RESUMO
The aim of this clinical trial was to compare the 5-year cumulative survival of atraumatic restorative treatment restorations using high-viscosity glass-ionomer restorations (ART/HVGIC) and conventional resin composite restorations (CRT) placed in patients with intellectual and/or physical disability. Patients referred for restorative care to a special care service in Córdoba, Argentina, were recruited. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. The treatment protocols were ART (hand instruments/HVGIC) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). Two independent, trained and calibrated examiners evaluated restoration survival using established ART codes after 6, 12, 24, 36 and 60 months. The proportional hazard model with frailty corrections provided survival estimates. Jackknife errors were used to test 5-year results. Sixty-six patients (13.6 ± 7.8 years) with 16 different medical conditions participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was provided for 47 patients (71.2%). A total number of 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). Four patients died between the 3 and 5-year follow up. Percentage survival and jackknife standard error were calculated and were significantly higher for all ART/HVGIC restorations (90.2% ± 2.6) than for all CRT restorations (82.8% ± 5.3), 5 years after placement (p=0.044). These 5-year follow-up results confirm that ART/HVGIC is an effective treatment protocol for patients with disability, equal to that of conventional resin composite restoration. The results of this clinical trial support the use of ART as an evidence-based treatment resource contributing to the reduction of inequalities in access to oral health care among people with disability.
Assuntos
Resinas Compostas/uso terapêutico , Tratamento Dentário Restaurador sem Trauma/métodos , Restauração Dentária Temporária/métodos , Pessoas com Deficiência , Cimentos de Ionômeros de Vidro/uso terapêutico , Adolescente , Adulto , Criança , Pré-Escolar , Resinas Compostas/química , Falha de Restauração Dentária , Feminino , Seguimentos , Cimentos de Ionômeros de Vidro/química , Humanos , Masculino , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Viscosidade , Adulto JovemRESUMO
OBJECTIVES: To assess the 3-year cumulative survival rate of atraumatic restorative treatment (ART) and conventional resin composite restorations (CRT) placed in persons with disability. MATERIALS AND METHODS: Patients referred for restorative care to the Haemophilia Foundation special care service were treated by one of two specialists. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. Treatment was provided as selected unless this option proved clinically unfeasible when an alternative technique was proposed. The treatment protocols were ART (hand instruments/high-viscosity glass-ionomer) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). After 6, 12, 24 and 36 months, two independent, trained and calibrated examiners evaluated restoration survival using established ART codes. The proportional hazard model with frailty corrections gave survival estimates over 3 years. RESULTS: Sixty-six patients (13.6 ± 7.8 years) with 16 different disability profiles participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was used for 47 patients (71.2%). Altogether, 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). The 3-year cumulative survival rates and jackknife standard errors for the 182 ART and 116 CRT restorations were 94.8 ± 2.1 and 82.8 ± 5.3%, respectively (p = 0.01). CONCLUSIONS: The 3-year follow-up results confirm that ART is an effective treatment protocol. CLINICAL RELEVANCE: Patients with disability, many of whom have difficulty coping with CRT, may benefit from the ART approach.
Assuntos
Resinas Compostas/uso terapêutico , Tratamento Dentário Restaurador sem Trauma/métodos , Assistência Odontológica para a Pessoa com Deficiência , Falha de Restauração Dentária , Cimentos de Ionômeros de Vidro/uso terapêutico , Adolescente , Silicatos de Alumínio , Feminino , Humanos , MasculinoRESUMO
The aim was to test the null-hypothesis that there is no difference in the cumulative survival rate of retained composite resin (CR) sealants and a high-viscosity glass-ionomer Atraumatic Restorative Treatment (ART) sealant in first permanent molars calculated according to the traditional and the modified retention assessment criteria over a period of 3 years. This cluster-randomized controlled clinical trial consisted of 123 schoolchildren, 6-7-years-old. At baseline, high-caries risk pits and fissures of fully erupted first permanent molars were treated with CR and ART sealants. Evaluations were performed after 0.5, 1, 2 and 3 years. Retention was scored for free-smooth surface and for each of three sections into which the occlusal surface had been divided. The modified criterion differed from the traditional in that it determined an occlusal sealant to be a failure when at least one section contained no visible sealant material. Data were analysed according to the PHREG model with frailty correction, Wald-test, ANOVA and t-test, using the Jackknife procedure. The cumulative survival rates for retained CR and ART sealants in free-smooth and occlusal surfaces for both criteria were not statistically significantly different over the 3 years. A higher percentage of retained CR sealants on occlusal surfaces was observed at longer evaluations. Cumulative survival rates were statistically significantly lower for the modified criterion in comparison to the traditional. The modified retention assessment criterion should be used in future sealant-retention studies.
