Oral Health Inequalities between Rural and Urban Populations of the African and Middle East Region.

Although there have been major improvements in oral health, with remarkable advances in the prevention and management of oral diseases, globally, inequalities persist between urban and rural communities. These inequalities exist in the distribution of oral health services, accessibility, utilization, treatment outcomes, oral health knowledge and practices, health insurance coverage, oral health-related quality of life, and prevalence of oral diseases, among others. People living in rural areas are likely to be poorer, be less health literate, have more caries, have fewer teeth, have no health insurance coverage, and have less money to spend on dental care than persons living in urban areas. Rural areas are often associated with lower education levels, which in turn have been found to be related to lower levels of health literacy and poor use of health care services. These factors have an impact on oral health care, service delivery, and research. Hence, unmet dental care remains one of the most urgent health care needs in these communities. We highlight some of the conceptual issues relating to urban-rural inequalities in oral health, especially in the African and Middle East Region (AMER). Actions to reduce oral health inequalities and ameliorate rural-urban disparity are necessary both within the health sector and the wider policy environment. Recommended actions include population-specific oral health promotion programs, measures aimed at increasing access to oral health services in rural areas, integration of oral health into existing primary health care services, and support for research aimed at informing policy on the social determinants of health. Concerted efforts must be made by all stakeholders (governments, health care workforce, organizations, and communities) to reduce disparities and improve oral health outcomes in underserved populations.

Cost implications for the treatment of five oral lesions commonly found in HIV/AIDS.

The objectives of this study were to determine the cost of a prescribed treatment plan; to compare the costs in an academic hospital cost with that of private pharmacy; and to determine the average treatment cost per visit. The descriptive, retrospective study that investigated the cost implications of the treatment of five oral lesions associated with HIV/AIDS: oral candidiasis, oral hairy leukoplakia, periodontal diseases, oral ulcers and Kaposi's sarcoma. One hundred and twenty four cases with oral HIV lesions were selected from the list of 181 HIV patients listed in the attendance registers of three hospitals in the selected study sites. A data capture sheet was used to obtain information related to diagnosis, investigations done, staging of the disease, treatment plan and treatment outcome. None of the patients were on antiretroviral therapy. The association between the number of hospital visits and the total cost of treatment was significant (p < 0.05). Also, there was a significant negative relationship between the outcome of treatment and the total hospital costs (p < 0.05). The lower the hospital treatment cost, the better the outcome. There was no significant association between staging of the disease and the hospital cost (p > 0.05), but the CD4 count significantly influenced the hospital cost (p<0.05). The average hospital treatment and private pharmacy cost was 207.06 and 357.85 rands respectively (16.21 euros and 28.02 euros respectively). There is a need to evaluate the current treatment protocols, as some treatments may be ineffective. Governments should endeavour to provide antiretroviral and other relevant drugs, at no cost, to HIV/AIDS patients.

Patterns of oral manifestation of HIV/AIDS among 225 Nigerian patients.

OBJECTIVE: The purpose of this study was to determine the prevalence of the oral manifestations of HIV/AIDS and to correlate the prevalence of these lesions with the stages of the disease in the Ife-Ijesa zone, Nigeria. No comprehensive data were available for correlating it with the staging of HIV/AIDS in this region. SUBJECTS: The pattern of oral HIV lesions as classified by the EC-Clearinghouse was studied in 225 confirmed consecutive HIV-infected patients in this zone. METHODS: Clinical dental examinations were conducted under natural daylight on all consenting HIV patients, sitting in an upright chair, using dental mirrors and probes. RESULTS: The prevalence of oral HIV lesions was 84.0%, with lesions ranging in number from one to six. The commonest HIV lesion was pseudo-membranous candidiasis (43.1%) followed by erythematous candidiasis (28.9%), angular cheilitis (28.9%), linear gingival erythema (24.0%) and ulcerations (8.9%). Lesions less commonly found were oral hairy leukoplakia (1.3%) and salivary gland swellings (1.3%). Heterosexual intercourse was the most common mode of transmission (94.7%) and HIV-1 (96.9%) the most prevalent pathogen among the study population. The majority of the patients were in the WHO clinical stage III (59.1%) and presented late. CONCLUSIONS: The prevalence of oral HIV lesions in the present study was high.

The global network on dental education: a new vision for IFDEA.

