Factors inhibiting the implementation of the Atraumatic Restorative Treatment approach in public oral health services in Gauteng province, South Africa

Abstract

Objective:To investigate potential barriers to the utilisation of the ART approach in a South African public oral health service.Method:7 barriers were identified: patient load/work load, operator opinion, patient opinion, service management, material supply, clinical ART skill, chair-side assistance. Operators were asked to answer a questionnaire one year after completing the ART training. Responses ranged from 1 = no barrier to 5 = highest barrier. Treatment data per operator were collected during 1 year after training, for both dentitions, including: number of extracted teeth, placed traditional restorations, ART restorations. The restoration/extraction (REX) ratio and the proportion of ART restorations (ART%) of the total number of restorations were calculated and correlated with the barrier variables. Pearson correlation, ANOVA and 2-tailed t-tests were used in the statistical analyses.Results: Patient load/work load (mean = 2.80: SE = 0.16) was the strongest barrier (p<0.001) and clinical ART skill was the weakest barrier (p<0.001). A significant correlation between material supply and mean REX score was observed in both dentitions. In primary teeth, the ART% correlated significantly with clinical ART skill (r= -0.63; p<0.01). In permanent teeth, statistically significant correlations were observed between ART% and patient load/work load (r = -0.54; p<0.05), patient opinion (r = -0.76; p<0.01), operator opinion (r = -0.53; p<0.05), chair-side assistance (r = -0.57; p<0.05), oral health service management (r = -0.46; p<0.05).Conclusions:1 year after ART training completion high patient load/work load, followed by insufficient provision of materials/instruments, were the two most inhibiting barriers to the use of ART in the public oral health services. Dentists’ perceptions of low clinical skill levels in performing ART confidently inhibited the use of ART in primary teeth in children.

Two decades of ART: improving on success through further research

“…Investigations have been carried out in South Africa 44 and in Tanzania 35 asking government dentists what they consider to be the major barriers that exist to using ART. In both these cases the barriers include: work load, lack of provision of materials and perception of clinical skill.…”

Acceptance and Discomfort from Atraumatic Restorative Treatment in Secondary School Students in Egypt

“…This concern within the country's profession needed to be addressed, as these perceptions could inhibit the introduction of the ART approach on a wider scale. Potential barriers to introducing new techniques in (oral) health care need to be addressed early if the introduction is to have a chance of success [7] .…”

Knowledge and conduct of public health system dentist about atraumatic restorative treatment

“…Most dentists participating in the study were female (71.0%), reflecting the feminization of the odontological profession 13 , were aged twenty to thirty-nine years, had graduated twenty or more years ago and were employed in the public service. As noted by Rios et al 10 , most dentists working in the FHS are postgraduate specialists, especially in the clinical area.…”