Integrating silver diamine fluoride into school-based oral health programs: A pilot study.

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). 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. 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. 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. 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.

Acceptance of silver diamine fluoride use in community dwelling older adults, nursing home residents, and caregivers

ObjectivesThe present critical analysis aims to propose an action protocol for the use of silver diamine fluoride (SDF) in pediatric patients in a hospital setting, especially for those who are currently awaiting hospital dental treatment under general anesthesia.Material and MethodsA literature search was performed in the PubMed/MEDLINE from 2009 to 2021 using the search terms “silver diamine fluoride”, “pediatrics silver diamine fluoride”, “application silver diamine fluoride”, and “AND” ‐ combined with terms: “potassium iodide”, “properties”, “adverse effects”, “early childhood caries”, “patient with disability”, “management”, “special health care needs patient”. Articles that recorded the type of teeth, application protocol, the concentration of the product, and possible complications of the treatment were selected.ResultsFour hundred and sixteen related articles were obtained, of which 13 were finally chosen on the basis of the search criteria. The age at which the use of SDF was recommended ranged from the first year of life to 12 years, in most cases in primary teeth. The study populations varied in size from 53 to 799 patients. An analysis of the characteristics of SDF and its use in pediatric patients with dental caries was performed. The recommended concentration was 38% SDF, applied twice yearly. The main complication reported was staining. A decision algorithm was designed including SDF as an agent for caries control in patients attending the specific population of our hospital (divided into two groups: healthy children aged 0−4 years and patients with special health care needs (SHCNs) aged 0−18 years).ConclusionsSDF therapy appears to be effective in the control of caries in pediatric patients. We propose an action protocol for patients with early childhood caries to reduce risk, complications, and the progression of lesions. The protocol is aimed especially at pediatric patients who also have some systemic pathology, disability, SHCNs, and/or behavioral difficulties.

Silver diamine fluoride can arrest dental caries and prevents its progression. By doing so, it provides an alternative care path for those patients in whom traditional restorative treatment cannot be done, for example, children lacking cooperating ability. Although silver diamine fluoride had been used as a caries preventive measure in 1970s in Japan, it had not become popular in the other part of the world. Now, many countries have recommend the use of 38% silver diamine fluoride solution for caries prevention as well as for caries arrest. Recently, The American Academy of Pediatric Dentistry provided the guidelines regarding the use of silver diamine fluoride for dental caries management in children and adolescent including those with special healthcare needs.

BackgroundUsing silver diamine fluoride (SDF) for caries management has raised dentists’ interests in Southeast Asia (SEA). However, information about the teaching of SDF in dental schools in SEA is limited. Therefore, this survey aimed to describe the extent to which SDF had been introduced into the education of undergraduate students in the dental schools in SEA.MethodsAn online questionnaire survey was conducted on the duration, method, contents, and barriers regarding the teaching of SDF. Teachers in charge of undergraduate program in pediatric dentistry and those in community dentistry in all the 90 dental schools in SEA were approached and we required each department to reply once only. Descriptive statistics and Chi-square test were used to describe and assess the differences between the two departments in the teaching of SDF.ResultsA total of 81 responses from the departments of 49 schools were received, giving a school-level response rate of 54% (49/90). SDF was taught in the undergraduate program in 86% (42/49) of the respondent schools, and 50% (21/42) of these schools had included SDF in the teaching for five or more years. Almost all (98%) of the departments taught SDF through lectures. Furthermore, 55% of them adopted SDF in clinical practice. Regarding the teaching content, the use of SDF for arresting cavitated caries lesion was the most commonly covered (82–97%), followed by for arresting early noncavitated lesions (69–82%), for preventing new caries development (66–79%) and for treating dental hypersensitivity (77%). There were variations in the post-treatment instruction taught. For the departments not teaching SDF, the most common reason (10/19, 53%) was that SDF was not available.ConclusionSDF is covered in the undergraduate program in most of the dental schools in SEA. The use of SDF to arrest cavitated caries lesions in primary teeth is usually taught. However, other applications of SDF, such as for prevention of caries and treatment of dental hypersensitivity, are less commonly mentioned in the teaching.

