Exploring the decisions made by pediatric dentists when choosing behaviour management strategies for children with autism

Objectives: General anaesthesia (GA) is commonly used for managing the dental treatment of children with autism (children with autism). However, less invasive behaviour management alternatives may reduce the need for GA. This study aimed to explore the factors that shape the choices Canadian pediatric dentists make with respect to the array of behaviour management methods in order to provide safe and effective dental care for children with autism. Methods: Semi-structured qualitative interviews were conducted with pediatric dentists across Canada using Zoom. We included: 1) actively practicing Canadian pediatric dentists, 2) practicing in a hospital and/or private office settings. Recruitment occurred through purposeful, convenience, and snowball sampling until data saturation was achieved. Hour-long recorded interviews were transcribed and thematically analyzed using interpretive description. Results: Eleven pediatric dentists from nine provinces/territories (six females, five males) participated (3-40 years’ experience). Six themes shaped practitioner decision making: 1) variations in patient characteristics (e.g., age, severity of autism, treatment needs), 2) building patient resilience in and out of the dental environment, 3) diverging views toward the use of advanced behaviour management strategies, 4) involvement of the family in shared decision making, 5) running a business within a resource limited system, and 6) individual practitioner characteristics (e.g., tolerance, flexibility). Points of tension emerged when discussing the use of advanced behaviour guidance techniques, such as physical restraint and GA. Some practitioners viewed GA as a missed opportunity to build patient resilience and comfort with dentistry. These practitioners preferred desensitization where trust is built over several appointments. In contrast, other specialists saw GA as a means of fostering equity, avoiding physical conflict, and delivering high quality care. Conclusions: Practitioner decision-making is complex, context-dependent, and shaped by individual ideologies. Research that holistically identifies the range of behaviour management strategies and underlying discretionary tensions is important in increasing the discourse within this field and aid in developing evidence-based guidelines for dental management of children with autism.