Assuntos
Resinas Compostas/uso terapêutico , Tratamento Dentário Restaurador sem Trauma/métodos , Cimentos de Ionômeros de Vidro/uso terapêutico , Selantes de Fossas e Fissuras/uso terapêutico , Criança , Cárie Dentária/prevenção & controle , Retenção em Prótese Dentária , Falha de Restauração Dentária , Dentina/efeitos dos fármacos , Feminino , Seguimentos , Humanos , Masculino , Dente Molar , Medição de Risco , Propriedades de Superfície , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , ViscosidadeRESUMO
Abstract The aim was to test the null-hypothesis that there is no difference in the cumulative survival rate of retained composite resin (CR) sealants and a high-viscosity glass-ionomer Atraumatic Restorative Treatment (ART) sealant in first permanent molars calculated according to the traditional and the modified retention assessment criteria over a period of 3 years. This cluster-randomized controlled clinical trial consisted of 123 schoolchildren, 6–7-years-old. At baseline, high-caries risk pits and fissures of fully erupted first permanent molars were treated with CR and ART sealants. Evaluations were performed after 0.5, 1, 2 and 3 years. Retention was scored for free-smooth surface and for each of three sections into which the occlusal surface had been divided. The modified criterion differed from the traditional in that it determined an occlusal sealant to be a failure when at least one section contained no visible sealant material. Data were analysed according to the PHREG model with frailty correction, Wald-test, ANOVA and t-test, using the Jackknife procedure. The cumulative survival rates for retained CR and ART sealants in free-smooth and occlusal surfaces for both criteria were not statistically significantly different over the 3 years. A higher percentage of retained CR sealants on occlusal surfaces was observed at longer evaluations. Cumulative survival rates were statistically significantly lower for the modified criterion in comparison to the traditional. The modified retention assessment criterion should be used in future sealant-retention studies.
Assuntos
Humanos , Masculino , Feminino , Criança , Selantes de Fossas e Fissuras/uso terapêutico , Resinas Compostas/uso terapêutico , Tratamento Dentário Restaurador sem Trauma/métodos , Cimentos de Ionômeros de Vidro/uso terapêutico , Propriedades de Superfície , Fatores de Tempo , Viscosidade , Análise de Sobrevida , Seguimentos , Resultado do Tratamento , Retenção em Prótese Dentária , Medição de Risco , Falha de Restauração Dentária , Cárie Dentária/prevenção & controle , Dentina/efeitos dos fármacos , Dente MolarRESUMO
BACKGROUND: Failed restorations in primary teeth are not always re-restored. Is re-restoration not required anymore? OBJECTIVE: To compare survival rates of primary molars with intact and defective amalgam and ART restorations. METHODS: A total of 649 restored primary molars, of which 162 were assessed with defective restorations for mechanical reasons, from a cluster-randomised controlled clinical trial, were followed up over a period of 3.5 years. Restored primary molars, extracted because of dental sepsis or toothache, were considered a failure. Primary molars with defective restorations were followed up from the time they were assessed defective. Data were analysed using PHREG model with frailty correction, Wald test, t-test, and jackknife procedure. RESULTS: The survival rate of primary molars with intact restorations (96.3%) was statistically significantly higher than that of primary molars with defective restorations (75.9%) over a 3-year period (P < 0.0001). Neither the effect of treatment protocol (amalgam or ART) (P = 0.05) nor the type of surface (single or multiple) (P = 0.73) was observed with respect to the survival rate of restored primary molars. CONCLUSIONS: Survival rates for primary molars with intact and defective amalgam and ART restorations were high. The 3-year survival rate of primary molars with intact restorations was significantly higher than that of primary molars with defective restorations.
