American Dental Association

View all recommendations from this society

Released June 27, 2016

Avoid protective stabilization, sedation or general anesthesia in pediatric patients without consideration of all options with the legal guardian.

Some children do not respond to communicative behavior guidance techniques and require treatment of dental disease. Advanced behavior guidance techniques of sedation, protective stabilization, and general anesthesia offer risks and benefits often beyond the health knowledge of parents and other caretakers. Informed consent best practice requires a thorough, understandable explanation of these techniques and alternatives including deferral of treatment with its inherent risks.


Support for the ADA’s development of Choosing Wisely recommendations was provided by a grant from the Robert Wood Johnson Foundation.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their dentist.

How The List Was Created

The American Dental Association (ADA) is a professional organization that supports the practice of evidence-based dentistry and routinely develops clinical guidelines for various clinical topics, including the use of dental sealants to prevent tooth decay and fluoride toothpaste for young children.

To create this list, the ADA’s Council on Access, Prevention and Interprofessional Relations established a Steering Committee consisting of ADA members representing evidence based experts in general dentistry and various disciplines within dentistry, including research, cariology, oral surgery, periodontology, public health, geriatrics and pediatric dentistry. Steering Committee liaisons included representatives from the ADA Council on Dental Practice, Council on Dental Benefit Programs, Council on Communications and Council on Scientific Affairs and representatives from dental specialty organizations.

The Steering Committee reviewed critical issues in dentistry to identify potential recommendation topics and developed, through an evidence-based process, a list of recommendation statements with supporting scientific evidence. Via an intense consensus process, the Steering Committee prepared a list of recommendation statements which were sent to the Council on Access, Prevention and Interprofessional Relations for review. The Council voted to recommend the final five recommendation statements on this list to the ADA Board of Trustees for its approval. The five recommendation statements were approved for distribution by member vote by the ADA Board.

ADA’s disclosure and conflict of interest policy can be found at www.ADA.org.

Sources

American Academy of Pediatrics; American Academy of Pediatric Dentistry, Coté CJ, Wilson S; Work Group on Sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006 Dec;118(6):2587-602.

Academy of Pediatric Dentistry Council on Clinical Affairs, American. Guideline on protective stabilization for pediatric dental patients. Pediatr Dent. 2013 Sep-Oct;35(5):E169-73.

Council on Clinical Affairs, American Academy of Pediatric Dentistry. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent 2014;36(6):179-191.

Council on Clinical Affairs, American Academy of Pediatric Dentistry. Policy on a patient’s bill of rights and responsibilities. Pediatr Dent 2014;36(6): 113-14.

American Academy of Pediatric Dentistry. Guideline on protective stabilization for pediatric dental patients. Pediatr Dent. 2013 Sep-Oct;35(5):E169-73.

American Academy of Pediatrics and American Academy of Pediatric Dentistry. Guideline for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures Pediatr Dent. 2008-2009;30(7 Suppl):143-59.