Atraumatic Restorative Treatment for Dental Caries

Atraumatic Restorative Treatment for Dental Caries Atraumatic restorative treatment for the management of dental caries: A Review Abstract: Atraumatic restorative treatment is a method of minimal caries intervention that uses only hand instruments. Over the past few years, there has been an increase in the number of studies reporting on various aspects of the Atraumatic Restorative Treatment and it is over three decades ART has been introduced, so this was considered an appropriate time for a systematic review on ART. Objective of this review article was to assess the effectiveness of ART in management of dental caries. All randomized or quasi-randomized control trials on ART were included. Intervention with adhesive restorative material such as GIC with different viscosity was evaluated. Primary outcomes measures such as pain relief, patient discomfort, anxiety and durability of restoration was assessed. Studies showed survival rates ranging from 66% to 76% at 6 year for single surface restorations ART approach provided higher survival percentages for single surface restorations and it causes less pain and dis comfort. Key words: Atraumatic restorative treatment, Survival, Deciduous teeth, Permanent teeth Introduction: Dental caries is one of the most prevalent oral diseases of public health concern. It affects almost all individuals irrespective of age, sex, occupation, religion, castes etc in developed as well as developing countries. It varies greatly among countries, even within a country and from region to region and there are several reasons for this problem like changes in food habits, poverty, lack of facilities especially to underprivileged section of the society, etc. WHO objective of â€Å"Health for All† still remains a dream, particularly in the underprivileged population of the world. Also, there has been a radical change in the methods of treatment of dental disease. We have seen a change in approach of treatment by the dentist, starting with extraction, then conservation of tooth structure and now stress is being laid on preventive dentistry. But the underprivileged population have not benefited from these developments that have brought about improved oral health in the indus trialized world. Realizing the magnitude of this problem, particularly lack of oral health care in below poverty line segment of society, JE Frencken embarked on simplistic approach of removing caries with hand instruments and filling up the ‘cavity’. This approach is termed as Atraumatic Restorative Treatment.[1] ART was first discovered in Tanzania in mid 1980s to suit the needs of the developing countries by JE Frencken Later, in Zimbabwe, the experiment was repeated by his team in larger school population group. WHO endorsed the ART procedure for the underprivileged population on world health day in April 7, 1994.[2] The idea of ART is strongly supported by the modern scientific approach to controlling caries maximal prevention, minimal invasiveness and minimal cavity preparation.[3] Different studies have been investigating the various aspects of ART approach in the past and still continue to increase. Most of the studies have investigated the survival of ART restoration and sealants. As ART approach is being utilized all over the world since more than 25 years, there is a need to carry out a systematic investigation about the survival and effectiveness of ART restorations. So the present systematic review focuses on the effectiveness of ART in management of dental caries in deciduous and permanent teeth. Materials and Methods We attempted to identify all relevant studies. Detailed search strategies were developed for each database to be searched and it was carried out in the Medline, Embase, Hinari, k-hub. All randomized controlled trials or quasi-randomized controlled trials were included. Non-randomized controlled trials were excluded. Studies with Dentate participants, regardless of the age and sex, with a history of dental (coronal) caries who have undergone restorative treatment using either conventional restorative or ART approaches were included. Studies in which evaluators were calibrated and independent, Survival result more than 1 year were included. Interventions were adhesive restorative materials, such as GICs with different viscosities, placed with the ’true’ Atraumatic Restorative Treatment (ART) approach, including Interim therapeutic restoration (ITR) with hand instruments, compared with different restorative materials, such as amalgam, placed with conventional cavity prepar ation methods. Studies on modified ART approaches, Survival results Selection of Studies All records identified by the searches printed off and checked on the basis of title first, then by abstract or keywords or both. Records that obviously irrelevant were discarded and the full text of all remaining records were obtained. The full reports obtained from all the electronic and other methods of searching assessed independently by two review authors to establish whether the studies meet the inclusion criteria or not, using an inclusion criteria form, which previously prepared and pilot tested. Where resolution was not possible, a third review author consulted. If more than one publication of a trial was identified, all publications were reviewed and the paper with the first publication date included as a primary version. All studies meeting the