Teaching Silver Diamine Fluoride in U.S. Dental Schools’ Predoctoral Curricula

Abstract

Silver diamine fluoride (SDF), a low‐cost topical agent used in many countries to arrest dental caries, was cleared as a desensitizing agent by the Food & Drug Administration for the U.S. market in 2014. The aim of this study was to survey U.S. dental schools regarding their teaching of SDF. Email invitations were sent to all accredited U.S. predoctoral dental education programs (n=66) in September 2016. Deans, chairs, and selected faculty members were asked to respond or forward the survey‐link provided to the appropriate person in their school. Under the assumption that some respondents from the same school were unaware of SDF implementation across departments, multiple responses from the same school were collapsed for analysis. A total of 62 schools (94% response rate) responded to the survey, and 67.7% of them reported that SDF was part of their curricula. There was a wide variation across dental schools’ teaching about SDF indications and protocols of application. All but one school consistently agreed on using SDF for arresting caries on primary teeth. Only 18 respondents were able to confirm if there was an existing protocol at their school for the use of SDF. When re‐application after initially arresting caries with SDF was taught, 50% of respondents advocated 2×/year re‐application. Schools not teaching SDF (n=20) planned on including it in their curricula in the future. These findings suggest that, with the use of SDF increasing rapidly in the U.S. and its adoption in most dental schools, there is a need for the development of standardized evidence‐based protocols.

Acceptance of Parents to Silver Diamine Fluoride in Pre-cooperative Children: A Cross-sectional Study

“…8 Also, it was cleared as a desensitizing agent by the Food and Drug Administration for the US market in 2014. 9 According to Mellberg et al, fluoride introduced into the oral cavity gets cleared with passage of time; hence, a continuous supply of fluoride is essential for anticaries effect. 10 Enamel fluoride content was seen to increase significantly even after 6 months of application of SDF compared to fluoride varnish and APF gel.…”

Assessment of knowledge and perception about silver diamine fluoride (SDF) for treating older adults among graduating dental students

“…Additionally, it was reported that even among schools that contain SDF in their curriculum, not all faculty were aware of SDF being taught which creates an incongruent learning environment for dental students. 28 The same study also showed that the amount of time devoted to teaching SDF varies between schools: of the 42 schools that had SDF in their curriculum, 32.5% taught the material for <1 hour, 37.5% for 1-2 hours, and 25% for 3-5 hours. 28 These variations in time may be the reason for the inconsistent knowledge and perception of SDF among dental students from different schools which was captured in our results.…”

“…The inconsistency can be attributed to the fact that SDF is relatively new in the United States, as well as to the factors previously discussed that affected the implementation of SDF into clinical use such as the off‐label use and lack of universal guidelines. Additionally, it was reported that even among schools that contain SDF in their curriculum, not all faculty were aware of SDF being taught which creates an incongruent learning environment for dental students 28 . The same study also showed that the amount of time devoted to teaching SDF varies between schools: of the 42 schools that had SDF in their curriculum, 32.5% taught the material for <1 hour, 37.5% for 1‐2 hours, and 25% for 3‐5 hours 28 .…”

“…A study published in December 2018 found that 42 out of 62 U.S. dental schools surveyed included SDF as a part of their curriculum, and 18 of those schools had a protocol outlining the use of SDF. 28 As the option of using SDF is relatively new, and as it breaks the old paradigm of "drill and fill" as the gold standard for caries treatment, it should be taught in the classroom and applied in the clinics simultaneously to encourage future use in practice, in accordance with the more contemporary principles of minimal intervention dentistry. 27,29 The assimilation of SDF's off-label use in private practice is unknown, but future use may be gauged on current dental student comprehension and willingness to use it.…”

“…Exposure to properties and applications of SDF in the classroom might improve the students’ perception of future SDF use in dental practices, but dental schools in the United States are still in the process of recognizing and adopting this new treatment modality. A study published in December 2018 found that 42 out of 62 U.S. dental schools surveyed included SDF as a part of their curriculum, and 18 of those schools had a protocol outlining the use of SDF 28 . As the option of using SDF is relatively new, and as it breaks the old paradigm of “drill and fill” as the gold standard for caries treatment, it should be taught in the classroom and applied in the clinics simultaneously to encourage future use in practice, in accordance with the more contemporary principles of minimal intervention dentistry 27,29 …”