The implementation and preliminary evaluation of an ART strategy in Mexico: a country example

Abstract

The massive use of preventive measures in Mexico including fluoride toothpaste, a national program of salt fluoridation and education on prevention 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 to address this. This included the development of training materials, the organization of training courses for existing dentists and the incorporation of ART into the undergraduate curriculum. Results: Six years after the introduction of ART in the year 2000, it was estimated that over 2 million ART procedures had been provided. As part of the planning cycle, an evaluation was undertaken in 2008 to determine amongst Mexican dentists what were the perceived problems when implementing the ART approach. Such research identified that the scarcity of appropriate dental materials and the lack of suitable instruments were the major problems. In addition, a preliminary evaluation of ART restorations and sealants placed as part of this National Oral Health Program was undertaken. The survival outcomes after one year compared favorably with one other study conducted in Mexico but were somewhat lower than the results reported from a number of other countries. Conclusion: The ambitious and forward thinking policy for improving the oral health in Mexico is now showing dividends. One example is the ART strategy, which has been successful both in terms of the number of ART procedures provided and generally in terms of clinical outcomes.

The atraumatic restorative treatment (ART) strategy in Mexico: two-years follow up of ART sealants and restorations

“…The major problem experienced by 45% of the respondents was found to be the scarcity or unavailability of appropriate dental materials and the lack of suitable instruments; those that were available being of poor quality [1]. …”

“…Between 1989 and 2001, the mean DMFT score among 12-year olds declined from 4.4 to 1.91. Of this, the decayed tooth component was 1.54, the missing teeth component 0.04, and the filled teeth component was 0.34 [ 1 ]. The prevalence of dental caries in schoolchildren aged 12 years was 58% [ 1 ].…”

Tratamento restaurador atraumático: percepção dos dentistas e aplicabilidade na atenção primária

“…De acordo com este estudo, a introdução do ART nos serviços públicos de atenção odontológica em países latino-americanos ocorreu, mas ainda encontra-se em fase incipiente. No México, uma exceção à regra latino-americana, a adoção de uma estratégia que utiliza as restaurações atraumáticas no serviço público de saúde como alternativa para amenizar o problema da falta de acesso aos tratamentos restauradores tradicionais já é uma realidade bem sucedida (13). Para que isso ocorresse, foi necessário o desenvolvimento de materiais didáticos, a organização de cursos de formação para dentistas e a incorporação do ART nos currículos de graduação.…”

Minimal intervention dentistry: part 5. Atraumatic restorative treatment (ART) – a minimum intervention and minimally invasive approach for the management of dental caries

“…39 The reasons for this lack of care is obviously multifactorial but demands the question whether other models of delivery of oral care using approaches such as ART could be explored in France, for instance providing prevention and caries management within the schools as is done in other countries. 40 Likewise, non-mobile elderly or physically and mentally handicapped people might not easily be able to access the dental clinic. Although oral health data for the elderly in France is limited, a report by the Haute Autorité de Santé (HAS) showed that elderly people have little access to dental care and that between 30-60% require restorative treatment.…”