{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T14:59:02Z","timestamp":1790348342536,"version":"4.1.0"},"reference-count":27,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004368","name":"Colgate-Palmolive","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004368","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,27]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Dental caries remains one of the most prevalent chronic diseases in childhood worldwide. In Brazil, untreated carious lesions continue to affect oral health and quality of life in school-aged children. Minimally invasive approaches for caries management have demonstrated feasibility in community settings and may expand access to preventive and restorative care in socially vulnerable populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicentre longitudinal intervention study will recruit 50\u2009000 children aged 6\u201312 years from public schools in five Brazilian cities (Santos, Ponta Grossa, Bras\u00edlia, Fortaleza and Bel\u00e9m). All participants will undergo clinical examination using the International Caries Detection and Assessment System (ICDAS) and will receive preventive and educational measures, including oral health counselling, supervised toothbrushing with fluoridated toothpaste (1100 ppm F), toothbrushes, toothpaste and application of Duraphat fluoride varnish to permanent molars and incisors. Among children with active carious lesions, 2500 will enter the longitudinal minimally invasive treatment phase according to lesion severity: fluoride varnish for ICDAS 1\u20132 lesions; fluoride varnish or atraumatic restorative treatment (ART) sealants for ICDAS 3 lesions; and ART with high-viscosity glass ionomer cement for ICDAS 4\u20136 lesions. Participants will be re-evaluated every 3 months for up to 24 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Expected outcomes<\/jats:title>\n                    <jats:p>The primary outcome will be control of caries activity assessed longitudinally using ICDAS criteria. Secondary outcomes include inactivation of white spot lesions, survival of restorations and sealants and adherence to preventive measures. The study is expected to generate evidence to support public oral health policies and minimally invasive strategies for school-based caries management in Brazil.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This protocol has been approved by the human research ethics committee of Universidade Metropolitana de Santos\u2014UNIMES (protocol number: 7.630.345. Approved on 10 June 2025). Results will be submitted to international peer-reviewed journals and presented at international conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06999005\">NCT06999005<\/jats:ext-link>\n                      (registered on 14 May 2025).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-118205","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T14:05:39Z","timestamp":1790345139000},"page":"e118205","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal evaluation of minimally invasive protocols for the prevention and control of dental caries in Brazilian schoolchildren: a multicentre study protocol"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06999005","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9853-1138","authenticated-orcid":false,"given":"Sandra Kalil","family":"Bussadori","sequence":"first","affiliation":[{"name":"Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, S\u00e3o Paulo, Brazil"},{"name":"School of Dentistry, Universidade Metropolitana de Santos, Santos, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine Marcilio","family":"Santos","sequence":"additional","affiliation":[{"name":"School of Dentistry, Universidade Metropolitana de Santos, Santos, Brazil"},{"name":"Postgraduation Program in Health and Environment, Universidade Metropolitana de Santos, Santos, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elza Padilha","family":"Ferri","sequence":"additional","affiliation":[{"name":"School of Dentistry, Universidade Metropolitana de Santos, Santos, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Claudia Rodrigues","family":"Chibinski","sequence":"additional","affiliation":[{"name":"School of Dentistry, Universidade Estadual de Ponta Grossa, Ponta Grossa, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Let\u00edcia Diniz Santos Vieira","family":"Pereira","sequence":"additional","affiliation":[{"name":"School of Dentistry, Aria, Bras\u00edlia, Distrito Federal, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9497-9333","authenticated-orcid":false,"given":"Caroline Diniz Pagani Vieira","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyselle Ribeiro De Carvalho","family":"Oliveira","sequence":"additional","affiliation":[{"name":"School of Dentistry, Universidade Federal do Par\u00e1, Bel\u00e9m, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dicler de Sant\u2019Anna Vitor","family":"Barbieri","sequence":"additional","affiliation":[{"name":"School of Dentistry, S\u00e3o Leopoldo Mandic, Campinas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9055-1524","authenticated-orcid":false,"given":"Cinthya Cosme Gutierrez","family":"Duran","sequence":"additional","affiliation":[{"name":"Postgraduation Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3476-9064","authenticated-orcid":false,"given":"Anna Carolina Ratto 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