The advent of globalization has changed our perspectives radically. It presents increased understanding of world affairs, new challenges and exciting opportunities. The inequitable distribution and use of finite energy resources and global warming are just two examples of challenges that can only be addressed by concerted international collaboration. Globalization has become an increasingly important influence on dentistry and dental education. The International Federation for Dental Educators and Associations (IFDEA) welcomes the challenges it now faces as a player in a complex multifaceted global community. This report addresses the new circumstances in which IFDEA must operate, taking account of the recommendations made by other working groups. The report reviews the background and evolution of IFDEA and describes the extensive developments that have taken place in IFDEA over the past year with the introductions of a new Constitution and Bylaws overseen by a newly established Board of Directors. These were the consequence of a new mission, goals and objectives for IFDEA. An expanded organization is planned using http://www.IFDEA.org as the primary instrument to facilitate the exchange of knowledge, programmes and expertise between colleagues and federated associations throughout the world, thereby promoting higher standards in oral health through education in low-, middle- and high-income countries of the world. Such aspirations are modified by the reality and enormity of poverty-related global ill health.

Self-perceived and unmet general health need among PLWHA in Nigeria.

OBJECTIVE: This study set out to determine the self-reported unmet health needs of people living with HIV/AIDS (PLWHA) in a Nigerian population. METHODS: A prospective study conducted among consecutive 209 consenting PLWHA in the South-western Nigeria; who sought for care in the Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife and General Hospital, Ilesa were recruited. Participants completed a comprehensive survey seeking information to determine their unmet needs in the following areas: Medication, Dental, Mental, Home care, Hospital admission, access to antiretroviral therapy and emergency services. RESULTS: One or more unmet needs were reported by 79.4% of the sample. Needs for medication, home-based care and mental care were more likely to be unmet. There was a statistically significant relationship between unmet needs and living arrangements (p < 0.05). CONCLUSIONS: Perceived oral health status was the factor that best predicted the unmet need. Perceived oral health status of these patients should be improved to reduce the level of the unmet needs.

Self-perceived and unmet general health need among PLWHA in Nigeria

Objective: This study set out to determine the self-reported unmet health needs of people living with HIV/AIDS (PLWHA) in a Nigerian population. Methods: A prospective study conducted among consecutive 209 consenting PLWHA in the South-western Nigeria; who sought for care in the Obafemi Awolowo University Teaching Hospitals complex; Ile-Ife and General Hospital; Ilesa were recruited. Participants completed a comprehensive survey seeking information to determine their unmet needs in the following areas: Medica- tion; Dental; Mental; Home care; Hospital admission; access to antiretroviral therapy and emergency services. Results: One or more unmet needs were reported by 79.4of the sample. Needs for medication; home-based care and mental care were more likely to be unmet. There was a statistically significant relationship between unmet needs and living arrangements (p0.05). Conclusions: Perceived oral health status was the factor that best predicted the unmet need. Perceived oral health status of these patients should be improved to reduce the level of the unmet needs

Dental Care Utilization and Satisfaction of Residential University Students

Aim: The objective of this study was to provide information on the level of utilization and satisfaction of residential university students with the dental services provided by the dental clinic of a teaching hospital. Volunteers and Material: A stratified sampling technique was used to recruit volunteers from the outpatient clinic of the Obafemi Awolowo University Teaching Hospital Complex; Ile-Ife; Nigeria. Information was collected by a self-administered questionnaire composed of questions that measure the level of utilization and satisfaction with the dental services provided. Questionnaires were provided to 650 randomly chosen students residing in the University hostels. There were 39 refusals; and 6 incomplete questionnaires were discarded. This left a sample size of 605 volunteers. Results: Forty seven students (7.8) indicated that they visited the dental hospital within the last 12 months. Males and females utilized the dental services equally; and utilization increased with age and the number of years spent on campus. Anticipation of painful dental treatment; high dental charges; long waiting times and being too busy for a dental visit were cited as the most important impediments to seeking dental treatment. Females expressed greater satisfaction with the services. Conclusion: Dental service utilization among the students was found to be low. Oral health awareness campaigns; improving the quality of the services; and shortening the waiting time are expected to increase service utilization and satisfaction

Management of the oral manifestations of HIV/AIDS by traditional healers and care givers.

