Transferring ART research into education in Brazil

ABSTRACT The aim of this study was to evaluate the teaching of the Atraumatic Restorative Treatment (ART) approach in Brazilian dental schools. Materials and Methods: A questionnaire on this subject was sent to Pediatric Dentistry, Operative Dentistry and Public Health Dentistry professors. The questions approached the followig subjects: the method used to teach ART, the time spent on its teaching, under which discipline it is taught, for how many years ART has been taught and its effect on the DMFT index. Results: A total of 70 out of 202 dental schools returned the questionnaire. The ART approach is taught in the majority of the Brazilian dental schools (96.3%), and in most of these schools it is taught both in theory and in clinical practice (62.9%). The majority (35.3%) of professors teach ART for 8 hours, and most often as part of the Pediatric Dentistry discipline (67.6%). It has been taught for the last 7 to 10 years in 34.3% of dental schools. Most professors did not observe a change in the DMFT index with this approach. There is a diversity in the teaching of ART in Brazil in terms of the number of hours spent, the teaching method (theory and practice), and the disciplines involved in its teaching. Conclusions: It is necessary to address the training of professors in the ART approach for the whole country. An educational model is proposed whereby a standard ART module features as part of other preventive and restorative caries care educational modules. This will facilitate and standardize the introduction and adoption of the ART approach in undergraduate education in Brazil.


INTRODUCTION
Thus, in Brazil, it is desirable to have, as soon as possible, dental practitioners who are competent theoretically and clinically in the ART approach, to enable them to implement the treatment required by the population under the responsability of each health team.
It was considered that a study regarding the teaching of ART in Brazil, covering all the regions of the country, would provide important information to health managers. This study might also enable the Brazilian authorities to find ways to facilitate the teaching and practice of ART in Brazilian dental institutions. Therefore, the aim of this study was to contact all dental schools in Brazil seeking information, through a questionnaire, from the professors from different disciplines regarding the teaching of ART at the undergraduate level, and to make recommendations based on the outcomes.

Addresses of Dental Professors
The professors' e-mails were obtained from the websites of the universities and individual schools. When an institution did not have a website, or the names of professors were not readily available, the secretaries of the deans of these institutions were contacted by telephone to supply updated information about the professors' names and their electronic addresses.
All addresses were entered into a computer database, using Microsoft excel software.

RESULTS
A total of 70 of the 202 dental schools in Brazil answered the questionnaire, which represents an almost 35% response rate. The question: "Is the ART approach taught in your institution?" was answered by the majority as "yes" (96.3%); the remaining 3.7% answered "no".
According to the respondents, ART is taught both in theory and in clinical practice in the majority of dental schools (62.9%). In 14.3% of the dental schools, ART is taught through a combination of theoretical teaching, laboratory and clinical practice. ART is taught only through theoretical teaching in 13.3% of dental schools, only clinical teaching in 8.6%, and only laboratory practice in 0.9% of schools (Figure 2).
Regarding the time spent with ART teaching, the majority of dental schools answered "8 hours" (35.3%), followed by "from 8 to 20 hours" (29.5%), "more than 20 hours" (27.6%)," less than 8 hours" (3.8%), while 3.8% did not answer    With respect to the question "For how long has the ART approach been taught?", the majority (34.3%) answered that this approach has been taught for "7 to 10 years", while 29.5% answered "4 to 6 years", 17.1% answered "1 to 3 years", 4.8% stated that ART has been taught for "more than 10 years" and 14.3% did not know ( Figure   5).
As regards the DMFT index, none of the respondents stated that the DMFT was worse because of the ART approach. The majority (66.7%) answered that the index had remained the same, and 33.3% did not know.   There are many studies that have used questionnaires to evaluate the curricular structure, teaching philosophies, knowledge, the skills of teaching, the status and factors associated with organizational innovation in dental schools 1,25,29 . In the present study, data was collected from nearly 35% of all dental schools in Brazil, which represents 70 schools. Although in our study we used a short questionnaire, with the intention of improving the response rate, other similar studies have had a response rate ranging from 70.5% to 100% 1,25,29 .

DISCUSSION
This difference in response rates may have occurred because Brazilian people are resistant to answering questionnaires for evaluation; for example, some studies have responses as low as 8.4% 34 , 35% 13 and 39.5% 3 . Another possible reason is that some of the non-respondent dental schools might not as yet have incorporated ART within their curricula and were reluctant to report on this.
The high percentage (96.3%) of the responding dental schools that teach ART to their students reveal the importance that their professors attach to ART. The majority of the professors (62.9%) teach the ART approach only theoretically and clinically, however laboratory practice is important to teach some of the finer details that the approach requires 27 , such as proper cavity cleaning (preparation) and glass ionomer cement manipulation.
Most dental schools claim that they spend between 8 and 20 hours on the teaching of ART. We believe that a minimum of 8 hours