inclusion criteria then underwent data extraction and a quality assessment. Types of Outcome Measures Primary Outcome Measure Pain relief, i.e. freedom from symptoms of pain and sensitivity as reported and experienced by the patient. Patient discomfort during the procedure measured by physiological measurement or behavioral observation. Patient’s anxiety and stress after treatment. Durability of restoration survival time of restoration (in months) from the time of placement. Secondary outcome measures Defects of restorative materials such as wear, fracture and staining (color changes) of restoration. Restoration failure, e.g. replaced restorations. Marginal integrity of restoration. Secondary caries. Results Pain, Anxiety and Discomfort: Five studies were reported on pain out of which three studies suggested that ART was found to be less painful.[4,5,6] In a study conducted by Rahimtoola S et al[7] pain was reported when ART technique was used but was significantly less than the conventional restorative technique. While in one study there was no significant difference in the pain levels of children treated using conventional restorative treatment, atraumatic restorative treatment or ultraconservative treatment but it was observed that when conventional restorative treatment was used, more children neededlocal anesthesia.[8] One study showed that the levels of dental anxiety were less in patients treated with ART as compared to conventional restorative treatment.[9]The studies from Topaloglu et al[10] and de Menezes Abreu et al[11] reported no difference in the levels of dental anxiety. ART technique has a potential to cause less discomfort to the patient and to less invasive to the dental tissue than conventional approach. The patient’s acceptance of ART was verified by Mickenautsch et al[12] who observed that both children and adults receiving ART restorations responded positively to the treatment. Study conducted by Schriks MC[13] and Van Amerongen WE[14] stated that children treated according to the ART approach using hand instruments alone experience less discomfort than those treated using rotary instrument. Similar findings were reported by ECM Lo CJ Holmgren also.[5] A summary of these studies outcomes is presented in Table1. TABLE 1: Overview of studies having assessed dental pain, anxiety and discomfort between the ART and the traditional treatment approach Comparison Age Operator background Variable measured Conclusion ART vs rotary Instruments[7] 6–16 years old Dentists Pain: -Questions: Did you feel any pain during treatment? ART caused less pain ART vs rotary Instruments[8] 4–7 years old Pedodontist specialist Pain: -Wong–Baker FACES Pain Rating Scale ART caused less pain ART vs rotary instruments vs ultraconservative treatment[4] 6–7 years old Pedodontist specialist Pain: -Wong–Baker FACES Pain Rating Scale -No difference in levels of pain among treatments -Local anaesthesia was more frequent given in the rotary instrument group ART vs rotary instruments ART vs ART with Carisolv [10] 6–7 years old Pedodontist specialist Anxiety: -Venham Picture Test No difference in levels of anxiety between treatments ART vs rotary Instruments[9] Children and adults Dentists and dental therapists Anxiety: -Childrens fear survey schedule -Corahs dental anxiety scale Both children and adults treated with the ART were less dental-anxious ART vs rotary instruments vs ultraconservative treatment[11] 6–7 years old Pedodontist specialist Anxiety: -Facial Image Scale No difference in levels of anxiety among treatments ART vs rotary Instruments[13] 6-year-old children Dental students and dentists Discomfort: -Heart rate and modified Venham index (observations) ART caused less discomfort Durability of Restoration Various studies showed that survival rates were lower with increasing period of time.[15,16] Frencken JE[15] assessed the survival of ART restoration after first, second and third year evaluation interval and found that the survival rate of one surface ART restoration were higher in first year compared to second and third year. Lo ECM[16] Suggested that cumulative survival rates of the large restoration were lower, being 77% and 46% after 3 and 6 year respectively. There were no statistically significant differences in cumulative survival percentages of the evaluated ART restorations between single and multiple-surface restorations at 1-year (p=0.137) and 2-year (p=0.377) evaluations. But at the 10-year evaluation, the survival rate for single-surface restorations (65.2%) was 2.1 times higher than that for the multiple surface restorations (30.6%). This difference was statistically significant (p=0.009).[17] Secondary Outcome Measures: Defects of restorative materials wear and fracture of restoration: Studies conducted by Lo ECM[16] and Frencken JE[18] showed that most of the restoration were in good condition and had only minor defects and wear which did not warrant further treatment. Secondary caries Increment of secondary caries was found to be maximum in a study conducted by Zanata RL[17] while other studies showed no statically significant difference.[18,19] Operator effect. Frencken JE [18] et al observed an operator effect for single surface ART restorations. It was observed in one study that experienced operators place better ART restoration than inexperienced operators.