Management of Dental Caries Through the Atraumatic Restorative Treatment (ART) Approach M Rahmatulla, JE Frencken
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Atraumatic Restorative Treatment (ART) Approach to Control Dental Caries: A Global PerspectiveCHAPTER 1

Dr. J.E. Frencken,
Associate Professor in Preventive Dentistry, University of Nijmegen, the Netherlands and Manager of WHO's ART Programme
Dear Guest of Honour, other Distinguished Guests, Chairman, colleagues, ladies and gentlemen. It is a great privilege indeed to be here at this unique occasion and I, therefore, would like to thank the organizers of this conference for having invited me to present the keynote address.
The theme of this year's symposium relates to a caries management topic that has gained much attention by many in recent years. In choosing the Atraumatic Restorative Treatment (in short ART), I assume that the organisers wanted to indicate that they may consider this innovative caries management approach suitable for use in the host country, India, and in neighbouring countries.
Keynote address at the International symposium on ‘ART’ held in Chennai on 13 August,19992
I would like to congratulate the organisers for having made that choice.
The last few decades have witnessed huge developments in the prevention and management of dental caries. The high decrease in the prevalence of dental caries in the younger part of the population of industrialized countries since the seventies serves as an example. In lesser-industrialized nations, however, the larger part of the population has not benefited from these positive developments in caries control. Thus, in spite of all the positive developments in caries prevention and management, well over three quarters of the world's population suffer from untreated tooth decay. This situation is in no way unique to less-industrialized countries since, in industrialized countries, disadvantaged sectors of the community receive little or no dental care. Thus, despite the huge achievements, dental caries remains a global problem.
In order to improve oral health of a community in a sustainable manner, it is unwise to concentrate on one particular aspect of it. It is more advantageous in the long term to concentrate on developing and implementing a comprehensive package that include essential elements of oral care such as: promotional, preventive, management and emergency care. Such a package needs to be acceptable and affordable to both the Government and the local community concerned. The World Health Organization's Oral Health Unit has recently developed such a package. One of the components of this comprehensive oral health package concerns: The appropriate use of the Atraumatic Restorative Treatment (ART) approach.
The ART approach, Ladies and Gentlemen, involves the excavation of cavitated tooth surfaces with hand-instruments followed by the restoration of the cavity and sealing of any associated pits and fissures with an adhesive filling material. This treatment approach has been proven to be highly effective. Studies have shown that up to 88 percent success can be achieved after three years for ART restorations in single tooth surfaces.
Because ART, in combination with a hand-mixed glass-ionomer, does not require the use of electricity, oral care can be provided everywhere. Performing ART hardly requires the use of local anaesthesia and the approach is considered patient-friendly. This has opened doors for providing comprehensive oral care to population groups that currently lack such care.3
With the initial encouraging survival rates of ART restorations and sealants at hand, the World Health Organization realized the potential that ART offers and, with financial assistance from the Government of the Kingdom of the Netherlands, it developed a Plan-of-Action to promote the use of ART at a global level. The promotion of ART is targeted at three distinct areas, namely: education, community demonstration programs and research.
Distinguished Guests, Colleagues, Ladies and Gentlemen, I hope you agree with me that this new caries management approach has its use in the health sector. I'll now present some examples of possible uses of ART.
ART in General Dental Practice
We think that ART should be part of the basic armamentarium in routine dental practice since it is the least invasive of the existing caries management approaches. However, because rotating equipment is usually available in such a setting, small modifications to the ART concept can be considered. The minimal use of local anaesthetics and drills with ART means that the whole approach does not induce the anxiety often found with traditional restorative procedures. As such, it is an excellent introduction to dentistry for young children who can experience fearless dentistry from the beginning thereby building a long-standing confidence in dentistry and the dental profession. Dentists can ask their clientele: What do you prefer a filling with or without drilling?
ART in Schools
The use of ART in the school situation is one of its most important applications. Through the ART approach, restorative and preventive care for tooth decay can be taken into schools.
ART for the Housebound and the Elderly
The mobility of the ART approach has opened doors for providing oral care to many population groups who might currently lack such care. This includes the housebound and the elderly, the physically and mentally handicapped.
I am pleased to conclude by saying that, within the short time period from introduction of ART till to date, much has been achieved. However, we are not satisfied and would like to further improve the approach.
Dear Guest of Honour, other distinguished guests, chairman, ladies and gentlemen. I have arrive at the end of the keynote address. I hope that I have 4been able to introduce the Atraumatic Restorative Treatment approach to you and to have raised your eyebrows with respect to its potential in contributing to improve the oral health in many population groups. Much will be debated about how best to manage dental caries during this conference. And I wish all those participating fruitful and constructive deliberation in harmony and friendship.
I thank you for your attention.