Use of ART in posterior primary teeth: a conjoint analysis

Objectives: Many organizations worldwide endorse the use of Atraumatic Restorative Treatment (ART) as a means of restoring caries in populations that have little access to traditional dental care or for patients for whom traditional treatment is not feasible. The little information available about ART in the US indicates that ART is used more in anterior teeth. In this study, we investigate factors that influence the use of ART in posterior teeth in children.

Methods: A conjoint survey was sent to a random sample of 2247 members registered as specialists by the American Academy of Pediatric Dentistry. We identified three factors (age of the child, level of cooperation, type of insurance) and varied each across three levels to create a nine cell conjoint design (9 clinical scenarios). We were then able to elicit weights practitioners place on these factors. Lesion location, depth and extension were fixed in the nine clinical scenarios.

Results: 707 (31%) pediatric dentists completed the survey. Child’s cooperation had the biggest impact on pediatric dentists' decisions to use ART (72 %) compared to child’s age (23 %) and type of insurance coverage (7 %). For the age factor, age of three years had the greatest utility (0.27) compared to age 8 (-0.167). For types of insurance coverage, having no insurance (0.073) had the greatest utility compared to having public insurance (-0.082). 

Conclusions: Conjoint Analysis is a valid procedure to show the relative importance practitioners place on different factors that may influence their decision to use ART. Overall, uncooperativeness was a strong predictor of ART use in the posterior teeth. Although insurance coverage was the least important factor overall, having public insurance made pediatric dentists more reluctant to use ART in children in this conjoint analysis.