Background: Dental caries is a prevalent dental problem affecting primary and permanent teeth. Early demineralization of enamel lesions can be reversed through remineralization. Many studies have focused on caries prevention and disease progression arrest using silver diamine fluoride (SDF). No in vitro studies have compared the remineralization effects of different 38% SDF solutions on artificially demineralized enamel lesions. This study aimed to compare the remineralization potential of three commercial 38% silver diamine fluoride formulations on artificial enamel lesions in primary teeth using a pH cycling model. The hypothesis was as follows: different commercial SDF formulations would exhibit varying remineralization effects, as measured by surface microhardness, due to potential differences in their compositions. Materials and Methods: In this study, 75 primary molars were randomized into five groups (N = 15): I: baseline, II: SDF Riva Star Aqua® 38%, III: Riva Star® 38%, IV: SDF Advantage Arrest® 38%, and V: control. Artificial caries were created by submerging teeth in 10 mL of demineralization solution (pH 4.5) for three days in a light-resistant container, ensuring distinct visual changes in the enamel as per the International Caries Detection and Assessment System (ICDAS level 2). After pH cycling, all samples underwent a standardized Vickers microhardness test (VMHT) with a 50 g load for 15 s. Data were analyzed using one-way ANOVA and Tukey’s post hoc test, with a significance level set at p ≤ 0.05. Results: The one-way ANOVA test indicated a significant difference in microhardness among the groups (SDF Riva Star Aqua, SDF Riva Star, and SDF Advantage Arrest), with an F-value of 167.73 and p < 0.001. The post hoc Scheffé test showed that SDF Riva Star Aqua and SDF Riva Star were not significantly different (p = 0.388). However, SDF Advantage Arrest had a significantly higher mean microhardness compared to both groups (p < 0.001). Overall, these results show that SDF Advantage Arrest leads to greater microhardness than SDF Riva Star Aqua or SDF Riva Star. Conclusions: SDF Advantage Arrest showed superior performance among the SDF-treated groups, significantly increasing microhardness compared to SDF Riva Star Aqua and SDF Riva Star. This suggests that SDF Advantage Arrest offers enhanced remineralization and structural strengthening, making it the most effective option for managing demineralized primary teeth. Future research should investigate the long-term performance and mechanisms of these treatments to optimize clinical protocols for preserving primary tooth integrity.

Context:Antisepsis achieved through appropriate use of irrigants is essential for endodontic success. Identification of newer anti-bacterial agents gives alternatives to clean the canal as eradication of the infection prior to obturation does affect prognosis.Objective:Comparison of the anti-bacterial action of 3.8% silver diamine fluoride and 2% chlorhexidine gluconate against Enterococcus faecalis in root canals.Materials and Methods:Forty-four single-rooted teeth were decoronated, and the root section was enlarged with peeso-reamer (No: 3) to standardize length and diameter. The samples were then autoclaved and divided into two study groups and two control groups. Enterococcus faecalis ATCC 29212 was inoculated into all test samples for 72 hours. The samples were enlarged with peeso-reamer (No: 5) after placement of respective medicament for 24 hours. Shavings were collected and inoculated on Brain Heart Infusion agar for 24 hrs to measure the colony forming units.Results:Both 3.8% silver diamine fluoride and 2% chlorhexidine showed a superior capacity to sterilize the root canals than control groups.Conclusion:The use of silver diamine fluoride as an endodontic irrigant is feasible as it can effectively remove the microbes present in the canal and circumpulpal dentin.

Caries is the most ubiquitous infectious disease of mankind, and early childhood caries (ECC) is the most prevalent chronic disease in children worldwide, with the resulting destruction of the teeth recognized as a global health crisis. Recent the United States Food and Drug Administration (FDA) approval for the use of silver diamine fluoride (SDF) in dentistry offers a safe, accessible, and inexpensive approach to arrest caries progression in children with ECC. However, discoloration, i.e., black staining, of demineralized or cavitated surfaces treated with SDF has limited its widespread use. Targeting SDF-treated tooth surfaces, we developed a biohybrid calcium phosphate nanocomposite interface building upon the self-assembly of synthetic biomimetic peptides. Here, an engineered bifunctional peptide composed of a silver binding peptide (AgBP) is covalently joined to an amelogenin derived peptide (ADP). The AgBP provides anchoring to the SDF-treated tooth tissue, while the ADP promotes rapid formation of a calcium phosphate isomorph nanocomposite mimicking the biomineralization function of the amelogenin protein. Our results demonstrate that the bifunctional peptide was effective in remineralizing the biomineral destroyed by caries on the SDF-treated tooth tissues. The proposed engineered peptide approach offers a biomimetic path for remineralization of the SDF-treated tissues producing a calcium phosphate nanocomposite interface competent to be restored using commonly available adhesive dental composites.

