title: The atraumatic restorative treatment (ART) strategy in Mexico: two-years follow up of ART sealants and restorations.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  18 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Global Oral Health, College of Dental Sciences, Radboud University Nijmegen Medical Centre, P,O Box 9101, Nijmegen 6500 HB, The Netherlands. j.frencken@dent.umcn.nl.
authors.forename: Elisa
authors.initials: E
authors.lastname: Luengas-Quintero
authors.forename: Jo E
authors.initials: JE
authors.lastname: Frencken
authors.forename: Jorge Alejandro
authors.initials: JA
authors.lastname: Muñúzuri-Hernández
authors.forename: Jan
authors.initials: J
authors.lastname: Mulder
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D057087:Dental Atraumatic Restorative Treatment / Q000379:methods*; D003731:Dental Caries / Q000628:therapy*; D003804:Dentin / Q000473:pathology; D005500:Follow-Up Studies; D005899:Glass Ionomer Cements; D006801:Humans; D008800:Mexico; D010895:Pit and Fissure Sealants; D011204:Poverty Areas; D011446:Prospective Studies; D012044:Regression Analysis; D016019:Survival Analysis
chemical_list: D005899:Glass Ionomer Cements; C515713:Ketac Molar Easymix; D010895:Pit and Fissure Sealants