[15] Marginal Integrity of Restoration: In a study the restorations that were evaluated with the USPHS criteria at the 5-year examination, unacceptable marginal integrity, either a crevice extending to the enamel–dentine junction or the restoration being fractured was found in 9% of the small and 21% of the large restorations.[18] While in another study, 63.6% of the ART restorations were assessed as ‘good’, 15% as having a ‘slight marginal defect’ at 3years.[19] Restoration Failure Failure occurred in 24% of the small restorations and 41% of the large restorations. The large restorations had a higher relative risk of failure, 5.87, compared with the small restorations.[16] Failures were related to unacceptable marginal defects and total loss of restoration. Frencken JE [18] reported failure of total 28 ART restorations placed in 25 students during the 3 year period. While same author in another study reported 106 ART restoration failures from total of 487 ART single surface posterior restorations.[15] Discussion: The ART approach seems to be an economic and effective method for improving the oral health not only of people in developing but also of those in industrialized countries (Frencken and Holmgren 2004).[1] It may be considered as a safe and conservative alternative for conventional restorative dental treatment, particularly for Class I (occlusal) dental cavities. Pr imary outcome measures: Pain, Discomfort and Anxiety: The originators of the ART approach noticed that the technique had a potential to cause less discomfort to the patient and to be less invasive to the dental tissues than the conventional approach. The patients acceptance of ART was verified by Mickenautsch and Rudolph[12], who observed that both children and adults receiving ART restorations responded very positively to the treatment. Dentists also seemed to approve the â€Å"new† approach. Among the main reasons given were those related to the patients comfort: the reduced use of local anesthetic and absence of the noisy drill and suction.[20] Some suggested that ART as found to be less painful and cause less dental anxiety. The reasons could be contributed to the operator’s level of specialization and /or skills in handling anxious children. The studies from Topaloglu et al [10] and de Menezes Abreu et al [4,11] in which no difference in levels of dental anxiety and dental pain were observed, were performed by pediatric dentists. In the studies that favored ART [7,8,13] all operators, but the one from de Menezes Abreu et al, [8] were non-pediatric dentists (general practitioners, dental therapists or dental students). However, the latter study had included children younger than 6 years, and all those given the conventional treatment received local anesthesia and the restorations were performed under rubber dam isolation. It is not unrealistic to argue that age and the use of the needle and that of rubber dam might have influenced childrens perception of pain. In light of all these aspects, it can be hypothesized th at the behavior management provided by a pediatric dentist may overcome much of the discomfort that a child can feel independent of the restorative treatment approach. Durability of Restoration: The survival percentages of single surface non occlusal posterior ART restoration were significantly higher than for comparable amalgam restoration 4.4, 5.3 and 6.3 years. Although it is known that non occlusal glass ionomer restoration survive long but significant lower survival results for non occlusal amalgam than for comparable ART glass ionomer restorations were observed.[15] The cumulative survival rate of ART single surface restoration remained high throughout the study 92.7% (SE 3.0%) over 2 years and65.2%(SE 7.3%) up to 10 years. These rates are in the line with the results of other investigations, which reported survival rates ranging from 66% to 76% at 6 year for single surface restorations. The cumulative success of 65.2% observed in this study could be considered even better due to the longer period of clinical service. The survival rates of multiple surface restorations (class II) decreased significantly from 2 to 10 years. After 2 years, the survival rates between single and multiple surface restorations were similar. These results are consistent with those of Cefaly and Farag which observed similar survival rates for class 1 and class II restoration after 1 and 5 years, respectively. However, a statistical difference was apparent over the 10 year evaluation period (65.2Ãâ€"30.6% success rates for single and multiple surface restorations, respe ctively).[17] Secondary outcome measures: Defects of restorative material such as Wear, Fracture and Staining of Restoration: The annual wear rate of the high strength glass–ionomer material used in their study was rather stable at around 20-25 m after the first year and this did not increase much with time or size of the restoration. This rate is very satisfactory and may help to alleviate some of the concerns of earlier reviews on ART. The use of an adhesive material in ART restorations also makes repair of restorations with gross defects and wear possible and total replacement may not be necessary.[15] Reasons for minor defects and wear can be explained by the fact that firm finger pressure was applied over the restorative material to ensure good penetration of glass ionomer into the pits and fissures, as recently demonstrated.