Pharmacological approaches and physical restraint in dental care for individuals with intellectual and neurodevelopmental disabilities and challenging behaviour: a scoping review of patients' and caregivers' experiences.

Purpose: There is controversy and debate around the use of pharmacological and physical dental behaviour support techniques amongst practitioners treating patients with challenging behaviour and intellectual and neurodevelopmental disabilities. However, the experiences of patients and caregivers remain underexplored. This scoping review aimed to identify the experience of patients with intellectual and neurodevelopemental disabilities and challenging behaviour and their caregivers regarding the use of physical and pharmacological procedures during dental care.

Methods: A scoping review was conducted, incorporating evidence from both quantitative and qualitative study designs to clarify concepts and identify gaps in the literature, using all the main medical databases.

Results: From 1575 screened records, 13 studies were included. Ten were quantitative or mixed-method studies focusing on the acceptance of behaviour support techniques from the caregiver's perspective, particularly for children with special needs. Seven studies were from the Americas, none from Europe or Africa. Two major themes emerged: validity of consent; and the acceptance of different dental behaviour support techniques by parents and caregivers.

Conclusion: The most acceptable techniques for parents and caregivers were non-invasive, behaviour based support techniques. When these failed, physical support techniques seemed to be more acceptable than pharmacological approaches (sedation or general anaesthesia), although this may be related to cultural context and/or lack of financial support. No studies reported the patient perspective of behaviour support techniques so no conclusions can be drawn as to which techniques are acceptable from the patient's point of view. Further qualitative studies are essential to explore the experiences and expectations of patients with special dental care needs.