In many communities of South Africa, traditional healers are often the only means of health care delivery available. The level of knowledge and ability to recognize oral lesions of 32 traditional healers and 17 care-givers were assessed after a two-day workshop. The data collection instrument was a structured questionnaire, complimented by enlarged clinical photographs of the common oral manifestations of HIV/AIDS. Prior to the workshop, 46 (93.9%) of the 49 respondents had never had any formal information on oral health and 43 (87.8%) were unfamiliar with the symptoms of oral diseases. Thirty-five (71.4%) recognized bleeding gums from A4-size photographs and 11 (22.4%) recognized oral thrush. The recognition of other oral manifestations of HIV/AIDS were; oral hairy leukoplakia (41.0%), angular cheilitis (43.6%), herpes virus infection (56.4%), oral ulcerations (56.8%), and in children, parotid enlargement (27.3%), and moluscum contagiosum (56.8%). Traditional healers and caregivers constitute an untapped resource with enormous potential. A positive bridge should be built to link traditional healing with modem medicine in the struggle against HIV/AIDS.

Gender differences among oral health care workers in caring for HIV/AIDS patients in Osun State, Nigeria.

The study investigated the relationship between gender and knowledge, attitude and practice of infection control among oral health care workers in the management of patients with HIV/AIDS in Osun State of Nigeria. It was a cross-sectional survey using 85 oral Health care workers (OHCWs) enlisted in the public dental health clinics. A self-administered questionnaire was designed and used for data collection. A total of 85 questionnaires were distributed. The response rate was 93%; 42 (53%) were males and 37 (47%) females. The majority of the respondents were in the 25-40 year old age group and the mean age was 37.3 years. This study found significant differences in gender and ability to identify HIV/AIDS oral manifestations (p<0.001) and recognition of HIV/AIDS risk factors (p<0.001). There was statistically significant gender difference and infection control practices (p=0.02) among the OHCWs. Males were more compliant to the universal cross-infection control principle than the female respondents. A significant association (p< 0.001) was found between OHCW gender and their attitude to the management of HIV/AIDS patients with males showing a better attitude towards the care of HIV/AIDS patients. This study shows that there are significant gender difference in attitudes, behaviour and practices of OHCW with males faring better than the females. National AIDS Control Programme, Health Control bodies, Health educators and other organizations should make efforts to improve the attitude and practice of oral health care workers regarding the management of patients with HIV/AIDS.

Oral health-care workers and HIV infection control practices in Nigeria.

The first case of HIV infection was reported in Nigeria in 1986. Since then, the prevalence has risen from less than 0.1% in 1987 to 5.8% in 2002, and an estimated 3.6 million Nigerians now live with HIV/AIDS. More than 40 oral manifestations of HIV infection have been recorded and between 70% and 90% of persons with HIV infection will have at least one oral manifestation at sometime during the course of their disease. Oral health-care workers (OHCWS) are expected to play active roles in the prevention and control of HIV/AIDS. In this study, a one-day workshop was organized for 64 oral health workers in Ile-Ife, Nigeria, focusing on the epidemiology of HIV/AIDS, the oral manifestations, control and prevention of HIV in a dental environment, oral care of the infected patient and the ethical, legal and social aspects of HIV/AIDS. Participants' knowledge and practices of infection control were assessed with an infection control checklist administered pre- and post-workshop. Sixty (90.8%) respondents believed that HIV/AIDS was not yet a problem in Nigeria, and 58 (90.6%) believed that drugs have been developed which can cure HIV infection and AIDS. The men complied more with waste disposal regulations than women (P = 0.010). Twenty-nine of 58 (50.0%) did not discard gloves which were torn, cut or punctured. Seven (12.1%) did not change gloves between patients' treatment. Conscious efforts should be made to train OHCWS on all aspects of HIV/AIDS prevention and care. It must never be assumed that adequate information will be acquired through tangential sources.

Retrospective survey of antibiotic prescriptions in dentistry.

OBJECTIVE: To evaluate dentists' prescription writing patterns and their appreciation of the characteristics of antibiotics. DESIGN: Evaluation of drug prescriptions written over a six-month period. SETTING: Dental Hospital, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. SUBJECTS: Retrospective analysis of 313 prescriptions written by dentists attending to outpatient dental patients. RESULTS: The total number of drugs on one prescription ranged from one to seven with Penicillins being the most commonly prescribed drug. Some prescriptions were found to be incorrect with regards to dose, frequency, and duration. Instructions as to the best time of administering drugs with regards to meals were not stated in any prescription. CONCLUSION: Improvement through continuing education is desired on the part of prescribers to ensure a good standard of care and avoid practices that may increase antimicrobial resistance. Drug information services including side effects and drug interactions for professionals and consumers at the hospital is highly desirable.

