Atraumatic restorative treatment

La prevalencia de caries dental en dientes primarios en la mayoría de los países del mundo es muy alta. Es extraño ya que la caries dental es una enfermedad prevenible. ¿Por qué es tan frecuente una enfermedad prevenible? La respuesta está relacionada, entre otras cosas, con el estatus socioeconómico, el nivel de educación de la madre y los hábitos culturales de los niños. Lo que la investigación nos ha dicho es que colocar restauraciones no es la respuesta a la abundancia de caries presentes en estos niños. La caries dental es una enfermedad relacionada con el biofilm impulsada por el azúcar que puede controlarse siguiendo un estilo de vida saludable. Se sabe que la eliminación del biofilm dental de las superficies de los dientes regularmente reduce la prevalencia de lesiones de caries dental.The prevalence of dental caries in primary teeth in most world countries is very high. That is strange, to say the least, as dental caries is a preventable disease. Why is a preventable disease so prevalent? The answer is related, among others, to socio-economic status, level of education of the mother and cultural habits of the children. What research has told us is that placing restorations is not the answer to the abundance of cavities present in these children. Dental caries is a sugar-driven biofilm-related disease that can be controlled through following a healthy life-style. Removal of dental biofilm regularly from tooth surfaces is known to reduce the prevalence of dental carious lesions.Fil: Frencken, Jo. Radboud University Nijmege

Barriers to the Adoption of the ART Approach as Perceived by Dental Practitioners in Governmental Dental Clinics, in Tanzania.

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. 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. 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. The barriers studied were of low magnitude, with no significant impact on practice of ART in dental clinics in the pilot area

Evolution of the the ART approach: highlights and achievements

Atraumatic Restorative Treatment (ART) was initiated in the mid-eighties in Tanzania in response to an inappropriately functioning community oral health programme that was based on western health care models and western technology. The approach has evolved to its present standing as an effective minimal intervention approach mainly because the originators anticipated the great potential of ART to alleviate inequality in oral health care, and because they recognised the need to carry out research to investigate its effectiveness and applicability. Twenty-five years later, ART was accepted by the World Health Organisation (1994) and the FDI World Dental Federation (2002). It is included in textbooks on cariology, restorative dentistry and minimal intervention dentistry. It is being systematically introduced into public oral health service systems in a number of low- and middle income countries. Private practitioners use it. Many publications related to aspects of ART have been published and many more will follow. To achieve quality results with ART one has to attend well-conducted and sufficiently long training courses, preferably in combination with other caries preventive strategies. ART should, therefore, not be considered in isolation and must be part of an evidence-based approach to oral health with a strong foundation based on prevention

Dental Practitioners' Attitudes, Subjective Norms and Intentions to Practice Atraumatic Restorative Treatment (ART) in Tanzania.

The aim of this study was to describe the attitude and subjective norm of dental practitioners towards practicing the atraumatic restorative treatment (ART) in Tanzania. A pre-tested questionnaire on attitudes and subjective norms to practice ART was mailed to all 147 dental practitioners working in the regional and district government clinics. The independent variables were: gender, working experience, qualification and ever heard of ART. The dependent variables were: attitude, subjective norm and intention to practice ART. Chi-square tests and multiple regression analysis were used to test for effects between independent and dependent variables. Significance level was set at 5%. 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

Class I Gap-formation in Highly-viscous Glass-ionomer Restorations: Delayed vs Immediate Polishing

