FG Nkwocha1, GA Akinyamoju2, SO Ogbode2, FB Lawal3
- Department of Child Oral Health, University College Hospital Ibadan.
- Department of Family Dentistry, University College Hospital Ibadan.
- Department of Periodontology and Community Dentistry, University College Hospital, Ibadan.
Background: Dental caries is a common disease in children, which results in tooth loss if not treated. Children in suburban Nigerian communities have a high unmet treatment need index for caries, due to limited access to dental services.
Objective: To provide atraumatic restorative treatment (ART) as a field treatment for dental caries and assess the acceptability of this approach to pupils.
Methods: This is a report of the treatment of dental caries under field conditions among 432 pupils in six primary schools around the Primary Oral Health Clinics (POHC) at Idikan and Igboora, Oyo state, Nigeria. ART restorations were placed on asymptomatic class 1 cavitated carious teeth, were evaluated at six and twelve weeks for intactness and symptoms. Acceptability was assessed by asking the pupils immediately after treatment if they experienced pain/ discomfort while receiving the treatment. Data were analysed using descriptive statistics.
Results: The mean (SD) age of the participants was 9.2(1.8) years; 222(51.4%) were males. The mean (SD) DMFT/ dmft score were 0.06(0.36) [median (Range): 0.0(6)] and 0.07(0.41) [median (Range): 0.0(4)] respectively. Forty (71.4%) decayed teeth were eligible for ART. At six weeks 27(96.4%) fillings were intact while 1(3.6%) had a defective margin, at twelve weeks 23(82.1%) fillings were retained and 1(3.6%) had dislodged. All participants reported no pain during treatment and found the approach acceptable.
Conclusion: ART fillings were intact in 27(96.4%) and 23(82.1%) at 6 and 12weeks respectively. The provision of ART within a familiar environment is an acceptable
method of caries treatment in underserved schoolchildren.
Keywords: Field treatment, dental caries, Atraumatic restorative treatment.
Dr. F.G. Nkwocha
Department of Child Oral Health,
University College Hospital,
Dental caries is a multifactorial disease initiated by the bacterial biofilm (dental plaque) that covers the tooth surface.1 It is a dynamic process, with periods of demineralization and remineralization of tooth structure, caused by microbial metabolism at the tooth surface.2 If demineralization exceeds remineralization, a preclinical, subsurface carious lesion becomes a frank clinical cavity characterized by a breakdown of surface enamel and extension of the decay into the dentine.3 This leads to sensitivity and pain on exposure to stimuli such as cold foods and drinks. At this stage of the cavity formation, simple dental fillings would prevent further tooth damage and the need for complex treatment regimen or eventual loss of the affected tooth. Dental caries affects both deciduous and permanent teeth and has a worldwide distribution2. Studies from Nigeria reveal a prevalence between 14% and 46.9%.4,5
Children from suburban communities in Nigeria have been shown to have a high unmet need index for caries.4,6 Untreated dental caries leads to serious conditions such as dentoalveolar and facial space abscesses such as Ludwig’s angina. These abscesses when not promptly recognized and treated can be complicated by osteomyelitis, cavernous sinus thrombosis, necrotizing cervico-facial fasciitis and even death.7,8 Therefore, prevention of dental caries is very important, however, early diagnosis and prompt treatment of the lesions are required in order to prevent the aforementioned complications. This can be achieved when patient presents early for dental care and check-ups. But it has been shown that there is a low utilization of dental services among children from sub-urban communities,9,10 attributed to low oral health awareness, high cost of dental services where available and fear of dental treatment.11 These factors amongst others led to the rapid growth and promotion of Atraumatic Restorative Treatment (ART) as a minimal intervention technique for the treatment and prevention of dental caries.12 It involves the use of hand instruments only for the removal of carious lesions, followed by preparation and restoration of the cavity and its adjacent pits and fissures with an adhesive material such as high viscosity Glass Ionomer Cement (GIC).13,14
ART technique, introduced into dentistry in the late 1980s, has been noted to be useful in the treatment and prevention of dental caries in areas where conventional treatment cannot be applied, especially in low socio-economic communities, and areas far from modern dental facilities.14-16 ART approach presents numerous advantages such as no need for local anaesthesia and a dental drill; thus acceptable to children, young adults and patients with dental phobia.17
The field conditions in which ART can be performed include schools, refugee camps, orphanage homes as well as Community Dental Health Outreach (CODEH) programmes. ART carried out within these environments, provides children the opportunity to receive an effective dental treatment which is also affordable. Studies have evaluated ART in different field settings and found to be an acceptable and effective method of treatment of dental caries, with high proportion of retention of the fillings.16,17,18 However, evaluation of this form of secondary prevention of dental caries as one of the major of activities of Community Dentistry unit, Department of Periodontology and Community Dentistry, University of Ibadan is sparse. In addition, documentation on this evaluation is also scarce in many regions of Nigeria. We therefore aimed to descriptively report the provision of ART as a treatment for dental caries and its acceptability among primary school pupils in two suburban communities.