Dental caries in six, 12 and 15 year old Venda children in South Africa.

BACKGROUND: Oral diseases is still a major problem in most developing countries. Within the Republic of South Africa, there remains areas where few or no studies have been done on the oral health status. The emerging district health system with decentralisation of health services to address past inequity in health care in South Africa also provides compelling case for data collection at regional levels. OBJECTIVES: To assess the prevalence and severity of dental caries of school children; determine the caries patterns of the study population and to provide useful data for the planning of oral health services in this region. DESIGN: Descriptive analytical study. SETTING: School children in the Donald Fraser Health District, Venda in the Northern province, Republic of South Africa. SUBJECTS/METHODS: A total of 519 school children in the age groups 6, 12 and 15 years were examined by a calibrated examiner for dental caries using WHO diagnostic criteria. Both the schools, which were divided into rural and peri-urban locations and the children that participated were randomly selected. RESULTS: A mean dmft(sd) of 2.68(3.29) in six year olds and a mean DMFT (sd) scores of 0.61(1.50) and 1.26 (2.18) were recorded in the 12 and 15 year olds respectively. In the six year olds the upper anterior teeth showed highest susceptibility to caries, clearly indicating that black children suffer from early infant caries. At ages of 12 and 15 the mandibular molars were the teeth most affected. The decayed component constituted the main part of the dmft and DMFT scores. Ninety-nine percent of these lesions were untreated and the restorative care was almost nil. CONCLUSION: An important finding was the doubling of the mean DMFT from the 12-year-olds to 15-year olds and the caries levels for all age groups was higher than the provincial average. The treatment required were mostly extractions and simple fillings, the majority of which could be managed by dental auxiliaries using the Atraumatic Restorative Treatment Technique. This study indicates that preventive oral health measures should be implemented on the younger age groups in order to control dental caries.

Traditional oral health practices among Kanuri women of Borno State, Nigeria.

A structured questionnaire was administered on 495 women (urban 339, rural 156) from two LGAs of Borno State, Nigeria, using the interviewer method. The age range of the subjects was 12 to 80 years with a mean age (+/- SD) of 35.7 +/- 13.44 years. Majority (83.5%) did not have any formal education. Oral hygiene tools used by the respondents included toothbrush/paste 36 (7.9%), chewing stick 250 (54.9%), charcoal 159 (34.9%) and ordinary water 10 (2.2%). Of those using chewing sticks; 168 (67.2%) use Salvadora persica, 36 (14.4%) use Azadirachta indica and 46 (18.4%) use Eucalyptus camaldulensis. Forty (8.1%) of the respondents do not clean their teeth at all. Strong association was found between choice of teeth cleaning material and educational level (P=0.000). Three hundred and one (60.8%) of the respondents stain their teeth with flowers of Solanum incanum or Nicotania tabacum while, 218 (44.0%) perform tattooing of lip or gingivae and of this number 213 (97.7%) performed tattooing before marriage. Tattooing is usually performed without local anaesthesia with thorns of Balanites aegyptiaca and a mixture of charcoal & seeds of Acacia nilotica var. tomentosa as pigments. It is concluded that traditional oral health practices still constitute important part of the lifestyle in the study population.

Prosthetic parameters among dental patients in Ile-Ife, Nigeria.

The purpose of this study was to determine the Rest Vertical Dimension (RVD), Occlusal Vertical Dimension (OVD), Freeway Space (FWS) and their importance in the fabrication of dental prostheses. These prosthetic parameters were determined in 310 dentate patients attending the Dental Hospital of the Obafemi Awolowo University Teaching Hospitals' Complex Ile-Ife. The MMO was obtained by measuring inter-incisal distance. RVD and OVD were derived using Willis gauge. The FWS was taken as 'RVD minus OVD'. Of the 310 attendees, twenty-seven (8.7%) were denture wearers. There was no statistically significant difference between the genders with regards to the use of dentures (P = 0.17). The mean values (+/- standard deviation) for MMO was found to be 50.5 +/- 7.9 mm (range 18.0 to 70.0 mm). The RVD was 73.0 +/- 8.4 mm (range 50.0 to 94.0 mm) and OVD was 69.8 +/- 8.2 mm (range 47.0 t 92.0 mm). The mean FWS was 3.3 +/- 1.4 mm (range 1 to 9 mm). Following the loss of most of the posterior teeth or in a state of complete edentulism, the face profile appears squashed and the vertical dimensions are altered. To provide an efficient and functional prosthesis, the facial dimensions have to be restored to or near pre-edentulous state. The establishment of values for these facial dimensions in given population will assist in the provision of satisfactory prosthesis.

