Acceptability, feasibility and perceived satisfaction of the use of the Atraumatic Restorative Treatment approach for people with disability

Unmet caries treatment need is prevalent among people with disability, partly due to difficulties cooperating with conventional dental treatment. This study compared Atraumatic Restorative Treatment (ART) with conventional restorative treatment (CRT) in the clinic and under general anaesthesia (GA), in terms of feasibility, acceptability and respondent satisfaction in patients referred for special care dentistry. Patients referred for dental restorative care were treated using either ART or CRT approach. Acceptance, feasibility and level of satisfaction with the treatment provided were assessed. ANOVA with Bonferroni correction and Chi-square tests investigated differences in age, gender and Visual Analogue Scale satisfaction scores. A total of 66 patients (mean 13.6 ± 7.8 years) were included and 43 respondents chose ART. ART was feasible for 47 patients, with optimal placement of restorations for 79% of all patients receiving ART. CRT in the clinic was chosen by 15 respondents and was feasible for 5 (33%). Local anaesthesia was required for 4 of the 47 patients receiving ART and for 3 of the 5 patients receiving CRT in the clinic. Neither ART nor CRT could be performed in the clinic for 14 patients who were treated under GA (21%). Respondent satisfaction was higher for those receiving ART than CRT (in the clinic and under GA). It was concluded that ART is a satisfactory, feasible, acceptable and effective approach to restorative dental treatment in patients with disability who have difficulty coping with conventional treatment. More research is now required to confirm these results in a larger study population.

Aceitabilidade do tratamento restaurador atraumático pelos cirurgiões-dentistas do serviço público em São Paulo / Atraumatic Restorative Treatment acceptability by dentists in the public service of São Paulo

O objetivo deste estudo foi identificar a opinião dos Cirurgiões-Dentistas que trabalham nas Unidades Básicas de Saúde do Município de São Paulo/SP a respeito da utilização do Tratamento Restaurador Atraumático (ART) na rede pública. Realizou-se um levantamento com 207 Cirurgiões-Dentistas selecionados com amostragem por conglomerado por meio do programa OpenEpi. Os participantes foram avaliados por meio de questionários com respostas objetivas. Os dados foram analisados no programa Stata 9.0. Os resultados mostram taxa de resposta de 27,5% (57). Houve opiniões contrárias à prática do ART entre a maioria dos Cirurgiões-Dentistas daquele setor, entretanto também a maioria deles gostaria de ter maior treinamento teórico e prático para a realização do ART. Pode-se concluir que há interesse entre os Cirurgiões-Dentistas da rede pública em conhecer mais profundamente o ART.

The aim of this study was to identify the dentists opinions who work at Basic Health Units of São Paulo-SP regarding the use of Atraumatic Restorative Treatment-ART in the public oral health system. We conducted a survey of 207 dentists selected by cluster sampling with OpenEpi programo Participants were assessed through questionnaires with objective responses. Data were analyzed using Stata 9.0. The results show a response rate of 27.5% (57). There were opinions contrary to the ART among most dentists, but also most of them would like to have more theoretical and practical training for the ART. The results concluded that there is interest among the dentists from public health in deeper understanding of the ART.

Barriers to the adoption of the ART approach as perceived by dental practitioners in governmental dental clinics, in Tanzania

OBJECTIVES: This study aimed to determine the magnitude of the barriers to the practice of Atraumatic Restorative Treatment (ART) as perceived by dental practitioners working in pilot dental clinics, and determine the influence of these barriers on the practice of ART. MATERIAL AND METHODS: A validated and tested questionnaire on barriers that may hinder the practice of ART was administered to 20 practitioners working in 13 pilot clinics. Factor analysis was performed to generate barrier factors. These were patient load, management support, cost sharing, ART skills and operator opinion. The pilot clinics kept records of teeth extracted; teeth restored by conventional approach and teeth restored by ART approach. These treatment records were used to compute the percentage of ART restorations to total teeth treated, percentage of ART restorations to total teeth restored and percentage of total restorations to total teeth treated. The mean barrier scores were generated and compared to independent variables, using the t-test. The influence of barriers to ART-related dependent variables was determined using Pearson correlation coefficients. RESULTS: Mean barrier values were low, indicating low influence on ART practice. Female practitioners had higher scores on patient load than male practitioners (p = 0.003). Assistant Dental Officers had higher scores on cost sharing than Dental Therapists (p = 0.024). Practitioners working in urban clinics had higher mean scores on patient load than those who worked in rural clinics (p = 0.0008). All barrier factors were negatively correlated with ART practice indices but all had insignificant association with ART practice indices. CONCLUSION: The barriers studied were of low magnitude, with no significant impact on practice of ART in dental clinics in the pilot area.

