A 20-year perspective on the changing use of hand over mouth (HOM) and restraint in postdoctoral pediatric dental education.

PURPOSE This study assessed the current teaching and utilization of the hand over mouth technique in advanced educational programs in pediatric dentistry and compared these results to previous surveys. METHODS A survey, identical to those used in 1979 and 1989, was sent to pediatric dentistry program directors. Descriptive and comparative statistics evaluated the use of HOM, HOMAR, and restraint. Additionally, changing patterns of responses for programs and directors that responded to both the 1989 and 1999 surveys were assessed. RESULTS Eighty-seven percent of directors returned surveys. There was a significant decrease in the number of programs utilizing the HOM technique in the past 10 years (P< 0.0001). Among respondents that returned surveys in 1989 and 1999, 50% of the previous HOM users discontinued its use (P<0.03). Technique non-users were significantly less likely to describe the technique consistent with AAPD guidelines (P<O.0001). Although the 1989 respondents expressed significantly decreased certainty that restraint techniques were free of psychological sequealae compared to 1979 respondents, the continuing decreasing trend observed between the 1989 and 1999 groups was not significant. CONCLUSIONS With continuing uncertainty regarding psychological sequealae associated with HOM, there was a significant decrease in the number of programs advocating its use.