When Dr Frencken and others started to “propagate” the ART technique some years ago, I am sure that many of us had an initial reaction of strong reservation. After many years of promoting oral health by toothbrushing and fluorides, were we to be going back to former times' restorative philosophies? However, after having considered both the technique and its underlying philosophy, and especially after considering the realities of the oral health situation in many parts of the world, I believe that we have come to accept the ART as a useful tool in our practical secondary prevention. A very fortunate combination has been established of avid prevention researchers—who produce good quality and effective prevention, and dental material developers—who have seen the need and realized the potential of materials that are less sensitive to conditions, which are prevalent in the field in many countries. With my personal background, I will always urge dental care personnel to emphasize primary prevention.

However, we must also realize that we need alternatives for the less ideal situation. Thus, meetings such as this, where interactions and research experiences can be exchanged are very useful for continuing to strengthen our knowledge and focus on improving the oral health situation in populations everywhere.

I wish that oral health care researchers and practitioners in India and other countries may get experience and inspiration from these proceedings, so that our goal of Health for All can be achieved.

The editors thank the participants for their excellent contribution in bringing out this volume.

The Indian Society for Dental Research which is the Indian section of IADR sponsored the ‘ART’ Symposium in association with the WHO.

Several eminent Dental workers have provided us inspiration and support but for which this publication would not have been possible. Dr G Packhmov, Chief of Oral Health, World Health Organization and Dr RK Bali, President, Dental Council of India deserve a special mention.

Financial support provided by the GC Asia, WHO (SEARO), Dept of Science and Technology, CSIR, Indian Council of Medical Research, COSTED, Dentsply, Colgate and several other agencies made it possible to conduct a very successful symposium and bring out this Proceedings.

Our thanks are also due to the distinguished Statesmen, Policy Makers and Public Health Experts who participated at the Inaugural function, more particularly the State Governor of Tamilnadu, Justice M Fathima Beevi whose address lent great significance to the deliberations of the symposium.

We wish to record our sincere thanks to Dr Eli Schwarz, Executive Director, IADR for all his support and encouragement.

Last but not the least, for all those who evinced interest in the ‘ART’ deliberation and made this publication a reality.

We have already entered in the new millennium. The WHO objective of Health for All including Oral Health, by the year 2000 still remains a dream particularly in the underprivileged population of the world.

The poorer segment of population in south-east Asia and Africa in particular is reconciled to the fact that loss of teeth due to caries and periodontal disease is a natural phenomenon and nothing can be done to control it. Realizing the magnitude of the problem, JE Frencken embarked on simplistic approach of removing Caries with hand instruments and (with filling polycarboxylate cement) filling the cavity with cement. The approach ultimately becomes known as ‘ART’ (Atraumatic Restorative Treatment) in the mid eighties as a part of primary Oral Health Care program in Tanzania. Later in Zimbabwe the experiment was repeated by his team in large school population group. Extensive Field trial by team of ‘ART’ worker showed astonishing results. A comparative study of amalgam restoration and glass ionomer showed no significant difference in the longevity of restoration even after 3 years. The WHO endorsed the “ART” procedure for the underprivileged population on the World Health Day in 1994.

The need to popularize the simple ‘ART’ modality is by no means an easy one. Despite, several efforts to convey the message of ‘ART’ to the profession and the public, there is no adequate enthusiasm and interest in changing philosophies of Oral Health Care.12

Subject of public health importance always attracted me, hence the idea to hold an International Symposium on ‘ART’ struck to me, way back in early 1997. The 3rd Asian Academy of Preventive Dentistry (AAPD) Congress to which I was invited by the president of AAPD, Dr P Phantumvanith provided me an opportunity to interact with several ‘ART’ workers including the meeting with WHO Oral Health chief, Dr G Packhmov, in November, 1998 in Chang Rai, Thailand.

The willingness of several ‘ART’ workers to share their knowledge and experience paved way to hold the International Symposium in ‘ART’ in Chennai. The Chennai ‘ART’ Symposium attracted participants from both the East and West including Policy Makers, Public Health Workers and Decision Makers. The strong support of WHO (SEARO), Govt of India and Several agencies made the conference a real success.

We have attempted to collect the papers submitted by eminent ‘ART’ workers. However, we do not claim the Proceedings of the Chennai ‘ART’ Symposium to be complete, since some papers have not reached us within the stipulated time. The most important component of the Proceedings are the recommendations of the Symposium which were drafted by Dr JE Frencken and his team at the conclusion of the Symposium and will be of utmost importance, particularly to the developing countries of south-east Asia and Africa. Interestingly the proceedings are being released soon after the publication of the comprehensive work on ‘ART’ titled Atraumatic Restorative Treatment for Dental Caries by Dr JE Frencken and Dr C Holmgren.

