Abstract
A questionnaire survey was conducted on JSDH-certified dentists of the Japanese Society of Dentists which focused on the selection factors of behavior management methods and whether dentists inform patients with disabilities about these methods before they obtain consent. The objective was to identify problems that may support decision-making in regards to patients with disabilities.
The subjects were 300 dentists randomly selected among 1,053 JSDH-certified dentists of the Japanese Society of Dentists in 2016. The behavior management methods that they could perform were behavior modification（94.7％）, body restraint（85.2％）, physical control（78.7％）, N2O inhalation sedation（69.8％）, intravenous sedation（56.2％）, and general anesthesia（47.3％）. They were classified by the cluster analysis method as “the medicine group” and the “non-medicine group”. Dentists in the non-medicine group were significantly less likely to refer to the severity of the disorder, number of untreated teeth, wishes of the parents, and hospitalization time, than the medicine group. These results were attributed to the fact that the dentists in the non-medicine group had fewer behavior management methods, and it was inferred that the medical cooperation system for persons with disabilities was not established in the area. 12.4％ of the dentists do not always explain the suppression method to parents when the patient has the possibility of refusing the treatment. 40％ of dentists answered that sometimes they do not explain to parents the procedure of the treatment in order to perform general anesthesia or intravenous sedation in other medical institutions. In medical disputes, not explaining possible behavior management methods in order to obtain informed consent may be a violation of the duty to explain. Regarding “you explain the behavior adjustment method to the mentally handicapped yourself and ask for consent”, 33.7％ answered “occasionally”, 32.5％ “rarely”, and 17.2％ “never”. It is considered that decision support has not been provided in the field of dentistry for the disabled, and is not generally standardized in special needs dentistry. Guidance that standardizes the process of decision support is necessary.
