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.

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.

One year survival of ART and conventional restorations in patients with disability.

BACKGROUND: Providing restorative treatment for persons with disability may be challenging and has been related to the patient's ability to cope with the anxiety engendered by treatment and to cooperate fully with the demands of the clinical situation. The aim of the present study was to assess the survival rate of ART restorations compared to conventional restorations in people with disability referred for special care dentistry. METHODS: Three treatment protocols were distinguished: ART (hand instruments/high-viscosity glass-ionomer); conventional restorative treatment (rotary instrumentation/resin composite) in the clinic (CRT/clinic) and under general anaesthesia (CRT/GA). Patients were referred for restorative care to a special care centre and treated by one of two specialists. Patients and/or their caregivers were provided with written and verbal information regarding the proposed techniques, and selected the type of treatment they were to receive. Treatment was provided as selected but if this option proved clinically unfeasible one of the alternative techniques was subsequently proposed. Evaluation of restoration survival was performed by two independent trained and calibrated examiners using established ART restoration assessment codes at 6 months and 12 months. The Proportional Hazard model with frailty corrections was applied to calculate survival estimates over a one year period. RESULTS: 66 patients (13.6 ± 7.8 years) with 16 different medical disorders participated. CRT/clinic proved feasible for 5 patients (7.5%), the ART approach for 47 patients (71.2%), and 14 patients received CRT/GA (21.2%). In all, 298 dentine carious lesions were restored in primary and permanent teeth, 182 (ART), 21 (CRT/clinic) and 95 (CRT/GA). The 1-year survival rates and jackknife standard error of ART and CRT restorations were 97.8 ± 1.0% and 90.5 ± 3.2%, respectively (p = 0.01). CONCLUSIONS: These short-term results indicate that ART appears to be an effective treatment protocol for treating patients with disability restoratively, many of whom have difficulty coping with the conventional restorative treatment. TRIAL REGISTRATION NUMBER: Netherlands Trial Registration: NTR 4400.

The willingness of US pediatric dentists to use atraumatic restorative treatment (ART) with their patients: a conjoint analysis.

OBJECTIVES: The atraumatic restorative treatment (ART) was developed as an affordable, patient-friendly dental caries management procedure that does not need extensive operator training or special skills. The aim of this study was to determine factors that influence the decision to use ART using an innovative marketing research technique known as conjoint analysis. METHODS: A conjoint survey was completed by 723 members of the American Academy of Pediatric Dentistry. Three factors (age of the child, level of cooperation, type of insurance) were varied across three levels to create nine patient scenarios. The weights that practitioners placed on these factors in decisions to use ART in treating carious lesions were determined by conjoint analysis. Factors such as lesion location, depth, and extension were fixed in the nine clinical scenarios. RESULTS: Seven-hundred twenty-three pediatric dentists completed the survey (32 percent). Age of the child was the most important factor in pediatric dentists' decisions to use ART (46 percent) compared with level of cooperation (41 percent) and type of insurance coverage (11 percent). For the age factor, the age of 2 years had the greatest utility (0.55) compared with age 4 (-0.09) and age 6 (-0.46). For types of insurance coverage, having no insurance (0.124) had the greatest utility compared with having public insurance (-0.119). CONCLUSIONS: Although insurance coverage was the least important among the factors, being without insurance, being very young, and being uncooperative was the scenario where pediatric dentists most favored ART when making trade offs between different factors using the conjoint design.

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.

Minimal intervention dentistry procedures: a ten year retrospective study.

UNLABELLED: Minimal Intervention Dentistry (MID) is an effective treatment approach with increasing acceptance among dental professionals. OBJECTIVE: This study aimed to evaluate the MID impact on Dentistry by analyzing procedures performed on patients treated at a Pediatric Dentistry Graduate Program clinic which implemented MID. STUDY DESIGN: The number of procedures including sealants, modified atraumatic restorative treatment (mART), resin crowns, direct pulp capping, pulpotomy, pulpectomy, and deciduous/ permanent extractions from 333 pediatric patients treated between the years 2001 to 2003 and 2008 to 2010 in Distrito Federal, Brazil were analyzed. Statistical analysis involved chi-square and G Williams tests. RESULTS: 783 procedures were analyzed and demonstrated that there was a significant reduction of sealant placement in the last triennium when compared to the first one (p<0.0001). Moreover, there was a significant increase in the amount of mART (p<0.0001). This increase in mART procedures resulted in a significant reduction in procedures with pulp involvement: direct pulp capping (p=0.0014), pulpotomy (p=0.0014) and pulpectomy (p=0.0002). CONCLUSIONS: Based on the results, MID represented a positive impact on the intervention on caries lesions in patients, mainly reflected by the significant reduction in the number of direct pulp capping, pulpotomy and pulpectomy.