Assuntos
Falha de Restauração Dentária/estatística & dados numéricos , Restauração Dentária Permanente , Dente Molar , Dente Decíduo , Brasil , Criança , Resinas Compostas , Amálgama Dentário/uso terapêutico , Tratamento Dentário Restaurador sem Trauma , Cárie Dentária/terapia , Preparo da Cavidade Dentária/classificação , Preparo da Cavidade Dentária/métodos , Preparo da Cavidade Dentária/normas , Materiais Dentários , Restauração Dentária Permanente/métodos , Restauração Dentária Permanente/normas , Cimentos de Ionômeros de Vidro/uso terapêutico , Humanos , Dente Molar/diagnóstico por imagem , Sepse , Dente Decíduo/diagnóstico por imagem , Odontalgia , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of the study was to evaluate the exfoliation pattern of primary molars treated according to three treatment protocols. The hypothesis tested was that there is no difference in the exfoliation pattern of primary molars treated according to conventional restorative treatment using amalgam (CRT), atraumatic restorative treatment using highviscosity glassionomer (ART), and ultraconservative treatment (UCT). The latter consisted of restoring small cavities with ART and cleaning medium/large nonrestored cavities daily with toothpaste/toothbrush under supervision. METHODS: A sample of 302 children aged 67 years from a suburban area of Brasilia was followed up for 3.5 years. The numbers of treated molars were 341 (CRT), 244 (ART), and 275 (UCT). Exfoliation rates were obtained using the PHREG procedure. Differences between the three treatment protocol groups were tested using the Wald test. RESULTS: After 3.5 years, there was no difference over the exfoliation rates of all primary molars as 51.0% (CRT), 48.7% (ART), and 59.3% (UCT) had exfoliated at the overall period (P = 0.34). CONCLUSION: The three treatment protocols led to similar exfoliation patterns of all primary molars after 3.5 years.
Assuntos
Restauração Dentária Permanente/métodos , Dente Molar , Esfoliação de Dente/epidemiologia , Dente Decíduo , Brasil/epidemiologia , Criança , Tratamento Dentário Restaurador sem Trauma/efeitos adversos , Tratamento Dentário Restaurador sem Trauma/métodos , Cárie Dentária/cirurgia , Restauração Dentária Permanente/efeitos adversos , Feminino , Humanos , Masculino , Esfoliação de Dente/etiologia , Dente Decíduo/cirurgiaRESUMO
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.
Assuntos
Tratamento Dentário Restaurador sem Trauma/estatística & dados numéricos , Assistência Odontológica para a Pessoa com Deficiência/estatística & dados numéricos , Adolescente , Adulto , Anestesia Dentária/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Criança , Pré-Escolar , Resinas Compostas/química , Índice CPO , Tratamento Dentário Restaurador sem Trauma/instrumentação , Materiais Dentários/química , Índice de Placa Dentária , Falha de Restauração Dentária/estatística & dados numéricos , Restauração Dentária Permanente/instrumentação , Restauração Dentária Permanente/estatística & dados numéricos , Feminino , Seguimentos , Cimentos de Ionômeros de Vidro/química , Humanos , Masculino , Índice de Higiene Oral , Índice Periodontal , Modelos de Riscos Proporcionais , Análise de Sobrevida , Dente Decíduo/patologia , Adulto JovemRESUMO
BACKGROUND: To identify barriers to participation in a primary oral health care programme aimed at preventing early childhood caries, as perceived by nurses. METHODS: Of a total of 140 randomly selected nurses employed in 40 government health centres in Lima, 123 completed a pre-tested questionnaire. Background variables were districts' 'socio-economic status' (SES) and 'years of experience'. Factor analysis was performed. ANOVA was applied for testing the influence of the background variables on the barrier factors. Chi-square test was applied to test for differences between single item barriers and the background variables. The Likert-scale (1-4) was used. RESULTS: There was no statistical significant effect of 'SES' or of 'years of experience' of nurses on any of the 7 barrier factors, nor on the 11 single item barrier factors. The highest mean score (3.81) was obtained for the barrier factor 'importance of oral health', followed by 'perceived responsibility' (3.44). The lowest mean score was (1.70) for 'knowledge on caries prevention'. CONCLUSIONS: Nurses consider oral health very important and are willing to participate actively in programmes aimed at reducing Early Childhood Caries, provided that they will be trained well and that the director and dentists of the health centre give their consent.