This in vitro study evaluated the effects of delayed versus immediate polishing to permit maturation of interfacial gap-formation around highly viscous conventional glass-ionomer cement (HV-GIC) in Class I restorations, together with determining the associated mechanical properties. Cavity preparations were made on the occlusal surfaces of premolars. Three HV-GICs (Fuji IX GP, GlasIonomer FX-II and Ketac Molar) and one conventional glass-ionomer cement (C-GIC, Fuji II, as a control) were studied, with specimen subgroups (n=10) for each property measured. After polishing, either immediately (six minutes) after setting or after 24 hours storage, the restored teeth were sectioned in a mesiodistal direction through the center of the model Class I restorations. The presence or absence of interfacial-gaps was measured at 1000× magnification at 14 points (each 0.5-mm apart) along the cavity restoration interface (n=10; total points measured per group = 140). Marginal gaps were similarly measured in Teflon molds as swelling data, together with shear-bond-strength to enamel and dentin, flexural strength and moduli. For three HV-GICs and one C-GIC, significant differences (p<0.05) in gap-incidence were observed between polishing immediately and after one-day storage. In the former case, 80–100 gaps were found. In the latter case, only 9–21 gaps were observed. For all materials, their shear-bond-strengths, flexural strength and moduli increased significantly after 24-hour storage.</p

Class I Gap-formation in Highly-viscous Glass-ionomer Restorations: Delayed vs Immediate Polishing

This in vitro study evaluated the effects of delayed versus immediate polishing to permit maturation of interfacial gap-formation around highly viscous conventional glass-ionomer cement (HV-GIC) in Class I restorations, together with determining the associated mechanical properties. Cavity preparations were made on the occlusal surfaces of premolars. Three HV-GICs (Fuji IX GP, GlasIonomer FX-II and Ketac Molar) and one conventional glass-ionomer cement (C-GIC, Fuji II, as a control) were studied, with specimen subgroups (n=10) for each property measured. After polishing, either immediately (six minutes) after setting or after 24 hours storage, the restored teeth were sectioned in a mesiodistal direction through the center of the model Class I restorations. The presence or absence of interfacial-gaps was measured at 1000× magnification at 14 points (each 0.5-mm apart) along the cavity restoration interface (n=10; total points measured per group = 140). Marginal gaps were similarly measured in Teflon molds as swelling data, together with shear-bond-strength to enamel and dentin, flexural strength and moduli. For three HV-GICs and one C-GIC, significant differences (p<0.05) in gap-incidence were observed between polishing immediately and after one-day storage. In the former case, 80–100 gaps were found. In the latter case, only 9–21 gaps were observed. For all materials, their shear-bond-strengths, flexural strength and moduli increased significantly after 24-hour storage.</p

Conclusions from the symposium: Two decades of ART: success through research

Two decades of ART research has served as the catalyst for a new way of thinking about oral health care. It is now necessary to build on the success of ART research by educating existing and future oral health professionals and health decision makers about the benefits of the ART approach. It is also important to build upon the sound research base that already exists on ART even though enough is known about ART to consider it is a reliable and quality approach to control caries. While oral health promotion through prevention remains the essential foundation of oral health, the ART approach is an important corner stone in the building of global oral health

When Something Is at Stake: Differences in Soccer Performance in 11 vs. 11 During Official Matches and Training Games.

Olthof, SBH, Frencken, WGP, and Lemmink, KAPM. When something is at stake: Differences in soccer performance in 11 vs. 11 during official matches and training games. J Strength Cond Res 33(1): 167-173, 2019-11 vs. 11 training games are used to mimic the official match, but differ in playing duration and a consequence of winning or losing. Anxiety levels, crowd pressure, and the intention to win are examples of constraints present in the match, but absent or less prevalent in training. The aim is, therefore, to compare soccer performance in official matches with 11 vs. 11 training games. Six elite youth soccer teams played 5 official matches and 15 training games. Soccer performance, defined as a combination of game characteristics (game duration, transitions, and ball possession duration) and physical (distance covered, high-intensity distance, and sprints), technical (passing), and team tactical performance (inter-team and intra-team distances) and corresponding interaction patterns, was determined with video footage and positional data (local position measurement system). Soccer performance in official matches differed from similar training games, in a way that players covered more distance, sprinted more often, but game pace was lower and players made more mistakes. In addition, team width was smaller and length-per-width ratio larger and teams were tighter coupled in official matches. 11 vs. 11 training games can be used to mimic the match, in particular the team tactical performance. Coaches could increase physical and technical representativeness of training games by raising the stakes and increasing the consequence of winning or losing