Acceptability, feasibility and perceived satisfaction of the use of the Atraumatic Restorative Treatment approach for people with disability

Abstract

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.

High-viscosity glass-ionomer vs. composite resin restorations in persons with disability: Five-year follow-up of clinical trial

“…Suitability of the approaches was analysed in terms of acceptance, feasibility and level of satisfaction after one year of treatment, the results of which are published elsewhere. 7 Restorations were evaluated by two calibrated independent examiners at 6, 12, 24, 36 and 60 months using established ART restoration assessment criteria. 6 The inter-examiner consistency, expressed as kappa coefficient and the percentage of agreement (Po) at the 60 months evaluation was 0.84 (95%CI: 0.77-0.92) and 95% respectively.…”

“…5 The Atraumatic Restorative Treatment (ART) 6 approach has proven to be an acceptable, feasible and effective technique to prevent/restore cavities in this population. 7 Manual excavation reduces noise, anxiety and vibration by avoiding the use of rotary instruments and the use of a biological, less moisture-sensitive, high-viscosity glass-ionomer cement (HVGIC) makes ART an interesting alternative to conventional operative treatment. There is evidence that ART reduces the need for restorative care under general anaesthesia.…”

“…There is evidence that ART reduces the need for restorative care under general anaesthesia. 7 The survival results reported in meta-analyses on ART restorations in primary and permanent dentitions in different settings are high. 8,9 These results were reproduced when comparing the survival of ART restorations with conventional resin composite restorations in people with disability at one year 10 and at 3 years.…”

The feasibility of office‐based propofol sedation for dental care in patients with intellectual disability by sedation practitioners

“…In the survey among 195 dentists, Edwards and Marry demonstrated that physical barriers, lack of experience, lack of knowledge, and lack of facilities were common reasons for not offering dental care for special needs patients. Therefore, dental treatment for patients with special needs is often performed under general anesthesia usually in a hospital.…”

How to provide the evidence base for techniques and interventions that ensure equal treatment outcomes for people with disability?

“…We need also to be the advocates of our patients who have the right to expect and demand equal options and outcomes–to bridge the gap between our patients and the dental profession. What could be more satisfying than empowering the patient to express his/her desires in terms of treatment processes and outcomes? Encouraging steps have been made in Ireland where the results of a Delphi panel survey which included people with disability, produced a list of prioritized goals for dental services for that target group …”