Assuntos
Cárie Dentária/prevenção & controle , Promoção da Saúde , Acessibilidade aos Serviços de Saúde , Saúde Bucal , Atenção Primária à Saúde , Atitude do Pessoal de Saúde , Pré-Escolar , Aconselhamento , Cárie Dentária/enfermagem , Educação em Enfermagem , Feminino , Humanos , Lactente , Masculino , Relações Enfermeiro-Paciente , Enfermeiras e Enfermeiros/psicologia , Saúde Bucal/educação , Peru , Relações Profissional-Família , Classe Social , Responsabilidade Social , Fatores Socioeconômicos , Inquéritos e Questionários , Recursos HumanosRESUMO
BACKGROUND: The massive use of preventive measures in Mexico 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 of addressing this. The objective was to evaluate ART restorations and sealants placed in primary and permanent teeth in schoolchildren from deprived areas over a period of 2 years. METHODS: 18 Dentists from 13 municipalities in 6 states with the lowest human development index treated 304, 6- to 13-year-old schoolchildren with ART sealants and ART restorations (single-surfaces) on the school compounds. Ketac Molar Easymix was the filling material used. ART procedures were evaluated according to the ART assessment criteria after 1 and 2 years, by 7 calibrated evaluators. Survival rates were estimated, using the PHREG Model with frailty correction. RESULTS: The 2-year cumulative survival rates of fully and partially retained ART sealants were 73.1% (primary teeth) and 48.8% (permanent teeth). The dentine carious lesion failure rates of ART sealants in primary and permanent teeth over the 2-year period were 0% and 2.5%, respectively. The 2-year cumulative survival rates of single-surface ART restorations in primary and permanent teeth were 74% and 80.9%, respectively. Secondary carious lesion development occurred in 6 restored primary teeth (2.1%) and in one restored permanent tooth (1.3%). All restorations placed in primary teeth in one state survived, whilst those in one of the 5 remaining states failed statistically significantly more than those in the other 4. CONCLUSIONS: The ART procedures were of substantial quality and had prevented to a large extent the development of new dentine carious lesions in these children from socio-economically deprived areas.
Assuntos
Tratamento Dentário Restaurador sem Trauma/métodos , Cárie Dentária/terapia , Cimentos de Ionômeros de Vidro , Selantes de Fossas e Fissuras , Adolescente , Atitude do Pessoal de Saúde , Criança , Dentina/patologia , Seguimentos , Humanos , México , Áreas de Pobreza , Estudos Prospectivos , Análise de Regressão , Análise de SobrevidaRESUMO
The aim of the present study was to assess the caries experience of children aged 6 to 7 years old in a socially deprived suburban area of Brazil's Federal District, using the ICDAS II system and to investigate determinants of dental caries. The survey was carried out in six public schools by three calibrated examiners, on a sample of 835 children. ICDAS II codes had to be converted into dmf/DMF components at surface and tooth levels, resulting in unfamiliar caries variables, to enable some meaningful reporting of the findings. The prevalence of dental caries, including enamel and dentinal carious lesions, in primary teeth was 95.6% and in permanent teeth it was 63.7%. Mean values of d(2)mf(2)-t (enamel and dentinal lesions), d(3)mf(3)-t (dentine lesions), D(2)MF(2)-T and D(3)MF(3)-T indices were 6.9 ± 3.8, 3.2 ± 3.4, 1.7 ± 1.6 and 0.2 ± 0.5, respectively. Enamel carious lesions predominated in the dmf-t/s and DMF-T/S indices. Seven-year-old children had statistically significantly more enamel and dentine carious lesions in permanent teeth than 6-year-old children had. Using ICDAS II, the prevalence of dental caries in both dentitions was very high. In both dentitions, the decay component predominated, with hardly any restorations or extractions observed. The new ICDAS II system leads to overvaluation of the seriousness of dental caries experience and made reporting of outcomes cumbersome. Guidelines on analysing data and reporting results should be agreed upon before this system can be used in epidemiological surveys globally.
