A) a patient requires immediate diagnosis and/or urgent limited treatment and cannot cooperate due to emotional and cognitive developmental levels, lack of maturity, or medical and physical conditions;
    (B) urgent care is needed and uncontrolled movements endanger the patient, staff, or dentist;
    (C) treatment is initiated without protective stabilization and the patient becomes uncooperative, causing uncontrolled movements that endanger the patient, staff, or dentist, and protective stabilization will enable the dentist to protect the patient's safety and help to expedite completion of treatment;
    (D) a sedated patient requires limited stabilization to help reduce untoward movements during treatment;
    (E) an uncooperative patient requires limited treatment and sedation or general anesthesia may not be an option because the patient does not meet sedation criteria, there is a long operating room wait time, financial considerations, and/or parental or guardian preferences after other options have been discussed; or
    (F) a patient with special health care needs exhibits uncontrolled movements that would be harmful or significantly interfere with the quality of care.
  (10) Contraindications. Protective stabilization is contraindicated for:
    (A) cooperative, non-sedated patients;
    (B) patients who cannot be immobilized safely due to associated medical, psychological, or physical conditions;
    (C) patients with a history of physical or psychological trauma due to restraint;
Cont'd...