Contención clínica como técnica de manejo de conducta en odontología pediátrica: revisión integrativa
Resumen
Introducción. La modelación, gestión y orientación de la conducta del niño en el contexto estresante de la consulta odontológica constituye uno de los pilares de la odontología pediátrica. Cuando los métodos farmacológicos son inaccesibles, no están disponibles o no son asequibles, se vuelve imperativo establecer un contacto físico directo con el paciente pediátrico para contrarrestar conductas desadaptativas; a esta técnica se le denomina contención clínica (clinical holding). Sin embargo, no existe una política ni una guía única para los profesionales de la odontología sobre cómo sujetar a los niños de manera controlada, cómoda, cuidadosa, legal y apropiada. El objetivo de este artículo es revisar críticamente la literatura disponible y proponer un programa de formación o un protocolo de contención clínica aplicable a la odontología pediátrica. Metodología. Se realizó una búsqueda bibliográfica en bases de datos relevantes y se incluyeron estudios para la síntesis final de datos con base en una pregunta de investigación formulada mediante el marco SPIDER. Resultados. Se identificaron dieciséis artículos al finalizar la búsqueda bibliográfica. Estos fueron sometidos a una evaluación realista basada en la configuración Contexto–Mecanismo–Resultado. Discusión. Se aplicó el Modelo de Desarrollo de Teoría de Whetten para delinear una teoría sustentada en la evidencia mediante una evaluación por etapas de los estudios incluidos. A partir de ello se elaboró un esquema de recomendaciones y un programa de entrenamiento para respaldar el uso de la contención clínica en odontología. Conclusiones. Esta revisión respalda la contención clínica como una estrategia de manejo de conducta en odontología pediátrica y presenta un marco teórico con recomendaciones para los profesionales de la salud sobre su uso adecuado.
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