Abstract
BackgroundThe massive use of preventive measures in Mexico has resulted in a large decline in dental caries over the past two decades. There does however remain a largely unmet need for restorative treatment. This paper describes the steps leading up to the adoption of a strategy, as part of general health policy, to use Atraumatic Restorative Treatment (ART) within the Mexican public health service as a means of addressing this. The objective was to evaluate ART restorations and sealants placed in primary and permanent teeth in schoolchildren from deprived areas over a period of 2 years.Methods18 Dentists from 13 municipalities in 6 states with the lowest human development index treated 304, 6- to 13-year-old schoolchildren with ART sealants and ART restorations (single-surfaces) on the school compounds. Ketac Molar Easymix was the filling material used. ART procedures were evaluated according to the ART assessment criteria after 1 and 2 years, by 7 calibrated evaluators. Survival rates were estimated, using the PHREG Model with frailty correction.ResultsThe 2-year cumulative survival rates of fully and partially retained ART sealants were 73.1% (primary teeth) and 48.8% (permanent teeth). The dentine carious lesion failure rates of ART sealants in primary and permanent teeth over the 2-year period were 0% and 2.5%, respectively. The 2-year cumulative survival rates of single-surface ART restorations in primary and permanent teeth were 74% and 80.9%, respectively. Secondary carious lesion development occurred in 6 restored primary teeth (2.1%) and in one restored permanent tooth (1.3%). All restorations placed in primary teeth in one state survived, whilst those in one of the 5 remaining states failed statistically significantly more than those in the other 4.ConclusionsThe ART procedures were of substantial quality and had prevented to a large extent the development of new dentine carious lesions in these children from socio-economically deprived areas.
Highlights
The massive use of preventive measures in Mexico has resulted in a large decline in dental caries over the past two decades
Atraumatic Restorative Treatment (ART) sealants In primary teeth, all sealants were placed in occlusal surfaces
Carious lesion development in sealed permanent teeth was very low and equal to the findings reported in the meta-analysis on ART procedures, that in sealed primary teeth was zero, and only 2.1% and 1.3% of ART restorations in primary and permanent teeth, respectively, failed after two years because of secondary caries
Summary
The massive use of preventive measures in Mexico has resulted in a large decline in dental caries over the past two decades. Actions included: strengthening the curative care, expanding coverage to marginalized localities with problems of access and promoting alternative curative treatment through countrywide adoption of the Atraumatic Restorative Treatment (ART) approach [1]. This approach covers sealing of caries-prone pits and fissures with an ART sealant and using hand instruments and a high-viscosity glassionomer in restoring tooth cavities and adjacent pits and fissures (ART restorations) [2]. As these procedures do not require electricity and piped water, ART could be implemented in public health services in marginalized communities
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