Knowledge, Practices and Attitudes towards Silver Diamine Fluoride Therapy among Dentists in Japan: A Mixed Methods Study

Abstract

In 2021, the World Health Organization included silver diamine fluoride (SDF) as an essential medicine to manage caries in adults and children. SDF was developed in the 1960s, but its use for children became unpopular in Japan because of the decline and low prevalence of early childhood caries. This mixed methods study explored the knowledge, practices and attitudes towards SDF therapy among dentists promoting fluoride use in Japan. It also investigated senior dentists’ perceptions of SDF therapy in Japan. The quantitative study invited all 173 members of the largest organisation promoting fluoride use in Japan to complete a web-based questionnaire survey. Sixty (60/173; 35%) dentists promoting fluoride use in Japan completed the questionnaire survey. All dentists knew of SDF treatment, and 50 (50/60; 83%) used SDF for dental care. Fifty-nine dentists (59/60; 98%) agreed that SDF therapy was simple and quick. All 60 dentists agreed that SDF was effective to arrest caries; 51 dentists (51/60; 85%) agreed that SDF was effective to prevent caries. Most dentists (51/60; 85%) were concerned about SDF’s unaesthetic staining. Fifty-seven dentists (57/60; 95%) used SDF to arrest primary posterior teeth, and 52 dentists (52/60; 87%) used SDF to arrest root caries. However, 25 dentists (25/60; 42%) did not use SDF to prevent caries in permanent teeth. The qualitative study interviewed 12 senior dentists using snowball sampling and achieved data saturation. The dentists opined that SDF therapy was effective, simple, painless, non-invasive and inexpensive. SDF is seldom used in Japan at present because of the unaesthetic black staining and the low prevalence of early childhood caries; however, it can regain popularity by arresting root caries in the aging population.

National Survey on Silver Diamine Fluoride (SDF) Awareness, Knowledge, Attitude, and Use among General Dental Practitioners in the Kingdom of Saudi Arabia—An Exploratory Survey

“…Mirroring the results of the present study (60%), general practitioners in the Riyadh region [ 4 ] also agreed that SDF could arrest cavitated lesions. In contrast, in a similar survey conducted among Japanese dentists, about 90% considered it an effective tool against dental caries [ 7 ]. The higher acceptance of this material in the Japanese survey could be because the respondents were both general dentists and specialists.…”

“…Although the American Academy of Pediatric Dentists (AAPD) chairside guidelines for the use of SDF states that it is not necessary to remove the carious dentin before SDF application [ 30 ], more than half of the participants in our study did not agree on this step, similar to a study among pediatric specialists [ 16 ]. Similarly, SDF was first introduced as a means to relieve dentinal hypersensitivity, with evidence from several studies suggesting a high success rate [ 7 , 34 ]. However, many practitioners are oblivious to this use of SDF, as suggested by the results of this study.…”

“…Dental caries results in demineralization of the inorganic components and destruction of the organic components of the teeth. An array of different materials is constantly being experimentally studied to find materials either capable of reversing this process before the actual cavitation or inhibiting further destruction of sound tooth structure [ 7 ]. Silver diamine fluoride (SDF) is one such material that satisfies these characteristics along with its perceived psychological and emotional impacts, especially in anxious patients [ 8 ].…”

“…Evidence from multiple studies has highlighted SDF’s efficiency as an effective agent in arresting dental caries [ 7 , 14 ], as a relatively inexpensive treatment for the socioeconomically disadvantaged patient groups [ 15 ], and as an alternative for patients who cannot tolerate traditional dental care. Furthermore, in primary teeth, SDF use was found to be safe and efficient in arresting caries, which is an added advantage when dealing with high-risk children with intellectual and developmental disabilities [ 4 , 14 , 15 ].…”

Bioactive Materials for Caries Management: A Literature Review

“…The World Health Organization recognised SDF as an important medicine [ 54 ]. SDF therapy is effective for caries arrest and prevention, especially for difficult-to-treat lesions and elderly patients or patients with difficulties in routine hygiene procedures [ 55 , 56 ].…”