Objective: To determine the impact of operator knowledge and skills in the Atraumatic Restorative Treatment (ART) approach on the number of rendered tooth extractions and restorations in the Sedibeng district oral health service.

Methods: All dentists (3) and dental therapists (4) employed on full time basis in Sedibeng were trained in ART. The training followed standards recommended by the World Health Organisation. One year after training, the treatment ratio number of total restorations to number of tooth extractions was calculated per operator and compared with the one-year ratio before ART training.

Results: One dentist had left the service after one year. The treatment ratios of the remaining operators were 0.03, 0.02, 0.01, 0.01, 0.01 and 0.02 for the primary dentition, as well as 0.03, 0.01, 0.01, 0.01, 0.01 and 0.02 for the permanent dentition before training. One year after ART training, the treatment ratios had increased by most operators to 0.08, 0.06, 0.03, 0.01, 0.04 and 0.01, respectively for the primary dentition and 0.04, 0.03, 0.02, 0.08, 0.02 and 0.01 for the permanent dentition. The differences were statistically significant (p