As the world population ages, the requirement for cost-effective methods of treating chronic disease conditions increases. In terms of oral health, there is a rapidly increasing number of dentate elderly with a high burden of maintenance. Population surveys indicate that older individuals are keeping their teeth for longer and are a higher caries risk group. Atraumatic Restorative Treatment (ART) could be suitable for patients in nursing homes or homebound elderly but very little research has been done on its use in adults. Objective: to compare the cost- effectiveness of Atraumatic Restorative Treatment (ART) and a conventional technique (CT) for managing caries as part of a preventive and restorative programme for older adults. Methods: In this randomised clinical trial, 82 patients with caries were randomly allocated to receive either ART or conventional restorations. Treatment costs were measured based on treatment time, materials and labour. For the ART group, the cost of care provided by a dentist was also compared to the cost of having a hygienist to provide treatment. Effectiveness was measured using survival percentage of restorations after a year. Results: Eighty-two patients received 260 restorations, 128 ART and 132 conventional restorations. 91.1% of the restorations were on one surface only. After a year, 254 restorations were assessed in 80 patients. The average cost for ART and conventional restorations was €16.86 and €28.71, and the survival rates were 90.4% and 96.9% respectively. This resulted in a cost-effectiveness ratio of 0.18 (ART) and 0.29 (CT). When the cost of a hygienist to provide ART was inserted in the analysis, the resulting ratio was 0.14. Conclusions: ART was found to be a more cost-effective alternative to treat older adults after 1 year, compared to conventional restorations, especially in out of surgery facilities and using alternative workforce such as hygienists. ART can be a useful tool to provide dental care for frail and fearful individuals who might not access dental treatment routinely.