Survival of atraumatic restorative treatment (ART) sealants and restorations: a meta-analysis.

UNLABELLED: The purpose of this study is to perform a systematic investigation plus meta-analysis into survival of atraumatic restorative treatment (ART) sealants and restorations using high-viscosity glass ionomers and to compare the results with those from the 2005 ART meta-analysis. Until February 2010, four databases were searched. Two hundred four publications were found, and 66 reported on ART restorations or sealant survival. Based on five exclusion criteria, two independent reviewers selected the 29 publications that accounted for the meta-analysis. Confidence intervals (CI) and or standard errors were calculated and the heterogeneity variance of the survival rates was estimated. Location (school/clinic) was an independent variable. The survival rates of single-surface and multiple-surface ART restorations in primary teeth over the first 2 years were 93% (CI, 91-94%) and 62% (CI, 51-73%), respectively; for single-surface ART restorations in permanent teeth over the first 3 and 5 years it was 85% (CI, 77-91%) and 80% (CI, 76-83%), respectively and for multiple-surface ART restorations in permanent teeth over 1 year it was 86% (CI, 59-98%). The mean annual dentine lesion incidence rate, in pits and fissures previously sealed using ART, over the first 3 years was 1%. No location effect and no differences between the 2005 and 2010 survival rates of ART restorations and sealants were observed. The short-term survival rates of single-surface ART restorations in primary and permanent teeth, and the caries-preventive effect of ART sealants were high. CLINICAL RELEVANCE: ART can safely be used in single-surface cavities in both primary and permanent teeth. ART sealants have a high caries preventive effect.

Paediatric dentistry education of atraumatic restorative treatment (ART) in Brazilian dental schools.

AIM: To evaluate the degree of knowledge, use and teaching of atraumatic restorative treatment (ART) of paediatric dentistry lecturers in dental schools throughout Brazil. METHODS: A structured questionnaire was applied, containing questions regarding the use of ART, socio-demographic characteristics and academic degree background. Descriptive analysis and Poisson's regression were conducted in order to verify the association between exploratory variables and ART teaching (α=5%). RESULTS: Of the 721 questionnaires sent to dental schools, approximately 40% were returned (n=285). Some 98.2% of the participants teach ART. STATISTICS: Concerning dental lecturers who teach ART, in multiple regression model, considering ART indication (emergency versus restorative treatment) the lecturers residents of the Mid-West (PR=1.66; CI:1.13-2.45) and Northeast region (PR=1.33; CI:1.02-1.72) and lecturers who use ART regularly (PR=3.73; CI:2.11-5.59) teach ART as restorative treatment. When the question was about reason for using ART (conservative technique versus other techniques failures/fast treatment), lecturers with a longer period of TG (time elapsed since graduation) (PR=1.30; CI:1.08- 1.56) and also lecturers who use ART regularly (PR=2.87; CI:1.95-4.22), teach it as being a conservative technique. Regarding the patients' age covered by ART (versus without limitation), women (PR=1.26; CI:1.06-1.50) and lecturers who use ART regularly (PR=1.28; CI:1.06-1.54), teach that there is no age restriction. CONCLUSIONS: ART has been widely taught in Brazilian dental schools, is regularly used in lecturer's clinical practices and has positively influenced the appropriate teaching of this technique.

The dilemma of selecting suitable proximal carious lesions in primary molars for restoration using ART technique.

