Indigenous community members' views on silver diamine fluoride to manage early childhood caries

Abstract

Objectives Early childhood caries (ECC) continues to be the leading reason for pediatric dental surgery in Canada and is particularly prevalent among Indigenous children. Silver diamine fluoride (SDF) offers an alternative method to manage non‐restoratively caries. It is important to determine Indigenous communities' views on and receptivity toward SDF. Aim To understand Indigenous community members' views on pediatric dental surgery to treat ECC under general anesthesia (GA) and receptivity to SDF as an alternative to restorative surgery. Methods Focus groups and sharing circles congruent with an Indigenous ways of gathering information were conducted. Three interviewers engaged eight groups of First Nation and Metis communities in three rural Indigenous communities and ne metropolitan urban setting in Manitoba, Canada. Overall, 59 individuals participated. Open coding was guided by grounded theory and further analysis using Nvivo 12 software™. Results Participants mean age was 35.6 years, 88 percent (52 individuals) had a least one child, and 32 percent (19 individuals) were employed. Eight themes emerged, including respondents' fear of dental surgery under GA, fear of pain after dental surgery, parents' need for more information before accepting SDF treatment, and concern about the black staining of treated lesions. Conclusions Indigenous parents' acceptance of SDF as a treatment option is contingent on having more information and assurance that treatment under GA can be avoided. Understanding Indigenous parents' views may ensure better acceptance of SDF as a minimally invasive treatment option to manage ECC. A cautious and informative approach to SDF implementation in Indigenous communities is recommended.

Survival of Silver Diamine Fluoride Among Patients Treated in Community Dental Clinics: A Naturalistic Study

“…This study gains broader importance toward the realization of population health goals when considered within the contexts of its use, including evidence on the acceptability of SDF among diverse patient groups [23][24][25][26][27][28][29]. Findings indicate how this noninvasive, cost-effective, setting-exible treatment may be understood as a meaningful option that providers can con dently consider based on patient characteristics, treatment goals, and other factors.…”

“…Analyzing data by individual diagnosis (e.g., non-cavitated carious lesions vs. cavitated lesions, hypersensitivity versus nascent decay), proximity of the treated tooth to other teeth, rationale for providing only one SDF application in a year, or other important information from the dental record was prohibitive due to dentistry's convention of not including diagnostic codes in claims data. In particular, this limitation prohibited us from making causal claims regarding the use of SDF to prevent caries in primary dentition versus to arrest disease despite our results indicating this outcome [16] and from assessing the impact of on patient preference on SDF use on anterior dentition versus posterior dentition, another gap in the literature [22][23][24][25][26][27][28]. Because our interest is in a treatments suitable for primary prevention or the secondary prevention-oriented treatment of dental lesions and extremely early stage caries, our study likely sampled a healthier population, and should not be considered generalizable to a population with more advanced dental caries.…”

“…In addition, amidst the proliferation of the SARS-CoV-2 virus (COVID19), SDF has been recommended as an appropriate, non-surgical, non-aerosolizing caries management procedure that complies with guidance from public health o cials, regulatory bodies, and professional associations to limit the risk of exposure to airborne pathogens [18][19][20][21]. Concerns regarding the staining effects of SDF potentially limit its desirability for use on anterior dentition [22,23]. However, recent evidence also documents its acceptability among dentally underserved patient groups for use on posterior dentition, and when posited to parents as a safe, minimally invasive, and effective alternative to procedures that could be painful or for which their children might otherwise be sedated, with particular suitability for children with behavioral challenges, often surpassing provider preference for using SDF [24][25][26][27][28][29].…”

“…The existing literature on SDF focuses primarily on young children who still have primary dentition [10,13,15,[22][23][24][25][26][27][28] and older adults [16,30], often omitting older children, adolescents, and working-age adults. The strongest evidence on SDF derives from randomized controlled trials (RCTs) whether individual or aggregated into evidence reviews, which compare SDF with placebo or other treatments, limit the intervention to SDF alone versus when used in combination with restorative procedures, and generate ndings from samples treated under ideal clinical conditions and from analyses that control for covariates [6,[10][11][12][13][14][15][16][17].…”

Survival of silver diamine fluoride among patients treated in community dental clinics: A naturalistic study

“…and economic outcomes such as societal costs deferred by SDF treatment. We also encourage more implementation research to understand factors associated with the implementation and uptake of SDF in diverse community settings, in particular research that documents patient-centered outcomes such as patient acceptability of SDF as well as clinical outcomes [23][24][25][26][27][28][29]39].…”