Use of silver diamine fluoride for the maintenance of dental prostheses in a high caries-risk patient: A medical management approach

This manuscript presents evidence-based guidance on the use of 38 percent silver diamine fluoride (SDF) for dental caries management in children and adolescents, including those with special health care needs. A guideline workgroup formed by the American Academy of Pediatric Dentistry developed guidance and an evidence-based recommendation regarding the application of 38 percent SDF to arrest cavitated caries lesions in primary teeth.The basis of the guideline's recommendation is evidence from an existing systematic review "Clinical trials of silver diamine fluoride in arresting caries among children: A systematic review." (JDR Clin Transl Res 2016;1[3]:201-10). A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and gray literature databases to identify randomized controlled trials and systematic reviews reporting on the effect of silver diamine fluoride and address peripheral issues such as adverse effects and cost. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of the evidence and the evidence-to-decision framework was employed to formulate a recommendation.The panel made a conditional recommendation regarding the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program. After taking into consideration the low cost of the treatment and the disease burden of caries, panel members were confident that the benefits of SDF application in the target populations outweigh its possible undesirable effects. Per GRADE, this is a conditional recommendation based on low-quality evidence. Conclusions and practical implications: The guideline intends to inform the clinical practices involving the application of 38 percent SDF to enhance dental caries management outcomes in children and adolescents, including those with special health care needs. These recommended practices are based upon the best available evidence to-date. A 38 percent SDF protocol is included in Appendix II.

Introduction: The concept of minimally invasive dentistry has been developed in the last decade for the control of new caries, focusing on early arrest of lesions and remineralization of enamel and dentin. Objective: To analyze the existing literature on the treatment of carious lesions in primary teeth using a minimal intervention approach without the need for local anesthesia, covering: the non-restorative caries control technique and the use of sealants, the use of Silver Diamine Fluoride (SDF), Hall Technique (HT), selective removal of carious tissue and atraumatic restorative treatment (ART). Methodology: A search strategy was carried out in PubMed, Scopus and Google Scholar databases, using a combination of keywords including: Silver Diamine Fluoride, Hall Technique, selective removal of carious tissue and atraumatic restorative treatment, non-restorative caries control technique. Results: Regarding non-restorative control and the use of sealants, both have variable results, and their use is recommended in primary teeth and caries limited to the enamel. HT will be successful for the management of interproximal dentin caries in primary molars. SDF represents a high quality and safe cariostatic agent, despite subsequent pigmentation. Selective removal of carious tissue provides success in maintaining pulp vitality, and ART is often efficient, affordable, and practical for use in more remote areas of the population. Conclusions: Biological approaches are based on preserving tooth structure and maintaining function for as long as possible and, in the case of primary teeth, until they naturally exfoliate, many of these approaches fall under the term Minimal Interventional Dentistry. For the selection of the technique to be used, the type of lesion presented, and the conditions and cooperation of the patient should be considered, so there is no "one size fits all" in minimally invasive dentistry.

Previous studies have highlighted the high burden of oral diseases in refugee camps, but there are few robustly evaluated school-based oral health programmes in these settings. The objective of this study was to pilot a school-based toothbrushing, handwashing, and silver diamine fluoride (SDF) application in a refugee camp in Bangladesh. It hosts the world's largest number of refugees with over 1 million Rohingya from Myanmar. A prospective cohort study that consisted of a multipronged oral health intervention: supervised daily toothbrushing, handwashing, and SDF application of active caries in the primary and permanent dentition. Clinical examination of the children and child and parental questionnaires were completed at baseline and the 6-month follow-up. A total of 176 children were assessed at baseline, with a follow-up rate of 87.5%. The number of children reporting regular toothbrushing and handwashing significantly increased between baseline and 6-month follow-up, with a corresponding fall in plaque and bleeding scores. There was a 54.3% caries arrest rate in teeth where SDF was applied. Supervised toothbrushing and SDF application in learning centres in refugee camps can improve the oral health of refugee children and instil healthy hygiene habits. Further research is warranted to robustly assess the long-term impact of this intervention and scalability across humanitarian settings. In the absence of accessible oral health care in refugee camps, low-resource oral health interventions can safeguard oral health and instil healthy hygiene habits from a young age.