ART integration in oral health care systems in Latin American countries as perceived by directors of oral health

The aim of this study was to carry out a situation analysis of: a) prevalence of ART training courses; b) integration of ART into the oral healthcare systems and; c) strengths and weaknesses of ART integration, in Latin American countries. MATERIALS AND METHODS: A structured questionnaire, consisting of 18 questions, was emailed to directors of national or regional oral health departments of all Latin American countries and the USA. For two countries that had not responded after 4 weeks, the questionnaire was sent to the Dean of each local Dental School. The questions were related to ART training courses, integration of ART in the dental curriculum and the oral healthcare system, barriers to ART implementation in the public health system and recommendations for ART implementation in the services. Factor analysis was used to construct one factor in the barrier-related question. Means and percentages were calculated. RESULTS: The response rate, covering 55 percent of all Latin American countries, was 76 percent. An ART training course had been given in all Latin American countries that responded, with more than 2 having been conducted in 64.7 percent of the respondent countries. ART was implemented in public oral health services in 94.7 percent of the countries, according to the respondents. In 15.8 percent of the countries, ART was applied throughout the country and in 68.4 percent, in some areas or regions of a country. ART had been used for more, or less, than three years in 42.1 percent and 47.4 percent of the countries, respectively. Evaluation and monitoring activities to determine the effectiveness of ART restorations and ART sealants had been carried out in 42.1 percent of the countries, while evaluation training courses had taken place in only 3 countries (15.8 percent). Respondents perceived the "increase in the number of treated patients" as the major benefit of ART implementation in public oral health services. The major perceived barrier factors to ART implementation were "operator opinion" and "high patient load", followed by "lack in supplies of materials and instruments and operators" and "lack of ART training". Respondents recommended that the number of ART courses should be increased. CONCLUSIONS: The introduction of ART into the public oral health systems in Latin American countries has taken place but is still in its infancy. More ART training courses need to be organized if the approach is to be adopted in oral health service systems in these countries.

The implementation and preliminary evaluation of an ART strategy in Mexico: a country example

The massive use of preventive measures in Mexico including fluoride toothpaste, a national program of salt fluoridation and education on prevention has resulted in a large decline in dental caries over the past two decades. There does however remain a largely unmet need for restorative treatment. This paper describes the steps leading up to the adoption of a strategy, as part of general health policy, to use Atraumatic Restorative Treatment (ART) within the Mexican public health service as a means to address this. This included the development of training materials, the organization of training courses for existing dentists and the incorporation of ART into the undergraduate curriculum. RESULTS: Six years after the introduction of ART in the year 2000, it was estimated that over 2 million ART procedures had been provided. As part of the planning cycle, an evaluation was undertaken in 2008 to determine amongst Mexican dentists what were the perceived problems when implementing the ART approach. Such research identified that the scarcity of appropriate dental materials and the lack of suitable instruments were the major problems. In addition, a preliminary evaluation of ART restorations and sealants placed as part of this National Oral Health Program was undertaken. The survival outcomes after one year compared favorably with one other study conducted in Mexico but were somewhat lower than the results reported from a number of other countries. CONCLUSION: The ambitious and forward thinking policy for improving the oral health in Mexico is now showing dividends. One example is the ART strategy, which has been successful both in terms of the number of ART procedures provided and generally in terms of clinical outcomes.