title: Managing dental caries with atraumatic restorative treatment in children: successful experience in three Latin American countries.
abstract: OBJECTIVE
  To compare survival rates and cost differentials between the atraumatic restorative treatment (ART) technique and amalgams by type of dental personnel in Ecuador, Panama, and Uruguay.
  
  
  METHODS
  Children 7 to 9 years of age in rural and urban schools with at least one lesion with initial cavitated enamel caries or a dentinal lesion on a first permanent molar were selected and randomized into the ART (intervention) or amalgam (control) group. Restoration failure was evaluated at 12 and 24 months. Cooperation and pain experienced during the procedures were measured. Cumulative and incident failure of restorations at 12 and 24 months was calculated for dentists who placed ART or amalgam restorations and auxiliaries who placed ART restorations at 12 months only.
  
  
  RESULTS
  The total sample comprised 1 629 children. Study groups were similar by country, gender, and geographic location. Cumulative failure rate at 12 months varied by group: dentists' amalgam, 0.9% to 5.7%; dentists' ART, 2.0% to 10.5%; and auxiliaries' ART, 5.7% to 15.8%. At 24 months, higher cumulative failures were observed for the dentists' amalgam group compared with the dentists' ART group in Ecuador and Panama but not in Uruguay. Amalgam was least likely to have the best level of cooperation and an auxiliary using ART was associated with the least pain. The cost of using the ART approach for dental caries treatment, including retreatment, was roughly half that of using amalgam without retreatment.
  
  
  CONCLUSIONS
  Having auxiliary personnel perform ART will lead to treatment survival that is expected to be lower than dentists using amalgam or ART. In spite of the greater risk of failure, the rate is not unacceptable and potential cost savings are substantial.
authors.affiliation: Regional Program on Oral Health, Pan American Health Organization, Washington, D.C., United States of America.
authors.forename: Saskia
authors.initials: S
authors.lastname: Estupiñán-Day
authors.forename: Marisol
authors.initials: M
authors.lastname: Tellez
authors.forename: Sundeep
authors.initials: S
authors.lastname: Kaur
authors.forename: Trevor
authors.initials: T
authors.lastname: Milner
authors.forename: Alfredo
authors.initials: A
authors.lastname: Solari
mesh_terms: D002648:Child; D057087:Dental Atraumatic Restorative Treatment; D003731:Dental Caries / Q000628:therapy*; D004484:Ecuador; D005260:Female; D006801:Humans; D008297:Male; D010176:Panama; D011446:Prospective Studies; D014583:Uruguay