3-year survival rates of retained composite resin and ART sealants using two assessment criteria

Abstract The aim was to test the null-hypothesis that there is no difference in the cumulative survival rate of retained composite resin (CR) sealants and a high-viscosity glass-ionomer Atraumatic Restorative Treatment (ART) sealant in first permanent molars calculated according to the traditional and the modified retention assessment criteria over a period of 3 years. This cluster-randomized controlled clinical trial consisted of 123 schoolchildren, 6–7-years-old. At baseline, high-caries risk pits and fissures of fully erupted first permanent molars were treated with CR and ART sealants. Evaluations were performed after 0.5, 1, 2 and 3 years. Retention was scored for free-smooth surface and for each of three sections into which the occlusal surface had been divided. The modified criterion differed from the traditional in that it determined an occlusal sealant to be a failure when at least one section contained no visible sealant material. Data were analysed according to the PHREG model with frailty correction, Wald-test, ANOVA and t-test, using the Jackknife procedure. The cumulative survival rates for retained CR and ART sealants in free-smooth and occlusal surfaces for both criteria were not statistically significantly different over the 3 years. A higher percentage of retained CR sealants on occlusal surfaces was observed at longer evaluations. Cumulative survival rates were statistically significantly lower for the modified criterion in comparison to the traditional. The modified retention assessment criterion should be used in future sealant-retention studies.

Clinical Strategies for Managing Dental Caries in Egypt: Opinions of General Practitioner Dentists.

Background: To assess the approach of GPDs in Upper Egypt regarding preventive and restorative treatments for various stages of carious lesion development. Methods: A 42-item questionnaire was constructed for obtaining the GPD’s opinions. Factor analyses (with Varimax rotation) were conducted to identify scales (clusters) of variables. Logistic regression analyses, with continuing professional development as dependent variable, were conducted to test for the effect of single and scaled factors regarding indications to perform preventive or restorative treatments Results: All 70 participants returned the questionnaire. Three scale factors, i.e., treatment strategies, were identified as: ‘operative-minded dentists’ (who make >10 amalgam and resin composite restorations per week); ‘problem solvers’ (who have >10 years of experience, see >60 patients and make >10 temporary restorations per week); and ‘thinkers’ (who spend >50 hours / year on continuing professional development but also make >10 restorations per week). Logistic regression analyses found only one statistically significant relationship (p=0.03): ‘operative-minded dentists’ indicated provision of significantly less caries-preventive measures. Most patient visits were pain-induced. Conclusion: It was concluded that most GPDs in Upper Egypt have an operative-minded treatment philosophy, and spend less time on preventive measures. Amalgam is the most common restorative material used.

Knowledge of Primary Health Care Providers in Nairobi East District, Kenya, Regarding HIV-related Oral Facial and Other Common Oral Diseases and Conditions.

Background: In the Kenya primary health care (PHC) setting where most patients, including nearly 1.4 million HIV-infected people, seek medical care, PHC providers are expected to identify and manage HIV-related oral diseases during general consultations. This study aimed to assess the current knowledge of clinical officers and nurses in Nairobi East district of Kenya regarding HIV-related oral diseases and conditions. Design and Methods: A 40-item questionnaire was used in interviewing all 57 PHC providers in 2 administrative divisions in the district in a cross-sectional survey. Assessed categories were: knowledge about HIV-related oral lesions, clinical appearance of HIV-suspected conditions, knowledge about oro-pharyngeal candidiasis (OPC), general dental knowledge, common appearances of OPC, knowledge about periodontitis, causes of dental caries, frequency of general oral examinations and past training in oral health topics. The first 4 categories were confirmed as sub domains, with Cronbach’s alpha of 0.57, 0.54, 0.59 and 0.45 respectively. Results: All 57 PHC providers (15 clinical officers and 42 nurses) completed the questionnaire (response rate 100%). PHC providers did not routinely perform oral examinations. Their knowledge about HIV-related oral health topics and general oral health was found to be generally inadequate. Recommendations: A training module on HIV-related oro-facial lesions for Nairobi PHC providers, incorporating a practical session covering oral examinations, is recommended; especially in this high HIV-prevalence environment.

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.

Dental practitioners' attitudes, subjective norms and intentions to practice atraumatic restorative treatment (ART) in Tanzania

The aim of this study was to describe the attitude and subjective norm of dental practitioners towards practicing the atraumatic restorative treatment (ART) in Tanzania. A pre-tested questionnaire on attitudes and subjective norms to practice ART was mailed to all 147 dental practitioners working in the regional and district government clinics. The independent variables were: gender, working experience, qualification and ever heard of ART. The dependent variables were: attitude, subjective norm and intention to practice ART. Chi-square tests and multiple regression analysis were used to test for effects between independent and dependent variables. Significance level was set at 5 percent. A total of 138 practitioners returned completed questionnaires. More experienced dental practitioners encountered moderate social pressure than less experienced dental practitioners, who met strong social pressure (p=0.045). A total of 73.2 percent of dental practitioners felt that ART was worth introducing in Tanzania, 92.8 percent recommended ART training for all dental practitioners and 97.8 percent recommended inclusion of ART in dental curricula. Positive attitude, strong subjective norm and high intention to practice ART were recorded in 76.3 percent, 28.1 percent and 90.6 percent of the practitioners, respectively. Only subjective norm had a statistically significant influence on the intention to practice ART (p<0.0001). The results indicated that dental practitioners were willing to have ART introduced in Tanzania and had positive attitudes towards practicing this technique. Nevertheless, their intention to perform ART was strongly influenced by social pressures. Therefore, in order to have a successful introduction of ART in Tanzania, people who matter in the daily practice of dental practitioners need to accept and appraise the ART approach positively.