Assuntos
Índice CPO , Cárie Dentária/epidemiologia , Populações Vulneráveis/estatística & dados numéricos , Brasil/epidemiologia , Criança , Coroas/estatística & dados numéricos , Carência Cultural , Cárie Dentária/classificação , Esmalte Dentário/patologia , Falha de Restauração Dentária , Restauração Dentária Permanente/estatística & dados numéricos , Restauração Dentária Temporária/estatística & dados numéricos , Dentina/patologia , Estudos Epidemiológicos , Feminino , Humanos , Incisivo/patologia , Masculino , Dente Molar/patologia , Selantes de Fossas e Fissuras/uso terapêutico , Prevalência , Saúde Suburbana/estatística & dados numéricos , Extração Dentária/estatística & dados numéricos , Dente Decíduo/patologia , Dente não Erupcionado/epidemiologiaRESUMO
OBJECTIVE: To test the hypothesis that dental anxiety levels of children treated in accordance with the conventional restorative treatment (CRT) are higher than in children treated with the atraumatic restorative treatment (ART) or ultra-conservative treatment (UCT) protocols. MATERIALS AND METHODS: In total, 302 children aged 6-7-years old, with at least two dentine carious lesions, constituted the sample. A parallel group study design was used with ART and UCT as test groups and CRT as the control. The treatment was divided into two sessions. In the first session, one carious tooth (class II in a primary molar) was randomly selected and treated according to one of the treatments. All other treatments were performed in the second session. Before the first (FIS Tx-1) and before the second session (FIS Tx-2) the level of dental anxiety was assessed using the Facial Image Scale (FIS). The GLM test and Spearman's Rank Correlation Coefficient were used to analyse the data. RESULTS: No treatment group effect was observed on the FIS Tx-2 score (p = 0.64). A FIS Tx-1 score (p < 0.0001) effect on the FIS Tx-2 score was observed. The correlation coefficient between FIS Tx-1 and FIS Tx-2 scores was r = 0.30 (p < 0.0001). CONCLUSION: At the beginning of the second session there was no difference in dental anxiety levels of the children treated in the first session according to the three treatment protocols. A high dental anxiety score before the first session was a predictor of a high dental anxiety score at the second treatment session.
Assuntos
Ansiedade ao Tratamento Odontológico/classificação , Tratamento Dentário Restaurador sem Trauma/psicologia , Restauração Dentária Permanente/psicologia , Atitude Frente a Saúde , Bis-Fenol A-Glicidil Metacrilato/uso terapêutico , Cariostáticos/uso terapêutico , Criança , Amálgama Dentário/química , Ansiedade ao Tratamento Odontológico/psicologia , Cárie Dentária/terapia , Preparo da Cavidade Dentária/instrumentação , Preparo da Cavidade Dentária/métodos , Restauração Dentária Permanente/classificação , Dentina/patologia , Feminino , Fluoretos/uso terapêutico , Cimentos de Ionômeros de Vidro/química , Humanos , Masculino , Dente Molar/patologia , Higiene Bucal/educação , Selantes de Fossas e Fissuras/uso terapêutico , Poliuretanos/uso terapêutico , Dente Decíduo/patologia , Escovação Dentária , Cremes Dentais/uso terapêuticoRESUMO
The hypothesis was tested that the level of pain experienced by children during conventional restorative treatment is higher than during atraumatic restorative treatment (ART) or an ultraconservative treatment. The sample consisted of 244 children, 6- to 7 yr of age, who had at least two teeth with dentine carious lesions. Before the first treatment session (Tx-1), in which one of the carious teeth was treated using one of the treatments, the level of dental anxiety was assessed using the Facial Image Scale (FIS). The child reported the intensity of pain experienced during the procedure using the Wong-Baker FACES Pain Rating Scale. When conventional restorative treatment was used, more children needed local anaesthesia. Analyses excluding the data of children who had received local anaesthesia showed no treatment group effect on the Wong-Baker score, a FIS Tx-1 effect on the Wong-Baker score, and a statistically significant correlation between FIS Tx-1 and Wong-Baker scores. There was no significant difference in the pain levels of children treated using conventional restorative treatment, atraumatic restorative treatment or ultraconservative treatment. Local anaesthesia had to be administered more frequently to children in the conventional restorative group than to those in the other two treatment groups.
Assuntos
Anestesia Dentária/métodos , Tratamento Dentário Restaurador sem Trauma/efeitos adversos , Preparo da Cavidade Dentária/efeitos adversos , Restauração Dentária Permanente/efeitos adversos , Dor/etiologia , Anestésicos Locais/uso terapêutico , Distribuição de Qui-Quadrado , Criança , Ansiedade ao Tratamento Odontológico/diagnóstico , Cárie Dentária/terapia , Preparo da Cavidade Dentária/instrumentação , Preparo da Cavidade Dentária/métodos , Feminino , Humanos , Modelos Lineares , Masculino , Dor/prevenção & controle , Medição da DorRESUMO
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.
Assuntos
Atitude do Pessoal de Saúde , Tratamento Dentário Restaurador sem Trauma , Clínicas Odontológicas , Odontólogos/psicologia , Acessibilidade aos Serviços de Saúde , Odontologia Estatal , Competência Clínica , Custo Compartilhado de Seguro , Tratamento Dentário Restaurador sem Trauma/economia , Tratamento Dentário Restaurador sem Trauma/estatística & dados numéricos , Auxiliares de Odontologia/psicologia , Clínicas Odontológicas/organização & administração , Registros Odontológicos , Restauração Dentária Permanente/estatística & dados numéricos , Feminino , Humanos , Masculino , Pacientes/estatística & dados numéricos , Projetos Piloto , Administração da Prática Odontológica , Serviços de Saúde Rural/estatística & dados numéricos , Inquéritos e Questionários , Tanzânia , Extração Dentária/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos , Carga de TrabalhoRESUMO
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.
