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Background There is a lack of evidence on the effectiveness of moderate sedation in pediatric dentistry, compared to protective stabilization, which remains routinely used in Brazil despite moral questions. This prospective non-randomized clinical trial's objective is to evaluate the effectiveness of moderate sedation, compared to the protective stabilization, in the dental care of children with dental behavior management problems. Methods Participants will be 152 children under seven years of age with early childhood caries (ECC) who need specialized dental treatment due to a history of challenging behavior during dental care. The interventions to be compared are moderate sedation with oral administration of ketamine and midazolam and protective stabilization. The primary endpoint will be the child's behavior during treatment assessed using the Ohio State University Behavioral Rating Scale (OSUBRS). The secondary outcomes are (A) child's – behavior according to the visual analogue scale, anxiety, pain, and physiological stress; (B) parent's – satisfaction and anxiety; (C) family and child – impact on oral health-related quality of life (OHRQoL); (D) dentist's – satisfaction and stress; (E) procedure – adverse events of the intervention and dental treatment longevity. A cost-effectiveness analysis will be performed from the perspective of the Brazilian Unified Health System (SUS). Discussion Considering the primary outcome, this study hypothesis is that sedated children have better behavior during dental treatment than children whose behavior was managed by protective stabilization without sedation. Additionally, at the end of 12 months, we expect to identify participants' reported outcomes and objective measures related to dental behavior in early childhood. Trial registration Clinicaltrials.gov registration NCT04119180 on October 8th, 2019. https://clinicaltrials.gov/ct2/show/NCT04119180

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Introduction: Atraumatic restorative treatment (ART) is a minimally invasive approach of dental caries lesions that is indicated in primary and permanent dentition. Objectives: To investigate based on a review of the scientific literature, the use of ART as a minimally invasive treatment approach in Pediatric Dentistry. Methodology: A literature review was conducted to verify the evidence regarding Atraumatic restorative treatment as a minimally invasive treatment in pediatric dental patients. Searches were performed in the following electronic health databases: Pubmed, Scientific Electronic Library Online (SciELO), and Latin American and Caribbean Literature on Health Sciences (LILACS), using the following search terms: minimally invasive treatment and Atraumatic restorative treatment and dental caries. The inclusion criteria for the studies were epidemiological (cross-sectional, case-control, cohort, clinical trials) or qualitative studies that evaluated the use of ART in children's dental care; papers published in English, Portuguese or Spanish; and the publication date of the studies was limited to the last five years (2017 to 2022). Data were presented through a description of the included studies after a complete reading. Results: Twenty-three studies were identified and after the inclusion criteria were applied, eight studies were included in the full analysis. From the data analysis, it was observed that ART is a great alternative for the caries control and treatment of the lesions, contributing to the reduction of the patient's anxiety levels in relation to conventional restorative dental treatment, as it minimizes the fear of children regarding dental caries treatment. ART is a viable alternative to conventional treatments that are associated with local anesthetics, drills, and composite resin. In addition, the materials used in ART showed good results when compared to conventional restorative techniques in relation to the survival of the restoration. Conclusion: The use of the ART technique is an effective option for minimally invasive treatment for children, mainly young children, and especially nowadays due to the minimization of aerosols production for dental treatments due to virus transmission during pandemic period. In addition, ART is a comfortable and easy technique for both patient and dental health professional.

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