Atraumatic Restorative Treatment Research Articles

"Evaluation of Silver Diamine Fluoride Modified Atraumatic Restorative Treatment (SMART) on hypomineralized first permanent molar"- a randomized controlled clinical study.

Restoring first permanent molars affected with molar incisor hypomineralization (MIH) is challenging. Focusing on improving the quality of life for children affected by MIH, at least until the complete eruption of first permanent molars to receive full coverage, to decrease the hypersensitivity and to be able to perform proper oral hygiene measures, the purpose of this study was to compare silver modified atraumatic restorative technique (SMART) versus the conventional restoration and fluoride varnish application on moderate to severe hypomineralized molars. The comparison considered the restoration survival, hypersensitivity, and digital surface area changes after one year follow up. Twenty-eight children were selected (20 girls and 8 boys) with at least 2 MIH molars with the same defect severity. The study comprised 2 groups; MOD group (moderate hypomineralized molar severity) and SEV group (Severe hypomineralized molar severity) (n = 28 tooth). Each group was further subdivided into 2 subgroups according to the technique of restoration: SMART subgroup and CONV subgroup (high viscosity glass ionomer restoration and fluoride varnish application) (each = 14 tooth). Evaluation was done in terms of the restoration survival (6 months and 12 months), hypersensitivity at 1 weak, 6 months and 12 months and occlusal surface area changes at 12 months). Professional Fluoride varnish application and home prophylaxis using MI paste were the protocol for each child patient. There was no significant difference between the 4 subgroups, regarding tooth restoration integrity at 6-months vs. 12-months. However, a statistically significant difference in tooth restoration integrity between the 4 subgroups at 12-months (P = .049). Also, the hypersensitivity score, there was a statistically significant difference between the 4-time intervals (P < .001) and a statistically significant difference in surface area changes between the 4 subgroups. Selective removal of carious tissue and SMART restoration, combined with dental home and professional preventive measures every 3 months maintained the integrity of restorations in severely and moderately affected permanent molars up to 1 year. The study protocol was retrospectively registered on Clinical Trials (NCT05931822-05/ 07/2023).

A Bibliometric Analysis of the 100 Most-Cited Articles concerning Atraumatic Restorative Treatment.

The present study aimed to identify the 100 most-cited articles concerning Atraumatic Restorative Treatment (ART) through a bibliometric analysis. The search was conducted in the Web of Science database in December 2023. Scopus and Google Scholar were used to compare the number of citations. The following data were extracted from the articles: title, authors, number of citations, access type, institution, country, continent, year of publication, journal, keywords, study design, and theme. Collaborative networks were generated using the VOSviewer software. Google Trends was used to investigate the global popularity of "atraumatic restorative treatment" research. The 100 selected articles, published between 1996 and 2019, were cited 5,092 times, ranging from 21 to 239 citations. Caries Research (12%) and Community Dentistry and Oral Epidemiology (12%) published the highest number of articles. Clinical study (52%) was the most prevalent study design. The main theme addressed was restoration longevity (43%). Conventional high-viscosity glass ionomer was the most used restorative material (69%). The country with the highest number of articles was the Netherlands (33%) and Europe was the continent with most publications (38%). The Rabboud University of Nijmegen had the highest number of articles (25%). Frencken JE was the most prominent author (38%). The most common keyword was "atraumatic restorative treatment" (n=60). According to Google Trends, Tanzania was the country that searched the most about ART. The 100 most cited articles on ART were mainly composed of clinical studies focusing on the longevity of restorations and originated in Europe.

Effectiveness of silver diamine fluoride in arresting early childhood caries: a randomised controlled clinical trial.

Evaluate the effectiveness of biannual 38% SDF in arresting early childhood caries (ECC) compared to atraumatic restorative treatment (ART). One hundred children (aged 2-5 years) with ECC were (2-5 years) divided equally and randomly into two groups. Test group: 38% SDF biannually; Control group: ART. The primary outcome was caries arrestarrest, which was assessed at the 3,6,9, and 12 months interval. Oral health- related quality of life (OHRQoL) was evaluated at base line and after 12 months using the Parental-Caregiver Perceptions Questionnaire (P-CPQ) and Family Impact Scale (FIS). SDF was considerably more effective in arresting ECC after 12 months compared to ART. An overall significant improvement of OHRQoL was reported for both groups with SDF being faintly superior to ART.