[18] Secondary caries: It has been shown that caries left in occlusal enamel lesions had either not progressed at all or only progressed slightly under clinically ‘intact’ as well as ‘sometimes intact’ sealants after 3 years. In contrast, caries had progressed under sealants that were ‘never intact’.[18] No ART restoration failed because of carious lesion development only. Restorations failed because of a combination of dentine carious lesions and mechanical defects.[17] This pattern of failure was also observed by Frencken et al[15] but contrasts with the study of Prakki et al[21] which observed no caries even in those teeth whose ART restorations were missing. Operator effect: An operator effect has been cited in a number of ART studies.[18,22,23] Although all operators (dentists and dental therapists) in the studies referred to above had followed a training course on ART, the operator effect seems to indicate that in order to perform quality ART restorations, the operating dental personnel requires skill, diligence and comprehension. An ART training course of a couple of days may be too short for some qualified dentists and dental therapists.[15] The operators’ greater experience in applying ART and the use of a high-viscous glass ionomer in the study may explain the higher results.[18] Failure of Restoration: The finding that failures of ART restorations placed in the same child were correlated suggests that some factors related to the individual subjects such as diet, occlusion, and caries risk may influence restoration survival.[16] The predominant reasons for ART restorations to fail were unacceptable defects at the margin and re restoration.[15] Almost half of the failures were related both to the physical characteristics of the glass ionomer used and to the operators’ handling of the material. Few failures were due to excessive wear. The other half of the failures were considered to be operator related. The exact reasons for the unacceptable marginal defects were unknown. However, it can be speculated that improper mixing of glass ionomer, providing a mixture that was either too dry or too wet, was one of the reasons. Another reason could be the difficulty in inserting the material into the depths of deep and small preparations. Subsurface voids produced during insertion may have resulted in later fracture of the surface layer under pressure.[18] Compared to conventional treatment approaches, ART is still very young. Despite this, much progress has been made in researching various aspects of the ART approach. More experience in the actual technique of cleaning carious cavities with hand instruments has been gained and newer, physically stronger glass ionomers have been marketed as a result of its existence. These developments have most probably led to the higher survival results of ART restorations in permanent teeth in the more recent compared to the early studies. Conclusion: ART technique has proved to be less painful and causes less discomfort to the patients with high survival rate in both in primary and permanent teeth. This technique has the potential to make oral health care more available to a larger part of the world’s population than before. The greater part of the world’s population has no access to restorative dental care. ART should be taken seriously by the dental profession and educational courses should be organized before the approach is used in the clinic.

The Company Man Analysis Essay

ANALYSIS 7 Essay: The Company Man The typical business man involved in corporate America works anywhere from six to ten hours per day. Phil, â€Å"the Company Man† worked six days a week sometimes until eight or nine at night, making himself a true workaholic. Using his life story before he died Goodman is able to convey her liking toward Phil but her dislike of what the business world has turned him into. Not only does Goodman use a number of rhetorical devices but she also uses Phil’s past as well as the people who were once in Phil’s life to get her message across to her reader. Ellen Goodman sarcastically creates the obituary of a man who dedicated his life to his job and the company he worked for. Goodman uses anaphora, satire, diction, sentence structure, and selection of detail to complete her obituary of this â€Å"Company Man†. Emphasizing the fact that Phil worked himself to death, Goodman chose pure sarcasm to make this particular emphasis. She shows through this repeated phrases, that he must have chosen work over family quite often, working to provide for his family which resulted in the simple fact that â€Å"he worked himself to death, finally and precisely, at 3:00a. m Sunday morning. Goodman’s use of repetition leads to show her satirical writing. â€Å"On Saturdays, Phil wore a sports jacket to the office instead of a suit, because it was the weekend† shows Goodman’s use of satire in one of the many examples throughout the obituary. Toward the end of the essay, Goodman describes how the company president starts the funeral with a hint of sarcasm, â€Å"discreetly of course, with care and taste† using a tongue and cheek method to provide a subtle shift in tone. The president then begins to question who will replace Phil ending with a paradoxical sentence â€Å"‘Who’s been working the hardest? † getting down to the business of replacing Phil, providing another example of a stereotypical business approach. The vivid diction describes the sarcasm that Goodman has towards Phil. Goodman composes her paragraphs with careful rhythm and beat; she repeats â€Å"finally,† â€Å"precisely† and