Background: The effectiveness of school-based dental health programs has been vastly reported. The objective of the present study was to assess the oral health knowledge and attitudes of primary school teachers in Saudi Arabia and to identify any barriers in implementing school oral health programs. Methodology: A pretested self-administered questionnaire was used to assess the oral health knowledge and attitudes of primary school teachers including barriers in implementing school oral health programs. Results: A total of 61 primary schools were included in the present study with responses from 1186 teachers. The mean oral health knowledge score among primary school teacher of Abha-Khamis was found to be 16 ± 2.7. The overall attitude of primary school teachers regarding implementing school-based oral health program was found to be positive on Likert scale. The responses for barriers in implementing school oral health program were almost equally distributed: lack of material resources (21%), lack of professional training (25%), lack of availability of time (25%), lack of support from school administration (22%), and teacher's attitude was least perceived as a barriers (7%). Conclusions: The oral health knowledge among primary school teachers was found to be good with positive attitudes toward school-based oral health programs. The most significant barriers in implementing a school oral health program were administrative barriers. There is a need for concerned school authorities and health policy makers to address these barriers and to promote oral health in the community.

<b>Purpose:</b> The purpose of this study was to use qualitative methods to describe the key lessons learned during the stakeholder engagement stage of planning a randomized clinical trial comparing outcomes of silver diamine fluoride (SDF) as an alternative to pit-and-fissure sealants in a school-based delivery system. <b>Methods:</b> Eighteen caregivers and community-based stakeholders with involvement in the school-based sealant program Sealants for Smiles from the state of Montana, were recruited for this qualitative study. United States (U.S.) Patient-Centered Outcomes Research Institute (PCORI) methodology standards were used to develop two semi-structured interview guides consisting of 6 questions. One interview guide was used for telephone interviews with caregivers and the second was used for a stakeholder focus group. Content analytic methods were used to analyze the data. <b>Results:</b> All participants believed that a study comparing SDF and sealants was clinically relevant. Non-caregiver stakeholders agreed with the proposed primary outcome of the study (caries prevention) whereas caregivers also emphasized the importance of child-centered outcomes such as minimizing dental anxiety associated with dental care. Stakeholders described potential concerns associated with SDF such as staining and perceptions of safety and discussed ways to address these concerns through community engagement, appropriate framing of the study, proper consent procedures, and ongoing safety monitoring during the trial. Finally, stakeholders suggested dissemination strategies such as direct communication of findings through professional organizations and encouraging insurance plans to incentivize SDF use by reimbursing dental providers. <b>Conclusions:</b> Involving key stakeholders in early planning is essential in developing patient-centered research questions, outcomes measures, study protocols, and dissemination plans for oral health research involving a school-based delivery system.

BackgroundDental caries is a significant public health problem in Iran. Teaching minimally invasive interventions in paediatric dentistry may facilitate the provision of treatment for untreated dental caries in children. We evaluated the teaching of such interventions in both undergraduate dental curriculum and Paediatric Dentistry Specialty Training Programme (PDSTP) in Iran.MethodsThis was a cross-sectional questionnaire-based survey. Participants in this study were the directors of 40 undergraduate programmes and 15 PDSTPs in all Iranian dental schools (response rate = 100%). Descriptive statistics were reported.ResultsThe most commonly taught methods were preventive fissure sealant and preventive resin restoration (PRR), which were taught ‘both didactically and clinically’ in all undergraduate dental programmes. The least commonly taught methods were silver diamine fluoride (SDF), the Hall technique and resin infiltration, which were taught ‘both didactically and clinically’ in less than 5% of dental schools. The same three methods were the least commonly approaches taught in PDSTP, further, they were less often perceived to be ‘essential’.ConclusionsThere was a notable variation in the teaching of the management of dental caries in Iran’s dental education. Some minimally invasive approaches including SDF, the Hall technique and resin infiltration are not being commonly taught in Iranian dental schools despite the evidence base for these techniques.