Postoperative complaints following impacted mandibular third molar surgery in Ile-Ife, Nigeria.

An investigation into the pattern of complaints lodged by patients after impacted mandibular third molar surgery was done in a Nigerian teaching hospital over a period of 3 years. One hundred and twenty seven records were retrieved. Pericoronitis (71.2%), pulpitis (17.6%) and periodontitis (11.2%) were the reasons for surgery. No third molar surgery was done for prophylactic or orthodontic reasons. Sixty-one complaints were lodged by 49 (38.6%) patients on day 1, and 37 complaints by 35 patients on day 7. These complaints were verified by the findings of the examining clinician. Pain, swelling and trismus were the commonest complaints. A significant association (P = 0.042) was found between patients' complaints on the first postoperative day and the drug combination given. Similarly, there was a significant relationship (P = 0.0055) between the type of analgesics prescribed and the presence of postoperative pain. No significant relationship was however found between the complaints and patients' age, indication for extraction, impaction type and method of impacted tooth removal. Although the findings of this retrospective study are limited in their comparability, they suggest the need for an appraisal of pain management in patients undergoing mandibular third molar surgery in our hospital. Consequently, there should be a reduction in complaint rate thereby making selective review appointment on the first postoperative day feasible.

Policies and protocols for preventing transmission of HIV infection in oral health care in South Africa.

Human immunodeficiency virus (HIV) infection constitutes an unparalleled public health challenge. The unique nature of most oral health procedures, instrumentation and patient-care settings requires specific strategies and protocols aimed at preventing the transmission of HIV/AIDS between oral health care providers and patients, as well as between patients themselves. The present study investigated the level of information and training about protocols and policies for preventing the transmission of HIV/AIDS in oral health care settings in South Africa. The data collection techniques utilised available information, in-depth interviews and an open-ended questionnaire. The respondents were 20 purposively selected key informants who were senior officers for HIV/AIDS programmes and/or oral health organisations. Sixteen (80%) of the respondents reported that there were no existing oral health policies on HIV/AIDS in their health care institutions or organisations. None of the interviewees knew of any specific protocols on HIV/AIDS in the oral health care setting that emanated from South Africa. In addition, none of the dental professional associations had established an infection control committee or a support system for members who might become infected with HIV and develop AIDS. Territorial boundaries existed between sectors within the medical disciplines, as well as between the medical and oral health disciplines. Numerous general impediments were identified, such as prejudice, denial and fear, inadequate training and/or information about the infection, lack of representation and resources for policy planning, a lack of interest from the business sector, and approaching HIV/AIDS in the workplace as a 'one-time issue' Other obstacles identified included unemployment, poverty, illiteracy, disempowerment of women and inadequate communication of policies to service providers. Additional issues raised included the migrant labour systeM, complexities of language and culture, the large unstructured sex industry, high prevalence of sexually transmitted infections and lack of funding. All of these have an impact on oral health. Future policy directions identified included 'increasing access to HIV information and postexposure prophylaxis' 'shift towards care and support for those living with HIV/AIDS with emphasis on community and home-based care' and 'improving intersectoral co-ordination and collaboration'. The study demonstrated gaps in availability and access to policies and protocols on HIV/AIDS by managers and health workers. Specific strategic recommendations are made for oral health.

Helicobacter pylori in the dental plaque and gastric mucosa of dyspeptic Nigerian patients.

BACKGROUND: Presence of helicobacter pylori (H.Pylori) in the dental plaques may be associated with the presence of the same organism in gastric mucosa. OBJECTIVES: To assess and compare the prevalence of H. pylori in dental plaques and gastric mucosa of dyspeptic Nigerians. METHODS: Sixty-six consecutive patients undergoing endoscopy for investigation of dyspepsia were included in the study. A predesigned questionnaire was used to collect information on socio-demographic and other factors. Each patient also had clinical dental examination. Dental plaque scrapping was collected before endoscopy for helicobacter pylori culture, and at endoscopy, two gastric biopsy specimens were taken for culture and histology. RESULTS: The mean age (+/- SD) of the patients was 44.8 (+/- 17.4) years (range 5 to 80 years). The positivity rate of helicobacter pylori in gastric biopsy was 35 of 66 (53.0%) while the same for dental plaque was 46 of 66 (69.7%). The correlation (Spearman's) between gastric mucosa and dental plaque colonization with helicobactor pylori was significant (R = 0.30, P = 0.01). When concordant positivity of gastric biopsy culture and histology was taken as diagnostic, the sensitivity of dental plaque culture was found to be 82.9% and the specificity was 45.2%. CONCLUSIONS: This study revealed that helicobactor pylori has a high prevalence in the dental plaque of the population that we have studied and may therefore be of potential relevance in screening for such infection.