Effectiveness of silver diamine fluoride application with atraumatic restorative treatment in arresting the progression of dental caries: a systematic review protocol.

This review aims to evaluate the effectiveness of silver diamine fluoride application along with atraumatic restorative treatment in arresting the progression of dental caries when compared with other caries-arresting treatments in children and adults. A combination of silver diamine fluoride with atraumatic restorative treatment is a minimally invasive and cost-effective method to treat dental caries. It offers a solution for the progression of caries and restoration of cavitated lesions in both primary and permanent teeth. A comprehensive summary of the evidence will assist dental clinicians and guide subsequent clinical research. Randomized controlled trials involving human participants of any age with cavitated dental caries lesions will be included. The intervention arm will evaluate the effectiveness of silver diamine fluoride application with atraumatic restorative treatment in dental caries arrest with a control arm of either atraumatic restorative treatment or silver diamine fluoride application; or composite restoration; or sodium fluoride varnish or a placebo; or a study group with no intervention. Systematic searches for relevant studies will be conducted across multiple databases, including MEDLINE, Scopus, Cochrane CENTRAL, Dentistry and Oral Sciences Source, CINAHL, and Web of Science. ProQuest Dissertations and Theses and Google Scholar will also be searched for gray literature. The databases will be searched from January 2016 to the present. No restrictions will be imposed on the country of publication. Data appraisal, extraction, and synthesis will follow JBI guidance for systematic reviews of effectiveness. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system will be used to grade the certainty of evidence, and a Summary of Findings will be prepared. PROSPERO CRD42023426766.

Comparative Evaluation of the Survival Rates of Atraumatic Restorative Treatment Restorations Using Bilayer Technique along with Nanofilled Coating in Primary Molars: A Clinical Study.

To enhance the survival rate of atraumatic restorative treatment (ART) restorations using (class I and class II) bilayer technique of placing glass ionomer cement (GIC) along with nanofilled coating (NC) over the restorations, thereby improving longevity. A total of 178 primary molars in 67 children were selected and randomly divided into four groups. Group IA was treated with a single layer of GIC, followed by a protective layer of petroleum jelly in class I restoration. Group IB was treated with a single layer of GIC, followed by a protective layer of petroleum jelly in class II restoration. Group IIA was treated with bilayer GIC restoration followed by NC of GC-Coat Plus in class I, whereas group IIB was treated with bilayer GIC restoration followed by GC-Coat Plus in class II. Clinical analysis of all three groups was performed at 1, 3, 6, 9, and 12 months to evaluate the success of treatment procedures using predetermined criteria. Pearson's Chi-square and Kaplan-Meier estimates were utilized to evaluate the success of all four treatment procedures (p < 0.05). Out of 178 teeth, 33 teeth were in group IA, 36 teeth were in group IB, 43 teeth were in group IIA, and 40 teeth were available for evaluation at the end of the 12-month follow-up period. The overall success was determined to be 81% for group IA, 79.2% for group IB, 79.5% for group IIA, and 88.6% for IIB. At 6th-month follow-up, one clinical failure was observed in groups IA and IB. At 9 months follow-up, two clinical failures were observed in both group IA and group IB and three failures were observed in group IIB. At 12 months follow-up, four clinical failures were observed in group IA, three in group IB and one clinical failure was observed in group IIB. There was no statistically significant difference observed between the success of the four groups, suggesting that either of the techniques can be utilized for ART. No statistically significant difference was observed between the survival of class I and class II restorations of both the groups, indicating that either single-layer or bilayer technique along with NC can be adopted for the management of dental caries in primary molars using the ART approach. Khan N, Garg N, Garg N, et al. Comparative Evaluation of the Survival Rates of Atraumatic Restorative Treatment Restorations Using Bilayer Technique along with Nanofilled Coating in Primary Molars: A Clinical Study. Int J Clin Pediatr Dent 2024;17(S-1):S55-S60.