â€Å"perfect† three times. Phil’s constancy and lack of variation are embodied in rigid words such as â€Å"always,† â€Å"of course,† and â€Å"Type A. † Extreme diction such as â€Å"overweight,† â€Å"nervous,† and â€Å"workaholic† convey Phil as a worrywart with no fun at all in his life. These words mock Phil as a man sincerely obsessed with work that had lost track of his priorities. Goodman deepens her point when she introduces Phil’s family, using diction in relation to business to further emphasize the importance of work to Phil. To Phil’s wife Helen, â€Å"A company friend said ‘I know how much you will miss him. ’ And she answered, ‘I already have. ’† His eldest son tells the reader of how he went around the neighborhood gathering research on his father. His daughter recalls how whenever she was alone with him they had nothing to say to each other. When Phil’s youngest son reminisces on how he tried to mean enough to his father to keep him at home. Goodman informs the reader that the youngest child was Phil’s favorite. Goodman’s sentence structure of long, short, long, helps the shorter sentence stick out more to the reader. But she ends the paragraph with a sad ironic sentence, â€Å"My father and I only board here. † implying that he never really was successful. The descriptions of Phil in â€Å"The Company Man† are sardonically accusatory of the present way people live in society. Goodman makes light of how Phil is a heart attack waiting to happen, his seventy-hour workweeks and egg sandwiches. â€Å"Of course,† used thee times, translates as the acceptance that we have towards intolerable living conditions in order to fulfill the American dream. Like many Americans, Phil is constantly obsessed about his work and whether or not he will ascend to the top position. Through these details she describes the monotonous, repetitive way that society exists today. Throughout the column, images negatively portray the lifestyle that Phil lives. Superficially, all seems well because his family lives a comfortable existence. Emotionally, however, his family has missed his emotional support for years. His wife, Helen, gave up â€Å"trying to compete with his work years ago. † All of his children grew up in a so-called normal family with a father and mother. At his funeral, though, they do not have enough memories about him to say a proper eulogy. Phil himself was â€Å"overweight† and unhealthy, obsessed with work and negligent with his personal life. Goodman condemns the lifestyle that Phil leads by using negative and poignant imagery. Ellen Goodman develops an attitude of pity for Phil, and resentment for the company through rhetorical techniques by portraying that to his wife and to his children, Phil had become so consumed with his position as one of the Important People that he had all but completely removed himself from their emotional reach for the sake of his company life. Goodman’s vision of the corporate world and its influence and affect on our lives is portrayed through her diction and choice of detail in her anecdote of the reflection of the life of the A-Type, workaholic, Phil.

Media Violence and Children Essay

Your children are surrounded by violence. From video games and television to the news itself, bloodshed is everywhere. Many parents and educators fear that violence seen on the media will at the very least desensitize children, and that it may even make children more likely to commit atrocities themselves. Other people claim the violence seen on the media is not real, and that children understand this. So who’s right? In order to better understand this crucial issue, we need to examine the history of violence in entertainment as well as revelations made possible by modern science. Violence in entertainment is not new. Even in ancient Rome, people gathered to watch gladiators. In gladiator combats, two trained men (usually criminals or slaves) would fight each other in front of a cheering crowd. Sometimes, men would also be forced to fight wild animals. These shows were incredibly popular; in order to accommodate the huge masses of people eager to watch the combat, Roman officials built the Colosseum, which could seat 50,000 spectators, in 80 CE. The opening of the Colosseum was celebrated with 100 days of games, during which thousands of men and animals were seriously injured or killed. Long before children watched violent cartoons, they listened to violent stories. Even our most cherished fairy tales often contain bloodshed. In fact, modern versions of fairy tales tend to be a lot less violent than the originals. For example, in Hans Christen Anderson’s The Little Mermaid, the little mermaid has her tongue cut out, almost stabs her prince, and dies; Disney’s famous version of this classic tale is significantly happier and less violent. But why is violence such a popular form of entertainment? There are several possible answers, and they are probably all true to some extent. People like watching violence because it is, at least to some degree, forbidden; all functioning societies need to have laws against murder. Seeing other people’s pain also makes your own problems seem insignificant. Finally, some violence in the media was meant to teach a practical lesson. Many gladiators were condemned criminals, so their violent and entertaining death served as a warning against would-be criminals. Public executions have served the same purpose throughout history. Fairy tales also warned children