People in general are curious about progress in medical science. It goes without saying that the medical professionals are more curious and duty bound to receive as much information as possible on the latest developments in their field. Accordingly this International Symposium will deliberate on a special subject of dental science.

The specialists are better qualified and are beneficiaries of the knowledge retrieval and dissemination system of the modern era through such programs, where the knowledge continuum is maintained through a nexus of people interfacing with each other. Symposia and seminars will be of more use for the specialists than a well-stacked library. The interdisciplinary synthesis and the specialists surgery acquitance with developments in allied fields will further the medical science.

Another use of such interactive programs is the creation of public awareness. For the organized growth of science, the best hope lies mainly in wider community education. The lives of the present day young generation and those of the future will be shaped by science and technology. When they come to dominate the world, the need for awareness of science will be acute. Therefore, the public should be educated to their capacity alongside the professionals. They ought to be given at least a background on the wideranging medical field.

High standard of health care and a rapid rate of progress in health care are ultimate in our survival but these will not come easily. Gifted individuals should be motivated to build the institutional framework necessary for creative work and to foster traditions of academic thinking and excellence. I am glad 14that a group of committed individuals organized themselves as Indian Society of Dental Research (ISDR) to work in the right perspective.

In the last half century, medical science in India has made considerable progress contributing in a powerful way to the wellbeing of the individual as well as the society. Yet, provision of medical facilities for all citizens, a priority in all our development plans, cannot be said to have spread wide and far. For example, specialties like dental treatment still remain urban located. In this context, the pioneering efforts of ISDR, founded by Dr Rahmatulla, in introducing the ‘ART’, hailed as the poor man's dental treatment, in our country, deserve commendation.

Dental decay among the Indian populace is also on the rise unlike in old times. There might be several reasons for this problem. Independent India saw many sudden changes in the people's outlook and their lifestyles. Dietary habits have shifted towards western food, which do not possess the cleansing effect that our traditional food have. However, the methods of treatment for dental disease is undergoing radical change. As a result of improved treatment methods and restorative materials, the incidence of dental caries has even diminished in western countries, like USA. We should also benefit from these discoveries and inventions. The Atraumatic Restorative Treatment which is a World Health Organization program, undoubtedly is the most appropriate procedure for treatment for the economically disadvantaged people in India. Without research, science will not grow. The decline of dental caries as regards the whole world is a contribution of the dental research undertaken in pursuit of quality restorative dental care. Inadequacy in oral care can be countered successfully through proper forms of oral treatment and right amount of health education.

For dental caries, the patient had only two options of treatment: the root canal treatment and extraction. The Atraumatic Restorative Treatment is the latest in the treatment of tooth decay. In a largely populated country like ours where the majority do not have access to expensive medical treatment, this method seems to be the answer to the problem of dental decay.

However, the best approach to the problem of dental caries is not through treatment after the incidence but through prevention of dental decay, adhering to oral hygiene and proper diet. The use of fluoride in toothpaste, in different proportions for adults and children, can be puclicized vigorosly. The use of neem stick is a good alternative to toothbrush for the underprivileged rural people.

Health research, will be pivotal in new discoveries of preventive measure. We are hopeful of a brighter future because biomedical knowledge never 15ceases to grow, the increase in the knowledge and understanding is the product of hard work by researchers. Further research and hospitals education will lead to the decline of dental disease in the country. I hope the Indian Society for Dental Research will continue to strive for further achievements and be a leader in the field of medical research.

The society was founded in 1986 by a team of dedicated workers and has become a worthy multispecialty dental organization, known for such pioneering works. I hope that the Atraumatic Restorative Treatment would be taken to the rural village by the society, leading by example in solving the problem in extending specialist medical aid to the village people. Staff of the Primary Health Centers and private hospitals in rural areas can be trained to give Atraumatic Restorative Treatment by the professionals who receive training in this Symposium and other such workshops in future. These training sessions of rural staff will certainly be of equal consequence as that of the symposia and seminars in terms of better health care in our country.

I am thankful to the organizers for this opportunity and am happy to welcome all the delegates and wish them a successful deliberation during these three days.

With these few words, I inaugurate the International Symposium on Atraumatic Restorative Treatment and the 12th Annual Conference of the Indian Society for Dental Research.16