Clinical Outcome Success of Silver-Modified Atraumatic Restorative Treatment (SMART) in Treating Children with Dental Caries in Primary Teeth: A Systematic Review

Abstract Objective: A novel approach called silver-modified atraumatic restorative therapy (SMART) integrates glass ionomer cement (GIC) restorations with silver diamine fluoride (SDF). This new method combines the ability of GIC to seal the tooth and sever the nutrition that bacteria require to proliferate, with the bactericidal power of SDF. The purpose of this review is to evaluate and compare the available data regarding the efficacy of the SMART approach in treating children's carious primary teeth. Materials and Methods: The earliest date accessible up until February 15, 2024, was thoroughly searched in databases including Scopus, PubMed, Cochrane, Science Direct, Lilacs, Science Direct, Web of Science, and Google Scholar. The review only comprised randomized controlled trials. The PICO strategy (P: Children with dental caries in primary teeth; I: SMART; C: Conventional drill and fill method or atraumatic restorative treatment [ART] therapy; O: Clinical success) was adopted. Risk of bias assessment and quality of evidence were assessed using the RoB-2 tool and GRADE tool, respectively. Results: Four full-text publications that met the eligibility criteria underwent additional processing for data extraction and qualitative analysis. In three studies, no difference was found in the clinical performance of SMART and conventional drill and fill/ART therapy, whereas in one study, the clinical performance of SMART was found to be better than the conventional ART therapy. Conclusion: SMART and conventional drill and fill/ART techniques have comparable clinical performance for carious primary teeth of children. SMART can be used to treat asymptomatic deep carious lesions as well as apprehensive children. However, the cost-effectiveness of SMART restorations needs to be investigated in a variety of demographics.

Effectiveness of error-based active learning compared to conventional lecture-based method among undergraduate dental students: A randomized controlled trial.

Dental education assumes an indispensable role in adequately equipping students for a successful career in dentistry. Error-based active learning, an innovative approach in dental education, is a combination of mistake-driven learning (MDL) and case-based learning (CBL) to provide a transformative learning atmosphere for students. While active learning has gained popularity in dental education, the effectiveness of error-based active learning remains unexplored. This study aims to evaluate the effectiveness of error-based active learning among final-year dental undergraduate students in comparison with the conventional lecture-based approach. A parallel-arm single-blind randomized controlled trial was conducted in a dental institute in India from November 2022 to December 2022. A total of 74 students were randomly allocated to two groups: Group A (n = 37) received error-based active learning and group B (n = 37) received conventional lecture-based learning approach. Atraumatic restorative treatment (ART) was chosen as the topic for the study. The knowledge of students was assessed at three intervals: baseline, post-intervention, and 4 weeks after the intervention, using a self-designed and validated questionnaire with Cronbach's alpha of 0.87 and a content validity ratio of 0.84. A standard survey questionnaire was employed to evaluate students' perceptions of the teaching methods. Error-based active learning group outperformed the lecture-based group significantly in the post-intervention test (20.92 ± 1.42 vs 16.97 ± 3.06), with better knowledge retention (18.30 ± 2.02 vs 14.05 ± 4.26) and positive feedback from the students. The error-based active learning approach proved superior to the conventional lecture-based method in enhancing and retaining knowledge regarding ART.

Atraumatic Restorative Treatment: An Overview and Update

Atraumatic Restorative Treatment: An Overview and Update

1-year Results of Molar Incisor Hypomineralization-affected Cases Treated with Silver Modified Atraumatic Restorative Treatment: A Retrospective Study.

