The impact of the ART approach on the treatment pattern in a public oral health service in South Africa.

Contains fulltext : 52105.pdf (publisher's version ) (Open Access)The Atraumatic Restorative Treatment (ART) approach stands for restoring and preventing carious lesions in tooth surfaces without the use of the drill. It was introduced in South Africa in 1996 and adopted by all dental schools. However, no information was available on the introduction of ART into public oral healthcare services. This thesis aimed to investigate the impact of ART introduction on restorative care in relation to tooth extractions under conditions of a provincial public oral health service system. An increase in restorative care in relation to tooth extractions was observed after ART was introduced into an academic community oral health pilot programme. The changes were ascribed to the minimally invasive nature of ART, thus reducing patient anxiety and improving patient cooperation. These were incentives for the dental operators to place ART fillings more frequently, thus increasing restorative care in relation to extractions in this pilot project. After ART introduction into the public oral health service, it was shown that ART caused significantly less anxiety in children and adults than conventional restorative treatment using injection and high-speed drilling. However, the observed reduced patient anxiety did not result in a frequent use of ART or any increase of restorative care by public dental operators. Implementation barriers hindered ART utilization. The barriers high patient load; negative operator and patient opinion; insufficient service management; insufficient material supply; lack of clinical skills and insufficient chair side assistance were identified. It is concluded that a thorough situation analysis should precede the introduction of the ART approach into a public oral health service system, particularly in systems with a continuous lack of resources. If such an analysis identifies potential inhibiting barriers for an increase in restorative care and these factors cannot be adequately controlled, it is unlikely that the introduction of ART will yield optimal results.19 december 2007Promotores : Hof, M.A. van 't, Palenstein Helderman, W.H. van Co-promotor : Frencken, J.E.F.M.159 p