OBJECTIVE: To determine the examiner's accuracy in selecting proximal carious lesions in primary molars for restoration using the atraumatic restorative treatment (ART) approach. BASIC RESEARCH DESIGN: Intervention study. CLINICAL SETTING AND PARTICIPANTS: A total of 804 six to eight year-olds from 30 rural schools in Kenya participated in the study. INTERVENTION: Three examiners selected a total of 1,280 suitable proximal carious lesions in primary molars after examining 6,002 children from 30 schools randomly selected out of 142 schools in two divisions. Seven operators randomly paired on a daily basis with eight assistants restored the lesions. An explanation was provided for any cavity that was not restored. Pre-and post-operative radiographs of the cavities were also taken for evaluation. MAIN OUTCOME MEASURES: The examiner's choice of suitable proximal cavities restorable using the ART approach was related to the decision made to either restore or not during the operative stage. The radiographic findings of the selected cavities were also compared to the decision made by the operator. The results obtained were used to determine the examiner's accuracy in selecting suitable proximal cavities for restoration using the ART approach. RESULTS: The majority of the children recruited in the study were excluded due to absenteeism, pulpal-exposure or anxiety during the operative stage. Only 804 children received one restoration in their primary molars. The examiner's accuracy in selecting suitable ART-restorable cavities clinically was 94.9% and based on radiographic analysis was 91.7%. CONCLUSIONS: A trained and diligent examiner has a very good chance of selecting proximal carious lesions restorable with the use of ART approach, without the threat of dental pulpal-involvement during the excavation of caries.

A group of general dental practitioners' views of preformed metal crowns after participation in the Hall technique clinical trial: a mixed-method evaluation.

AIMS: The aims of this study were to investigate and describe the views of a group of general dental practitioners (GDPs) on their use of preformed metal crowns (PMCs) with the conventional method and the Hall Technique. The practitioners involved had previously taken part in a clinical trial of the Hall Technique. METHODS: The dentists' views were explored using a semi-structured interview (transcribed and analysed using a framework approach) and their use of crowns investigated (for conventional and Hall Technique) using a short questionnaire. RESULTS: Fourteen out of 17 dentists who participated in the trial were interviewed and completed the questionnaire. Prior to the trial, only three of the GDPs had been using conventional PMCs at all and this was 'infrequently'. None had been using them routinely. The semi-structured questionnaires revealed three main themes reflecting positively on the GDPs' experiences with the Hall Technique: its ease of use, its high patient acceptability, and the dentists' perceived clinical effectiveness of the technique. Thirteen of the 14 GDPs stated that they would continue to use the Hall Technique routinely and only one thought that he would not use it. CONCLUSION: Among a small group of GDPs with little experience or training in the use of the Hall Technique, it was perceived to be easy to use routinely, acceptable to patients and effective.

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.

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.

Caries management decision: influence of dentist and patient factors in the provision of dental services.

OBJECTIVES: Little is known about how dentists implement caries management and provide restorative dental services in everyday practice. This study explored whether or not recent concepts in caries management were implemented in practice by private practitioners. The influence of patient and practitioner characteristics on the provision of restorative dental services was also investigated through multidimensional analyses. METHODS: A sample of French general private dental practitioners was asked to record the characteristics of 35 preventive or restorative treatments made on vital permanent teeth. The data collection form was designed to explore dentists' attitudes towards caries management and their use of minimally invasive therapies. RESULTS: Twenty-six practitioners recorded the characteristics of 921 treatments performed on 457 patients. Results indicate that participants rarely performed non-invasive treatments. They used an inappropriate detection tool, as most of decisions to treat were based on visual inspection frequently associated with probing. Multidimensional analysis showed that dentists provided different restorative treatments depending on patient characteristics, with minimally invasive, esthetic restorations preferentially performed for healthy, young and well-insured patients. Restorative treatments and detection tools also varied markedly among practitioners. These variations in service patterns were not related to a specific patient profile in each dental practice. CONCLUSIONS: Results indicate that recent concepts in caries management have not yet been adopted in everyday practice. Patient and dentist characteristics influence the provision of restorative dental services. Decision-making in caries management not only depends on pathophysiology but also seems to be influenced by many other factors.

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

UNLABELLED: 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% of all Latin American countries, was 76%. An ART training course had been given in all Latin American countries that responded, with more than 2 having been conducted in 64.7% of the respondent countries. ART was implemented in public oral health services in 94.7 % of the countries, according to the respondents. In 15.8% of the countries, ART was applied throughout the country and in 68.4%, in some areas or regions of a country. ART had been used for more, or less, than three years in 42.1% and 47.4% 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% of the countries, while evaluation training courses had taken place in only 3 countries (15.8%). 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.

UNLABELLED: 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.

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.