Silver-modified atraumatic restorative treatment (SMART) can be an alternative method for molar incisor hypomineralization (MIH)-affected cases. The purpose of this study was to assess whether tooth location and cavity preparation affect the clinical success of MIH-affected permanent molars treated with the SMART technique. Modified United States Public Health Service criteria were utilized for the analyzes. The clinical records (3, 6, and 12 months) of 19 MIH-affected cases (6-12 years; no spontaneous pain and percussion/palpation sensitivity) treated with the SMART technique were assessed. The groups were allocated based on tooth location (mandibular-maxillary) and cavity preparation (class 1-2). The Fisher exact the Chi-squared test was utilized, and the p-value < 0.05 was accepted as statistically significant. Overall success rates were 94.7% at 3 and 6 months and 52.63% at 12 months. Clinical success did not differ statistically regarding location (p > 0.05). The class 1 cavity preparation group was found to be significantly more successful at the 12-month assessments (p = 0.033). The class of cavity preparation may affect the success of the treatment in long-term assessments. The SMART technique, especially in class 1 occlusal restorations, can be recommended as a short-term alternative to traditional treatment methods for MIH-affected cases. Bal C, Sozuoz MA, Sari MBD, et al. 1-year Results of Molar Incisor Hypomineralization-affected Cases Treated with Silver Modified Atraumatic Restorative Treatment: A Retrospective Study. Int J Clin Pediatr Dent 2024;17(6):683-689.

Silver modified atraumatic restorative treatment: a paradigm shift in dental caries management.

Silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) are treatment modalities that are minimally invasive and used for the prevention and control of dental caries. The amalgamation of these two techniques has led to the development of silver modified atraumatic restorative treatment (SMART). In this approach the carious lesion is restored with glass-ionomer cement (GIC) after SDF application. SMART effectively arrests caries without removing additional tooth structure, making it a promising option for caries management in children who lack cooperative ability.This article reviews the literature on SMART, the evidence regarding its applications in dental practice, its advantages, drawbacks, the scope for research, and clinical use.

Noninferiority of Silver Diamine Fluoride vs Sealants for Reducing Dental Caries Prevalence and Incidence

Dental caries is the world's most prevalent noncommunicable disease and a source of health inequity; school dental sealant programs are a common preventive measure. Silver diamine fluoride (SDF) may provide an alternative therapy to prevent and control caries if shown to be noninferior to sealant treatment. To determine whether school-based application of SDF is noninferior to dental sealants and atraumatic restorative treatment (ART) in the prevalence of dental caries. The Silver Diamine Fluoride Versus Therapeutic Sealants for the Arrest and Prevention of Dental Caries in Low-Income Minority Children (CariedAway) study was a pragmatic noninferiority cluster-randomized clinical trial conducted from February 2018 to June 2023 to compare silver diamine fluoride vs therapeutic sealants for the arrest and prevention of dental caries. Children at primary schools in New York, New York, with at least 50% of the student population reporting as Black or Hispanic and at least 80% receiving free or reduced lunch were included. This population was selected as they are at the highest risk of caries in New York. Students were randomized to receive either SDF or sealant with ART; those aged 5 to 13 years were included in the analysis. Treatment was provided at every visit based on need, and the number of visits varied by child. Schools with preexisting oral health programs were excluded, as were children who did not speak English. Of 17 741 students assessed for eligibility, 7418 were randomized, and 4100 completed follow-up and were included in the final analysis. Participants were randomized at the school level to receive either a 38% concentration SDF solution or glass ionomer sealants and ART. Each participant also received fluoride varnish. Primary study outcomes were the prevalence and incidence of dental caries. A total of 7418 children (mean [SD] age, 7.58 [1.90] years; 4006 [54.0%] female; 125 [1.7%] Asian, 1246 [16.8%] Black, 3648 [49.2%] Hispanic, 153 [2.1%] White, 114 [1.5%] multiple races or ethnicities, 90 [1.2%] other [unspecified], 2042 [27.5%] unreported) were enrolled and randomized to receive either SDF (n = 3739) or sealants with ART (n = 3679). After initial treatment, 4100 participants (55.0%) completed at least 1 follow-up observation. The overall baseline prevalence of dental caries was approximately 27.2% (95% CI, 25.7-28.6). The odds of decay prevalence decreased longitudinally (odds ratio [OR], 0.79; 95% CI, 0.75-0.83) and SDF was noninferior compared to sealants and ART (OR, 0.94; 95% CI, 0.80-1.11). The crude incidence of dental caries in children treated with SDF was 10.2 per 1000 tooth-years vs 9.8 per 1000 tooth-years in children treated with sealants and ART (rate ratio, 1.05; 95% CI, 0.97-1.12). In this school-based pragmatic randomized clinical trial, application of SDF resulted in nearly identical caries incidence compared to dental sealants and ART and was noninferior in the longitudinal prevalence of caries. These findings suggest that SDF may provide an effective alternative for use in school caries prevention. ClinicalTrials.gov Identifier: NCT03442309.