Assuntos
Feminino , Humanos , Masculino , Atitude do Pessoal de Saúde , Tratamento Dentário Restaurador sem Trauma , Clínicas Odontológicas , Odontólogos/psicologia , Acessibilidade aos Serviços de Saúde , Odontologia Estatal , Competência Clínica , Custo Compartilhado de Seguro , Registros Odontológicos , Tratamento Dentário Restaurador sem Trauma/economia , Tratamento Dentário Restaurador sem Trauma/estatística & dados numéricos , Auxiliares de Odontologia/psicologia , Clínicas Odontológicas/organização & administração , Restauração Dentária Permanente/estatística & dados numéricos , Projetos Piloto , Administração da Prática Odontológica , Pacientes/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Inquéritos e Questionários , Tanzânia , Extração Dentária/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos , Carga de TrabalhoRESUMO
The aim of this study was to describe the attitude and subjective norm of dental practitioners towards practicing the atraumatic restorative treatment (ART) in Tanzania. A pre-tested questionnaire on attitudes and subjective norms to practice ART was mailed to all 147 dental practitioners working in the regional and district government clinics. The independent variables were: gender, working experience, qualification and ever heard of ART. The dependent variables were: attitude, subjective norm and intention to practice ART. Chi-square tests and multiple regression analysis were used to test for effects between independent and dependent variables. Significance level was set at 5 percent. A total of 138 practitioners returned completed questionnaires. More experienced dental practitioners encountered moderate social pressure than less experienced dental practitioners, who met strong social pressure (p=0.045). A total of 73.2 percent of dental practitioners felt that ART was worth introducing in Tanzania, 92.8 percent recommended ART training for all dental practitioners and 97.8 percent recommended inclusion of ART in dental curricula. Positive attitude, strong subjective norm and high intention to practice ART were recorded in 76.3 percent, 28.1 percent and 90.6 percent of the practitioners, respectively. Only subjective norm had a statistically significant influence on the intention to practice ART (p<0.0001). The results indicated that dental practitioners were willing to have ART introduced in Tanzania and had positive attitudes towards practicing this technique. Nevertheless, their intention to perform ART was strongly influenced by social pressures. Therefore, in order to have a successful introduction of ART in Tanzania, people who matter in the daily practice of dental practitioners need to accept and appraise the ART approach positively.
Assuntos
Feminino , Humanos , Masculino , Atitude do Pessoal de Saúde , Restauração Dentária Permanente/métodos , Odontólogos/psicologia , Padrões de Prática Odontológica , Distribuição de Qui-Quadrado , Padrões de Prática Odontológica/normas , Opinião Pública , Análise de Regressão , Inquéritos e Questionários , TanzâniaRESUMO
The aim of this study was to describe the attitude and subjective norm of dental practitioners towards practicing the atraumatic restorative treatment (ART) in Tanzania. A pre-tested questionnaire on attitudes and subjective norms to practice ART was mailed to all 147 dental practitioners working in the regional and district government clinics. The independent variables were: gender, working experience, qualification and ever heard of ART. The dependent variables were: attitude, subjective norm and intention to practice ART. Chi-square tests and multiple regression analysis were used to test for effects between independent and dependent variables. Significance level was set at 5%. A total of 138 practitioners returned completed questionnaires. More experienced dental practitioners encountered moderate social pressure than less experienced dental practitioners, who met strong social pressure (p=0.045). A total of 73.2% of dental practitioners felt that ART was worth introducing in Tanzania, 92.8% recommended ART training for all dental practitioners and 97.8% recommended inclusion of ART in dental curricula. Positive attitude, strong subjective norm and high intention to practice ART were recorded in 76.3%, 28.1% and 90.6% of the practitioners, respectively. Only subjective norm had a statistically significant influence on the intention to practice ART (p<0.0001). The results indicated that dental practitioners were willing to have ART introduced in Tanzania and had positive attitudes towards practicing this technique. Nevertheless, their intention to perform ART was strongly influenced by social pressures. Therefore, in order to have a successful introduction of ART in Tanzania, people who matter in the daily practice of dental practitioners need to accept and appraise the ART approach positively.