Why the “Hand Over Mouth” Technique is Problematic for Dentists

Hand over mouth (HOM) techniques in pediatric dental patients trigger fear, anxiety, and non-compliance. Thankfully, sedation dentistry offers a safer, more effective alternative for the dentist and patient.

By Sharon Boyd, MA, RDH

Recently, a Virginia dentist made headlines by incorporating a “hand over mouth” (HOM) technique on a pediatric patient who failed to cooperate during a scheduled dental procedure. In addition to placing his hand over her mouth, his dental assistant also restrained the patients’ hands as they worked together to calm the patient. Shortly after that, they found themselves facing a police investigation.

When it comes to behavioral management—particularly in pediatric settings—sedation dentistry offers a gentler and safer alternative for patients with dental fear and anxiety.

The Long-Term Risk to Children (and Adults)

“Old School” methods such as hand-over-mouth practices simply entice fear in already anxious patients. Negative experiences such as the HOM technique in a dental practice can instill long-term phobia and anxiety related to future oral health care experiences. Just one occurrence of forced physical restraint is enough to prevent a child (and future adult) from desiring to step foot in a dental practice ever again.

Unfortunately, the effects of these techniques are far-reaching. They often create a widespread lack of trust within family and community networks, leading to doubt and lack of compliance when dentists prescribe treatment for pediatric patients.

Fear-Free Dentistry 

Considered abusive by some dentists and discouraged by leading dental organizations, dental schools no longer teach the HOM technique. The American Academy of Pediatric Dentistry (AAPD) officially eliminated the HOM technique from its behavioral management techniques several years ago. Two of the more prominent alternatives in its place remain to be voice control and sedation. Others include tell-show-do, modeling, positive reinforcement, and distraction.

HOM and restraint techniques also may be considered assault and, in addition to dental board disciplinary action and a lawsuit from the pediatric patient’s parent, can result in criminal charges being filed against a dentist who touches a child against the will of either the child or the child’s parents.

Sedation dentistry provides a safe, practical, and sensitive way to assist families when it comes to accessible pediatric dental procedures. Regardless of the child’s treatment complexity or level of uncooperativeness, planning for sedation ensures a predictable visit that is safe for the child and dental team alike.

When practices incorporate sedation into therapeutic and restorative procedures, it allows for greater transparency and peace of mind for all parties involved. Even using lighter forms of analgesia such as nitrous oxide can make a tremendous difference. Compared to treatment deferral, sedation makes it possible to intercept oral health concerns at earlier stages of development, minimizing the complexity of children’s dental needs in the future. Modern behavior guidance for pediatric patients as per the AAPD emphasizes that something as simple as nitrous oxide sedation both reduces anxiety as well as improves communication with young patients. It also raises the pain reaction threshold, reducing children’s likelihood to react negatively during their care experience.

For deep sedation, the AAPD recommends two trained professionals are present at all times during pediatric procedures, and some states require three trained professionals to be present. Since general anesthesia can be performed within properly trained and permitted private dental practice settings, anesthesia providers can reduce stress for families and caregivers by eliminating the need to visit a hospital or ambulatory setting for their child’s dental care. In turn, moderate to deep sedation makes care more accessible in situations where the children or parents may be more hesitant to comply with recommended care plans. State regulation greatly restricts the ability of general dentists to earn deep or general anesthesia permits for any patient but particularly for pediatric patients. This makes it quite difficult to locate a general dentist permitted to administer deep or general anesthesia to pediatric patients.

Based on the AAPD’s behavior management recommendations, it’s considered “unethical” to withhold sedation from children who need it. Dentists need to consider factors such as the child’s age, whether treatment deferral is appropriate, the extent of the child’s dental needs, and emotional development, among others.

It’s easy to see how safe and gentle sedation dentistry—rather than HOM techniques—is a favorable alternative for all parties involved. Trained, licensed, and permitted sedation dentistry provides a more relaxing experience for pediatric patients and safeguards the dental provider and business against potential legal action, both civil and criminal, related to the physical restraint of patients.


Author: Sharon has over 20 years of experience in the dental industry and is the founder of DentaSpeak, LLC. In addition to being a registered hygienist, she serves as a full-time patient education professional with special interests in strategic dental communications. She often works as a liaison between practitioners and patients, bridging the gap between care needs and patient concerns. Sharon is an Ironman, band mom, and enjoys volunteering at her family’s church.

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