Clinical holding as a behavior guidance technique in clinical pediatric dentistry: an integrative review

Introduction. The shaping, managing, and guiding of a child’s behavior in the stressful context of a dental setting forms one of the pillars of clinical pediatric dentistry. When pharmacological methods are inaccessible, unavailable, and unaffordable, establishing a direct physical contact with the pediatric patient to counter their maladaptive behavior becomes imperative. The way a child should be held is called clinical holding. However, there exists no singular policy or guideline for dental practitioners on how children should be held in a controlled, comfortable, careful, legal, and appropriate manner. This article thus critically reviews the current literature and recommends a training regimen or protocol for clinical holding as applicable to pediatric dentistry. Methodology. A literature search was carried out across relevant databases, and studies were included for final data synthesis based on the research question framed by the SPIDER framework. Results. 16 articles were identified at the end of the literature search. They went through a realistic evaluation based on the Context-Mechanism-Outcome configuration. Discussion. Whetten’s Model of Theory Development was then followed to outline an evidence-backed theory by a phase-wise evaluation of the included studies. An outline for recommendations and a training regimen was then drawn to justify clinical holding in dentistry. Conclusion. This review recommends clinical holding as an approach to guiding a child’s maladaptive behaviors in dentistry by developing a theory and framework of its use with recommendations for healthcare professionals.