Evaluating Glass Ionomer Cement Longevity in the Primary and Permanent Teeth-An Umbrella Review.

The aim of this umbrella review was to evaluate the longevity of glass ionomer cement (GIC) as a restorative material for primary and permanent teeth. Research in the literature was conducted in three databases (MedLine/PubMed, Web of Science, and Scopus). The inclusion criteria were: (1) to be a systematic review of clinical trials that (2) evaluated the clinical longevity of GICs as a restorative material in primary and/or permanent teeth; the exclusion criteria were: (1) not being a systematic review of clinical trials; (2) not evaluating longevity/clinical performance of GICs as a restorative material; and (3) studies of dental restorative materials in teeth with enamel alterations, root caries, and non-carious cervical lesions. Twenty-four eligible articles were identified, and 13 were included. The follow-up periods ranged from 6 months to 6 years. Different types of GICs were evaluated in the included studies: resin-modified glass ionomer cement (RMGIC), compomers, and low- and high-viscosity glass ionomer cement. Some studies compared amalgam and composite resins to GICs regarding longevity/clinical performance. Analyzing the AMSTAR-2 results, none of the articles had positive criteria in all the evaluated requisites, and none of the articles had an a priori design. The criteria considered for the analysis of the risk of bias of the included studies were evaluated through the ROBIS tool, and the results of this analysis showed that seven studies had a low risk of bias; three studies had positive results in all criteria except for one criterion of unclear risk; and two studies showed a high risk of bias. GRADE tool was used to determine the quality of evidence; for the degree of recommendations, all studies were classified as Class II, meaning there was still conflicting evidence on the clinical performance/longevity of GICs and their recommendations compared to other materials. The level of evidence was classified as Level B, meaning that the data were obtained from less robust meta-analyses and single randomized clinical trials. To the best of our knowledge, this is the first umbrella review approaching GIC in permanent teeth. GICs are a good choice in both dentitions, but primary dentition presents more evidence, especially regarding the atraumatic restorative treatment (ART) technique. Within the limitation of this study, it is still questionable if GIC is a good restorative material in the medium/long term for permanent and primary dentition. Many of the included studies presented a high risk of bias and low quality. The techniques, type of GIC, type of cavity, and operator experience highly influence clinical performance. Thus, clinical decision-making should be based on the dental practitioner's ability, each case analysis, and the patient's wishes. More evidence is needed to determine which is the best material for definitive restorations in permanent and primary dentition.

Minimal intervention dentistry: What is its clinical application and effectiveness in different continents? - A scoping review.

The aim of minimal intervention dentistry (MID) is to maximize the preservation of dental tissues through the use of modern and effective techniques and procedures. The central objective of MID is to increase the functional life of dental elements and, consequently, the quality of life of the population. The present study aimed to analyze and map the diffusion and clinical application of MID in different continents around the world. To perform this scoping review, the PRISMA checklist was used, adopting the following: population - dentists; concept - effectiveness of MID; and context - continents. The following databases were used: PubMed, European Archives of Paediatric Dentistry, Scientific Electronic Library, Latin Literature American and Caribbean Association in Health Sciences, and SCOPUS. The following keywords were used in the searches: "pediatric dentistry," "atraumatic restorative treatment," "dental caries," "child health," and "glass ionomer cements" using "and" and "or" combined with "minimal intervention dentistry." Studies published before 2010 as well as theses, dissertations, opinion articles, editorials, and guidelines, were excluded from the study. A total of 160 articles were obtained, and 17 articles were screened and selected for full reading. The analysis of the studies reveals the disparity in the use of minimal intervention techniques among continents due to a lack of knowledge of these techniques or lack of confidence in changing professional approaches, thus emphasizing the need for the dissemination and teaching of MID.

