Acceptability and feasibility of minimally invasive restorative procedures for patients with disability. A cohort study

Abstract

Background: Unmet caries treatment needs are prevalent among people with disability, partly due to difficulties of cooperation during conventional dental treatment. This cohort study compared atraumatic restorative treatment (ART), silver modified atraumatic restorative treatment (SMART), and conventional restorative treatment (CRT), in terms of feasibility and acceptability in patients referred for special care dentistry in a specialized university clinic.

Methods: Patients referred for dental restorative care were treated using either ART, SMART, or CRT approach. Acceptance, feasibility, and complexity for the provision of care according to the BDA Case Mix Tool were assessed. ANOVA with Bonferroni correction and Chi-square tests investigated differences in age, gender, and BDA scores. Spearman Logistic Regression was used to correlate treatment selection with BDA scores.

Results: From a total of 150 patients, 74 were included (20.6 ± 11.2 years of age) 26 chose ART, 35 SMART, 11 CRT and 2 were referred for sedation/GA. ART, SMART, and CRT were feasible for all patients who had selected these options, with optimal placement of restorations for all patients receiving ART, 95.8% of patients receiving SMART, and all patients receiving CRT. Local anesthesia was required for 4 of the 26 patients receiving ART and for the 11 patients receiving CRT, but not required for any of the patients receiving SMART (p = .001). BDA-complexity scores were significantly higher for patients receiving SMART (OR 3.730, 95% CI 0.0∼1.82, p ≤ .001).

Conclusions: ART and SMART are feasible and acceptable approaches to restorative dental treatment in patients with a disability who have difficulty coping with conventional treatment. CRT is more likely to be selected by patients with lower BDA-scores. The survival of the restorations should be assessed to determine the effectiveness of these options and further research is required to confirm the results of this pilot study in a larger population.

Keywords: atraumatic restorative treatment; restorative care; silver diamine fluoride; special care dentistry.