Despite long-term efforts to use appropriate dental equipment for treating dental caries in economically less developed countries, the predominant treatment remains extraction. The reasons for this failure to save teeth are given in this paper. Supported by results of research undertaken in economically developed countries, a 15-step treatment module for dental caries is presented. This technique, which is called Atraumatic Restorative Treatment (ART), is based on removing decalcified tooth tissue using only hand instruments and restoring the cavity with an adhesive filling material. The technique does not require electricity. The advantages and limitations of the technique are discussed and its use in a school oral health program in Zimbabwe presented. We conclude that ART can make restorative oral care more available to a larger part of the world population than it is today.

This study compares the Atraumatic Restorative Treatment (ART) technique to conventional amalgam restorations in the management of dental caries. The present report is limited to the results for one-surface restorations in the permanent dentition over a three-year period. A community field trial was carried out in rural villages in northeastern Thailand. Dental caries was treated using the ART technique in one village where 144 persons were treated with 241 restorations. In a second village, 205 conventional amalgam restorations were provided to 138 persons using mobile dental equipment. Both ART and amalgam restorations were performed by one dentist and two dental nurses without administering local anesthesia. Clinical evaluation was carried out one, two, and three years after placement. The longevity of the restorations was determined by computing the estimated cumulative survival rates according to the life table method. The survival rates of ART restorations (93%, 83%, 71% in years one, two, and three, respectively) were close to those for amalgam restorations (98%, 94%, 85%); however, differences were statistically significant. No statistically significant differences were observed between ART restorations in children and adults, or between those placed by the dentist and dental nurses. Survival rates were lower for occlusal surface restorations compared to those in other surfaces. ART is a feasible approach for the management of dental caries, especially for one-surface lesions in the permanent dentition. Because of its simplicity as a minimal intervention technique, ART can make the control of dental caries available to all people irrespective of their economic and living conditions.

Results of 28 CPITN surveys in 24 countries for the age group 35-44 years, stored in the WHO Global Oral Data Bank as of 1 July 1986 are assembled in an overview presenting: percentages of persons according to the highest score for each person, the estimated national percentages of edentulousness and the mean numbers of sextants affected per person. It is concluded that for a large majority in most of the populations observed, the progress of periodontal disease has been slow and seems to be compatible with retention of a natural dentition until at least the age of 50.

The aim of this experiment was to study clinical parameters when 3 different frequencies of plaque removal were applied to healthy gingivae in the beagle dog model. The maxillary first, second and third premolars of 12 beagle dogs, at the start of the experiment 2 years of age, were, after a thorough cleaning, submitted to daily plaque removal during a pre-experimental period of 8 weeks. At the start of the experiment, the dogs were distributed into 3 groups of 4 dogs each: one group was brushed 7 times a week, a second group was brushed 3 times a week and another group was brushed only once a week. Brushing was executed over a period of 24 weeks, on the right sides of the upper jaws. The left upper jaws served as controls. At regular intervals, the plaque index, the gingival index and probing depths were assessed. A "brushing effect" was calculated for each dog, to include information on all within-dog and between dog variations. Comparison of brushing effects revealed that in this experimental model, plaque removal with a frequency of 3 times a week was sufficient to preserve gingival health, whereas tooth brushing once a week resulted in gingival inflammation. Therefore it can be concluded that 3 times a week is the critical brushing frequency in the beagle dog model with healthy gingiva at baseline.