Physical and mechanical properties assessment of glass ionomer cements modified with TiO2 and Mg-doped hydroxyapatite nanoparticles.

High viscosity glass ionomer cements (GICs) are widely used in various clinical applications, being particularly effective in atraumatic restorative treatment (ART) due to the synergistic interaction between the material and the technique. However, the inadequate mechanical properties of GICs raise concerns regarding the predictability and longevity of these restorations in areas exposed to occlusal stress. Various modifications of the powder components have been proposed to improve the mechanical strength of GICs to withstand occlusal loading during mastication. In this in vitro study, we investigated whether the nanoparticles (NPs) added to commercially available GICs could fulfill this requirement, which would likely broaden the spectrum of their potential clinical applications. Two commercially available GIC powders (Fuji IX and Ketac Molar), modified by the addition of 5 wt.% TiO2, MgHAp100 or MgHAp1000 NPs, were incorporated into the corresponding liquid in an appropriate ratio, and the mixed cements were evaluated in terms of fracture toughness, flexural strength, Vickers microhardness and rheological tests and compared with the original material. Fuji IX containing 5 wt.% MgHAp100 NPs had lower flexural strength, while Ketac Molar with 5 wt.% TiO2 NPs showed increased fracture toughness. Vickers microhardness increased in Fuji IX following the addition of 5 wt.% TiO2 and MgHAp100 but decreased in Ketac Molar comprising 5 wt.% MgHAp100 (p < 0.05). Achieving a predictable bond between NPs and cement matrix, as well as ensuring a uniform distribution of the NPs within the cement, are critical prerequisites for enhancing the mechanical performance of the original cement.

Educators' perception of oral health in children's schools in Brazil

This study aimed to explore educators' perceptions regarding oral health promotion and the application of Atraumatic Restorative Treatment in the school environment. It is an exploratory descriptive observational study with a qualitative approach. The sample consisted of 18 educators from an Early Childhood Education Center. For data collection, a form was used with open and closed questions about oral health care for children: recreational and educational activities, supervised brushing and Atraumatic Restorative Treatment. Data were analyzed by descriptive analysis and by the Discourse of the Collective Subject. About 60% of educators considered caries a disease, 50% having observed toothache in children in the school environment. The educators considered the educational/preventive activities and the use of Atraumatic Restorative Treatment beneficial to the children. They reported relevance in oral health prevention and promotion actions carried out in the school environment, observing the generation of autonomy and empowerment in children. They also cited a favorable opinion on the use of Atraumatic Restorative Treatment.

Effectiveness of mixing procedure on the microleakge of glass ionomer cement as filling material in primary molars (in vitro study)

Background: Well-adapted restorations with adequate marginal sealing are of extreme importance for the success of atraumatic restorative treatment, The present study was carried out to find if the mixing procedure affect the marginal seal of hand mixed and capsulated glass-ionomer in Class I cavities of 30 non carious primary molars.Materials and Methods:Standardized Class I cavity preparations were prepared in 30 extracted sound primary molars. The teeth were then randomly divided into two groups: Group I: filled with mechanically mixed (capsulated) glass ionomer cement (GIC). Group II: filled with hand mixed glass ionomer . After that the teeth were subjected to 250 thermal cycles with a 15 second dwell time in each, then sectioned to be examined under the stereo microscope.Results:The sealing ability of the GIC filling materials was determined by their ability to inhibit dye penetration. Data were analyzed according to t-test. The hand mixed GIC provides a better seal than capsulated GIC, there were no significant differences between the two studied groups in their resistance to dye penetration. Conclusion: Hand mixed GIC presented a better performance regarding microleakage in comparison to capsulated GIC.

