“I guess it looks worse to me, it doesn’t look like there’s been a problem solved but obviously there is”: a qualitative exploration of children’s and their parents’ views of silver diamine fluoride for the management of carious lesions in children

Abstract

Background Despite growing evidence to support the use of silver diamine fluoride (SDF) for managing carious lesions, and the increased interest in SDF worldwide, uptake in the UK remains limited. This study explored parents’ and children’s views and acceptability of SDF for the management of carious lesions in children. Methods Eleven semi-structured face-to-face interviews were conducted with 11 parent–child dyads recruited from patients attending Dundee Dental Hospital and School. Interviews were transcribed verbatim, coded and thematically analysed. Results Previous dental experience varied across all child participants. Of the 11 children, five had undergone general anaesthesia (GA) for multiple primary tooth extractions. Two had received SDF treatment. Child participants expressed concerns about being picked on by their peers, if they had discoloured anterior teeth. Younger children appeared less concerned about the discolouration and child’s gender did not appear to influence parents’ decision-making, nor the child’s preferences regarding the use of SDF. Parents considered SDF to be particularly useful for anxious or uncooperative children but raised concerns about potential bullying at schools due to the unacceptable dental aesthetics when SDF is applied to anterior teeth. They believed they may be judged by others as neglecting their child’s oral health due to the black staining. Both parents and children were more accepting of the SDF when applied to less-visible posterior teeth. Parents accepted the use of SDF if such treatment avoided extractions under GA. Conclusion Despite the unfavourable aesthetics of SDF (black staining), parents appreciated SDF treatment, especially for uncooperative or younger children. However, both parents and children shared concerns about bullying at schools as a consequence of the black staining. Raising awareness about SDF was identified as one approach to encourage the uptake of SDF.

School-based caries prevention using silver diamine fluoride: A pragmatic randomized trial in low-income rural children

“…However, this approach can be underused due to prohibitive costs or local policies requiring that dentists be present in a supervisory capacity 16 . Considering the other benefits of SDF including cost-e=ectiveness 19 , patient tolerability 33 , e=iciency of treatment time 20 , and relative ease of application 22 , integrating silver diamine fluoride into school-based programs may result in more children being treated in less time and cost. Indeed, prior studies for SDF notes particular utility for dental public health programs and community approaches to caries prevention, especially amongst those in dental shortage areas or where sealants are otherwise infeasible 30 .…”

Parental acceptance of Silver Diamine Fluoride in two lower-middle-income countries: Iran and Tajikistan

“…Qualitative studies are best placed to explore underlying reasons for the choice of treatment. There are at least three such studies in which parental views on SDF were investigated in the UK, Hong Kong and Canada [ 9 , 37 , 38 ]. These studies pointed to a range of reasons for declining SDF such as the possibility of toxicity [ 37 ] as well as of bullying at school due to black discoloration [ 9 ].…”

“…The SDF is a clear ammonia solution containing silver and fluoride and may be used for arresting active dental caries [ 8 ]. While SDF was first adopted in the 1960s in Japan [ 8 ] it has only recently realized its potential after it was cleared by the United States Food and Drug Administration [ 9 , 10 ]. In recent years, there has been a wealth of evidence emerging from randomized controlled trials and multiple systematic reviews to support the effectiveness of SDF in arresting dental caries.…”

Cost‐effectiveness analysis of silver diamine fluoride to divert dental general anaesthesia compared to standard care

“…Alternative interventions of DGA include anxiolysis and conscious sedation, 13,18,19 and the minimally invasive dentistry (MID) techniques for managing moderate and severe stages of dental caries. The MID approach includes atraumatic restorative treatments (ART), 20–23 with/without a combination with stainless steel Hall crown technique, 24–27 and/or application of silver diamine fluoride (SDF) 28–31 . Currently, the Australian fluoride guidelines, 32 states that ‘silver diamine fluoride or silver fluoride might be used for people with caries in situations where traditional treatment approaches to caries management might not be possible’.…”

“…The MID approach includes atraumatic restorative treatments (ART), 20 , 21 , 22 , 23 with/without a combination with stainless steel Hall crown technique, 24 , 25 , 26 , 27 and/or application of silver diamine fluoride (SDF). 28 , 29 , 30 , 31 Currently, the Australian fluoride guidelines, 32 states that ‘silver diamine fluoride or silver fluoride might be used for people with caries in situations where traditional treatment approaches to caries management might not be possible’. However, SDF has the potential to enhance dental caries management non‐invasively in routine practice, resulting in preserving tooth structure and is less costly than surgical interventions if cost is a financial constraint by the client.…”