Parents’ Views on Silver Diamine Fluoride to Manage Early Childhood Caries

Abstract

Background: The use of silver diamine fluoride (SDF) as a nonsurgical caries management product is growing. Evidence suggests that SDF is very successful in arresting caries. However, a common concern with SDF treatment is the unaesthetic black staining. The purpose of this qualitative study was to determine parents’ views following their children’s treatment with SDF to manage severe early childhood caries (ECC). Method: Parents were interviewed as part of a mixed-method study of SDF to arrest severe ECC. Children with caries lesions in primary teeth were treated with 2 applications of 38% SDF, followed by fluoride varnish. Semistructured in-person and phone interviews were conducted with 19 parents of children in the study. Data were transcribed verbatim and manually coded and uploaded to NVivo 12 for further coding analysis. Results: None of the parents had previously heard about SDF, and they learned about it from the study dentist. Although parents trusted the dentist’s information on SDF, they welcomed additional evidence, especially relating to product safety and effectiveness. Some parents were minimally concerned with the black staining caused by SDF treatment. It was more important that SDF arrested caries progression, minimized pain and sensitivity, and prevented dental infection. However, some parents expressed concerns related to the unaesthetic black staining. Interestingly, many parents indicated that their children were not overly concerned with the black staining. A majority of parents said that they would recommend the treatment to others. Conclusion: This is the first qualitative study involving parents of children who were treated with SDF. Most parents were accepting of SDF as a nonsurgical treatment to arrest caries and minimize dentinal sensitivity secondary to caries, although some expressed concern about the black staining in anterior teeth. It is important to adequately inform parents of the negative aesthetic consequences and obtain informed consent before treatment. Knowledge Transfer Statement: This qualitative study revealed that many parents of children with severe ECC are accepting of SDF as a nonrestorative caries management option, despite the black staining of caries lesions. Dental professionals need to be aware of these parental concerns and obtain written informed consent prior to treatment. Parents also requested more information and resources on SDF on its benefits, effectiveness, and any associated risks.

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

“…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].…”

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.…”

“…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].…”