Peningkatan Kesehatan Gigi dan Mulut Melalui Revitalisasi Usaha Kesehatan Gigi Sekolah di SDN Pasar Kamis 2 Kabupaten Banjar

Pasar Kamis 2 elementary school is one of the elementary schools in Kertak Hanyar District that has not implemented a phase III school dental health program, so it is necessary to revitalize the school dental health program. The revitalization of school dental health programs aims to revive promotional programs for dental and oral health in elementary schools. The method applied for this community service activity is by carrying out promotional activities in the form of teacher training for school dental health businesses, training for little doctors, health promotion through the media snakes and ladders and the song SIGIBER, as well as joint toothbrushing activities. Preventive activities carried out include carrying out dental and oral health screening and carrying out fissure sealant treatment and atraumatic restorative treatment based on the results of the screening. Evaluation of community service activities is carried out by measuring the results of pretest and posttest students' knowledge and analyzing the provision of preventive measures to students. The results of this service show that there is a difference in knowledge before and after being given health promotion interventions, as well as an improvement in students' dental and oral health after preventive measures are given in the form of pit and fissure sealants and atraumatic restorative treatment. Revitalization of school dental health businesses is important so that promotional activities for dental and oral health in the school environment are not neglected so that they can improve dental and oral health and school children's achievement in learning.

Cost-effectiveness of dental caries prevention strategies in South African schools

BackgroundIn South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of children with dental caries remain untreated. To reduce this burden of disease, one key goal is to promote good oral health and address oral diseases through prevention, screening, and treatment among children. While all policies have been proven to be effective in the control and prevention of dental caries, it is unclear which of those strategies provide value for money. This study evaluated five caries preventative strategies in terms of the cost and benefits among South African school children.MethodsThe study uses a hypothetical South African population of school aged learners aged 5–15. The context and insights of the strategies utilized at the schools were informed by data from both grey and published literature. Using Markov modeling techniques, we conducted a cost-effectiveness analysis of Acidulated Phosphate Fluoride (APF) application, atraumatic restorative treatment (ART), sugar-reduction and fissure sealants. Markov model was used to depict the movement of a hypothetical patient cohort between different health states over time. We assessed both health outcomes and costs of various interventions. The health outcome metric was measured as the number of Decayed, Missing, Filled Tooth (DMFT). The net monetary benefit was then used to determine which intervention was most cost-effective.ResultsThe results showed that school-based caries prevention strategies are cost-effective compared to the status quo of doing nothing. The average cost per learner over the 10-year period ranged from ZAR4380 to approx. ZAR7300 for the interventions considered. The total costs (including screening) associated with the interventions and health outcome (DMFT averted) were: sugar reduction (ZAR91,380, DFMT: 63,762), APF-Gel (ZAR54 million, DMFT: 42,010), tooth brushing (ZAR72.8 million, DMFT: 74,018), fissure sealant (ZAR44.63 million, DMFT: 100,024), and ART (ZAR45 million, DMFT: 144,035). The net monetary benefits achieved for APF-Gel, sugar reduction, tooth brushing, fissure sealant and ART programs were ZAR1.56, ZAR2.45, ZAR2.78, ZAR3.81, and ZAR5.55 billion, respectively.ConclusionBased on the net monetary benefit, ART, fissure sealant and sugar-reduction appear to be the most cost-effective strategies for preventing caries in South Africa. In a resource-scarce setting such as South Africa, where there is no fluoridation of drinking water, this analysis can inform decisions about service packages for oral health.

Minimally invasive dentistry: history, theory and perspectives

The article is a literature review concerning certain aspects of the history of Russian dentistry. In this regard, minimally invasive methods are discussed, including air-abrasive, laser, sonic and ultrasonic preparation, as well as atraumatic restorative treatment without mechanical preparation. Indications for minimally invasive methods, assessment of caries activity and prognosis, causes and mechanisms of the accelerated restoration cycle are discussed. The need to preserve dental tissues has been undervalued in the past. Non-selective preparation to hard dentin is currently considered hypertherapy. The concept of minimally invasive dentistry is also applied in endodontics and periodontology. In patients with gingival recession, it is important to protect atrophic tissues from further damage. After a tooth extraction, excessive socket curettage should be avoided. The research in dentistry should be protected from conflicts of interest. Patients should be objectively informed about treatment options, given recommendations based on clinical indications, wishes and possibilities. It is also necessary to develop economic measures in order to reorient private dental clinics to receive patients with compulsory medical insurance and the use of minimally invasive methods.

