Basic Approach to Dental Treatment under Physical Restraint(based on the "Approach to Physical Restraints" premise provided the Ministry of Health, Laborand Welfare)Physical restraints employed in general medical and nursing care settings are based onrecommendations by the Ministry of Health, Labor and Welfare (MHLW), and have long beenused as an unavoidable technique in medical and nursing care settings from the perspective ofensuring safety. In principle, physical restraint is considered to be an act of abuse, though does
not fall under the category of "urgent and unavoidable cases"*, as defined in the "PhysicalRestraint Guidance" (edited by the Ministry of Health, Labor and Welfare's Operation Zero
Physical Restraint Promotion Council), thus is used in such instances where the life or body ofthe patient is in danger. Therefore, the Society has established the following criteria for patients
who are subject to use of physical restraint.

(1) Patients for whom physical restraint is deemed necessary to ensure the safety of dental
treatment due to their young age or some other disability.
(2) The necessity of physical restraint must be recognized by more than one person, such as adentist and a dental hygienist.
(3) The method and duration of restraint must be explained to the patient or guardian in an easyto-understand manner, and their consent must be obtained.
(4) A person other than the primary physician must be present during the restraint to monitor
safety.
Patients who meet these requirements are eligible for treatment under physical restraint.
Physical restraint includes use of a Restrainer®, towels, and restraint belts, as well as manual
restraint by the primary physician or assistant.

Procedures for performing dental treatment under physical restraint(1) The physician in charge of the procedure and at least one other dentist or dental hygienist mustfirst approve the need to use a restraint device (Restrainer®, towels, etc.).
(2) For treatment performed under mild manual restraint, verbal parental consent for restraint isobtained.
(3) When treatment is performed under restraint with a restraint device, consent by the patient orguardian must be obtained, and a consent form signed. When obtaining the consent, thetreatment provider must be sure to explain the method, duration, and preoperative andpostoperative measures of restraint.
(4) When using a restraint device, not only the surgeon but also an assistant dentist or dental
hygienist must assist the patient, and a biological monitor for heart rate and blood oxygen
saturation (SpO2) must be worn by the patient to ensure their safety.
(5) After dental treatment under physical restraint, the preoperative, intraoperative, andpostoperative conditions must be documented in the medical records of the patient.

Note: *Three requirements that fall under the category of “urgent and unavoidable cases”, asdefined by the Ministry of Health, Labor and Welfare.
(1) Imminence: When there is a significant likelihood that the life or body of the patient or others
will be endangered.
(2) Non-substitutability: There is no alternative to physical restraint.
(3) Temporality: Physical restraint must be temporary.