Patients' attitudes to wearing of gloves by dentists in Nigeria.

OBJECTIVE: To evaluate patient's attitudes to the use of gloves by dentists. DESIGN: This consisted of a four-item questionnaire administered to 445 consecutive patients attending our dental clinic. SETTING: . Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria. SUBJECTS: Four hundred and forty five patients above the age of fifteen years attending the dental clinic for the first time. RESULTS: Majority of the patients were in the 20-30 year age group and over 93% had formal education. Most of the respondents (88.8%) stated that glove wearing was essential and over 63% considered that glove wearing protected both the operator and the patient. Whilst about one-third of respondents would attend for treatment when gloves were not worn, 81.3% felt that gloves should be changed after each patient. There were statistically significant differences (p<0.05) in responses in relation to age-groups and educational attainment, however no sex differences (p>0.05) were reported. CONCLUSION: This survey showed a high level of awareness by patients on the use of gloves by dentists. It also found that age-groups and levels of educational attainment influenced patients attitude to glove use.

Caring for the people living with HIV/AIDS and AIDS orphans in Osun State: a rapid survey report.

The aim of the study is to obtain the views and opinions of People Living with HIV/AIDS (PLWHAS), community leaders and other stake holders (care providers and AIDS orphans), so as to assess the role of Non-Governmental Organisations in the control of HIV infection with the purpose of making appropriate recommendations for policy formulation on issues related to the health and care of PLWHAs. A qualitative research was carried out using in-depth interview method with a questionnaires as a guide. In all, 12 seropositives, 13 community leaders and 34 AIDS orphans were interviewed. Results indicate that there was a lack of networking between the six Non-Governmental Organisations working in the state in relation to HIV/AID. Also, none of these PLWHAs had concrete plans for the future of their children, though they all expressed some form of anxiety about their children's future. The burden of care of AIDS orphans often fall on the maternal family members. Top on the list of the problem of AIDS orphans was their poor education due to financial difficulties. There is the need for the government to provide, support, encourage and monitor the activities of the Non-Governmental Organisations and network with them so as to maximise the benefits that can be obtained from the role they play in HIV/AIDS management.

Clinical evaluation of the ART approach and materials in peri-urban farm schools of the Johannesburg area.

In this study, 1,325 school children from 7 farm schools were examined. Their mean age (+/- SD) was 10.5 +/- 3.0 (range 6-11) years. At baseline, the mean DMFT score was 1.1 +/- 1.7 and 36.4% of the children had caries. The prevalence of fluorosis among the children was 12.6%. Curative treatment was offered to all the children. A total of 113 children (8.5%) with one-surface cavities on permanent teeth and without fluorosis were treated using the atraumatic restorative treatment (ART) approach. A total number of 163 cavities were included in the study, of which 82 were treated with Fuji IX glass-ionomer cement and 81 with Ketac-MOLAR (hand mix). One year after treatment, restoration and sealant parts of ART fillings were examined. Caries status was also determined. The placing of the ART fillings and their evaluation were performed by different practitioners. A total number of 108 restorations (58 with Fuji IX, 50 with Ketac-MOLAR) were evaluated. Results of ART fillings showed a survival rate of 93.1% with Fuji and 94.0% with Ketac-MOLAR. Retention of the sealant parts of ART fillings was observed in 81% of restorations with Fuji IX and 76% with Ketac-MOLAR, not connected to the filled cavity. Caries was absent on all teeth restored with Fuji IX and noted in only one tooth restored with Ketac-MOLAR, not connected to the filled cavity. The retention rate after a 12-month period was acceptable and ART approach proved to be an appropriate technique for restoring teeth in this population group. There were no statistically significant differences between the survival rates of the two glass-ionomer restorative materials (P > 0.05).