Atraumatic Restorative Treatment (ART) as public policy: a Scoping Review

AbstractThis scoping review aimed to identify, describe, and analyze the use of Atraumatic Restorative Treatment (ART) as public policy. Inclusion criteria: studies on public oral health policies; dental caries; ART. Exclusion criteria: clinical studies; specific interventions; studies that report public policies that do not use ART as a strategy for caries treatment. The search was conducted in PubMed, BVS, Epistemonikos, Health Systems Evidence, and Rxforchange. The selection process and data extraction were performed by two authors independently according to the stages and categories of a conceptual framework. Of the 2253 eligible articles, 139 were duplicates, and 1680 were not included after reading the title and abstract. After assessing the full text, 414 articles were excluded. Twenty articles were included. Nineteen were conducted in nine countries (South Africa, Bolivia, Cambodia, Egypt, Mexico, Tanzania, East Timor, Tunisia, and Zimbabwe), and one in the Americas. The studies reported high prevalence of dental caries and lack of access to restorative procedures in health services as common problems. Policy developments followed a similar process, with the presence of governments, conceptual use of scientific evidence, and induction by the World Health Organization. Regarding implementation barriers, the included studies mentioned the lack of supplies and lack of induction by managers,while in relation to the facilitators, permanent education and professional practice were mentioned. Cohort studies have shown a survival rate greater than 80% after one year of follow up of the restorations performed. The findings of this review indicate that the use of ART in public policies is promising, however, its use is still in an early stage. Keywords: Dental Atraumatic Restorative Treatment. Dental Caries. Public Policy. Community Dentistry. Oral Health. ResumoEsta revisão de escopo teve como objetivo identificar, descrever e analisar o uso do Tratamento Restaurador Atraumático (ART) como política pública. Critérios de inclusão: estudos sobre políticas públicas de saúde bucal; cáries dentárias; ART. Critérios de exclusão: estudos clínicos; intervenções específicas; estudos que relatam políticas públicas que não utilizam o ART como estratégia para o tratamento de cárie. A pesquisa foi realizada no PubMed, BVS, Epistemonikos, Health Systems Evidence e Rxforchange. O processo de seleção e extração de dados foram realizados por dois autores, de forma independente, de acordo com as etapas e categorias de um quadro conceitual. Dos 2.253 artigos elegíveis, 139 eram duplicados e 1.680 não foram incluídos após a leitura do título e do resumo. Após avaliação do texto completo, foram excluídos 414 artigos. Vinte artigos foram incluídos. Dezenove foram realizados em nove países (África do Sul, Bolívia, Camboja, Egito, México, Tanzânia, Timor Leste, Tunísia e Zimbábue) e um nas Américas. Os estudos relataram alta prevalência de cárie dentária e falta de acesso a procedimentos restauradores nos serviços de saúde como problemas comuns. Os desenvolvimentos de políticas seguiram um processo semelhante, com a presença de governos, uso conceitual de evidências científicas e indução da Organização Mundial da Saúde. Quanto às barreiras de implementação, foram mencionadas a falta de insumos e a falta de indução por parte dos gestores. Quanto aos facilitadores, foram citados a educação permanente e a prática profissional. Estudos de coorte mostraram sobrevida superior a 80% após um ano de acompanhamento. Os achados desta revisão indicam que a utilização da ART nas políticas públicas é promissora, porém, sua utilização ainda é incipiente. Palavras-chave: Tratamento Dentário Restaurador sem Trauma. Cárie Dentária. Política Pública. Odontologia Comunitária. Saúde Bucal.