Atraumatic Restorative Treatment as public policy: a systematic review

Abstract Background: This systematic review aimed to identify, describe, and analyze the global context of Atraumatic Restorative Treatment (ART) as public policy. Methods: The inclusion criteria were: studies on public oral health policies, dental caries, or ART. The exclusion criteria were: clinical studies, specific interventions unrelated to the decision making of managers or policymakers, studies that report public oral health policies that do not use ART as a strategy for caries treatment. A literature search was conducted in PubMed, BVS, Epistemonikos, Health Systems Evidence, and Rx for change. There were no language restrictions. Data extraction was performed by two authors independently according to the stages and categories of a conceptual framework and organized in spreadsheets using Microsoft Excel 365. Of the 2253 eligible articles, 139 were duplicates, and 1680 were not included after reviewing the title and abstract. After assessing the full text, 414 articles were excluded. Results: 20 articles were included in the current review. Nineteen were conducted in nine countries: South Africa (n = 3), Bolivia (n = 1), Cambodia (n = 2), Egypt (n = 2), Mexico (n = 2), Tanzania (n = 4), East Timor (n = 1), Tunisia (n = 1), and Zimbabwe (n = 3), and one in the Americas. Regarding local contexts, the studies reported a high prevalence of dental caries and a lack of access to restorative procedures in health services as common problems. Policy development processes were similar in some aspects, such as the presence of governments, conceptual use of scientific evidence, and induction by the World Health Organization. Regarding the barriers identified in the implementation stage, the lack of supplies to carry out the procedures and induction of the work process by managers were mentioned. As for the facilitators, permanent education and professional practice were mentioned. Cohort studies have shown promising results, with a survival rate greater than 80% after one year of follow up. Conclusions: The findings of this systematic review indicate that the use of ART in public policies is a promising option for tackling common problems in several countries, however, its use is still in an early stage.