against the dangers of misbehaving. For example, the little mermaid disobeyed the rules of her father and her people, and she suffered as a result. Modern violence in the media is not that different from what occurred in the past. People enjoy watching violence because it is forbidden, distracting, and it can teach lessons about reality. At the same time, violence is becoming more and more prevalent. Additionally, much of the violence shown in video games, movies, and television is completely unrealistic; real consequences are very rarely shown, especially in cartoons. As a result, the violence may be too glamorized to teach real life lessons. Even if violence does teach a morality lesson, children may still be negatively affected. Vincent P. Mathews, a professor of radiology at Indiana University School of Medicine, discovered that watching violence on the media might actually alter brain function. Functional magnetic resonance imaging (fMRI) showed that watching violent images decreased frontal lobe brain activity in children whether or not they had previous problems of aggression. Decreased frontal lobe activity is associated with attention and self control problems. Also using fMRI, Klaus Mathiak at the University of Aachen in Germany discovered that playing violent video games and thinking about actually participating in real violent activities stimulate the same part of the brain. In other words, an individual’s brain cannot distinguish between violent actions that are committed by the individual and violent activities that are purely make believe. Additionally, violent video games may be training the brain for real life violent behavior. So what does all of this mean for parents? Children, like adults, are naturally drawn to violent images, and it is possible for children to learn valuable lessons from violent stories. However, exposure to too much violence, especially glamorized violence, probably does have a negative impact of children. Although more scientific research needs to be conducted before conclusive answers can be given, children may have a hard time distinguishing between real violence and fake violence, and simply watching violence may lead to increased behavioral problems. If you are worried that your children are watching too much violence, you should monitor exactly what they are watching. Movies and video games both have rating systems, and all televisions 13 inches or larger that were manufactured in the United States since January 2000 contain V chips. V chips allow parents to control what programs are watched, even when the children are unsupervised. You could also limit the amount of time that your children are allowed to spend watching television or playing video games, regardless of whether or not the programs or games contain violent content. Finally, you can discuss the reality of violence with you children to make sure that they can differentiate between make believe and reality.

Essay Language is Powerâ€Sexist Patriarchal Power - 1741 Words

â€Å"Language is power, life and the instrument of culture, the instrument of domination and liberation†- Angela Carter Language affects every aspect of our life, but we rarely question it; if we examine the words we use and the way we use them, we find a sexist patriarchal myth passed down from the ancient Greeks. Their leaders used the art of language to create a dichotomy between men and women, in order to retain power (Lecture Notes 2 Dec. 2011). For example, the two words we use to describe gender, masculine and feminine, limit us with their strict definitions. Sociologist Allan G. Johnson, in his The Gender Knot, defines â€Å"[masculine as] aggressive, daring, rational, emotionally inexpressive, strong, cool headed, in control of†¦show more content†¦This myth is an absolutist story that limits our capacities for greater social development. We —both men and women— must become actively aware of this pernicious myth, in order to overcome the obstacles women face as they seek greater social, political, and economic power. Language, myth, and power are three entangled elements we use to identify ourselves in a culture. National Public Radio’s Susan Stamberg interviewed Linguist Deborah Tannen on the effects language has on power (Tannen). Tannen explained that language builds connections between people, as time goes on these connections multiple and strengthen, increasing that person’s power. She gives the example of a supervisor’s relationships with their employees and employers, as they develop bonds and gain trust from their co-workers, they can later use these connections to advance their career (Tannen). Language builds connections and unites people. As people unite, they form a society and the people with the most connections gain more power. Society uses myth, as mythologist William Doty explains, to â€Å"model possibilities (both positive and negative) for the roles its citizens will enact† (28). The language people use holds power, because it constructs the myths that members of a culture use to dictate the roles of other members, thus distributing power.Show MoreRelatedEssay about Gender Issues in Religion1633 Words   |  7 Pagestheir impact on religious teaching and practice.[1] With some religions, their scriptures are considered to be infallible and therefore not to be questioned. So the question itself are religions sexist is a fairly new one. 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