Hand instruments are better accepted than rotary instrumentation for restoring tooth cavities in people with disabilities.

Many environmental barriers exist to the access of oral health care in the population with disability, but once these barriers have been overcome, and the patient has been able to find a dentist willing and able to treat them, challenges remain. The provision of high quality restorative treatment is related to the patient’s ability to cope with the anxiety engendered by treatment and to cooperate fully with the demands of the clinical situation. Between a quarter and a third of adults with intellectual disability are estimated to have dental anxiety. Unpleasant stimuli, such as the injection of local anaesthesia, or the noise and vibration of rotary instruments, may provoke disproportionate anxiety and subsequent opposition to treatment. In addition, poor muscle coordination, fatigability or oral dysfunction, such as drooling and tongue movement, may compromise restorative procedures. Sedation or general anaesthesia may improve clinical conditions for restorative work but these techniques have their own problems in terms of cost and patient morbidity.
A less anxiety-provoking restorative treatment is Atraumatic Restorative Treatment (ART). This approach is endorsed by the World Health Organisation and involves hand instrumentation and placement of high-viscosity glass-ionomer cement restorations. ART has been shown to be equally effective as conventional restoration in both primary and permanent teeth. It has been suggested that ART might help to reduce barriers to treatment for patients with disabilities but no trial comparing ART with conventional treatment in this population has yet been reported.
The present study aimed to compare ART with conventional restorative treatment in terms of respondent acceptance, satisfaction, feasibility of the approach and survival of the restorations over a three year period.

The ART approach is more suitable than conventional restorative treatment in people with disabilities

0.5, 1,2,3 years

Atraumatic Restorative Treatment (ART) in the clinic; conventional restorative treatment (CRT) in the clinic and under general anaesthesia (GA)