Abstract
BackgroundInterest in aqueous silver diamine fluoride (SDF) has been growing as a treatment for caries arrest. A cross-sectional study was conducted to identify factors associated with caregiver acceptance of SDF treatment for children presenting with caries at 8 Federally Qualified Health Centers. The study purpose was to examine associations between caregiver acceptance of SDF treatment for children with caries and (1) sociodemographic and acculturation characteristics of caregivers and (2) clinical assessments of the children by dentists.MethodsA caregiver survey collected information on: sociodemographic characteristics; acculturation characteristics, measured using the validated Short Acculturation Scale for Hispanics (SASH); perceived benefits and barriers of SDF treatment, including caregiver comfort; and perceived health-related knowledge. Chart reviews were conducted to assess: the medical / dental insurance of pediatric patients; cumulative caries experience, measured using decayed, missing, filled teeth total scores (dmft / DMFT); whether operating room treatment was needed; and a record of caregiver acceptance of SDF treatment (the outcome measure). Standard logistic regression models were developed for caregiver acceptance of SDF treatment for their children as the binary outcome of interest (yes / no) to calculate unadjusted odds ratios (OR) and adjusted ORs for covariates of interest.ResultsOverall, 434 of 546 caregivers (79.5%) accepted SDF treatment for their children. A U-shaped relationship between caregiver odds of accepting SDF treatment and age group of pediatric patients was present, where caregivers were most likely to accept SDF treatment for their children who were either < 6 years or 9–14 years, and least likely to accept SDF treatment for children 6 to < 9 years. The relationship between acculturation and caregiver acceptance of SDF treatment depended upon whether or not caregivers were born in the United States: greater acculturation was associated with caregiver acceptance of SDF treatment among caregivers born in this country, and lower acculturation was associated with caregiver acceptance of SDF treatment among caregivers born elsewhere.ConclusionsCaregiver acceptance of SDF treatment is high; child’s age and caregiver comfort are associated with acceptance. Providers need to communicate the risks and benefits of evidence-based dental treatments to increasingly diverse caregiver and patient populations.
Highlights
Interest in aqueous silver diamine fluoride (SDF) has been growing as a treatment for caries arrest
Purpose/objectives The purpose of this cross-sectional study is to identify factors associated with caregiver acceptance of SDF treatment for children presenting with caries at 7 Federally Qualified Health Centers (FQHCs) in the United States
Effect modification was present in our data, such that the relationship between acculturation and caregiver acceptance of SDF treatment depended upon whether or not caregivers were born in the United States
Summary
Interest in aqueous silver diamine fluoride (SDF) has been growing as a treatment for caries arrest. ECC is both multifactorial and highly prevalent among poor and disadvantaged children residing in underprivileged areas due to higher base rates of disease [2]. Their carious lesions often remain untreated due to limited financial resources and lack of access to dental facilities [3]. Recent findings based upon data collected as part of the National Health and Nutrition Examination Survey (NHANES) for the years 1999–2004 and 2011–2014 were that caries experience decreased from nearly 42 to 35% and untreated caries decreased from 31 to 18% among preschool-aged children in families with low incomes [7]. The proportion of affected carious surfaces may be shifting toward fewer untreated caries to more restored dental surfaces, even as dental caries disparities by poverty status remain for preschool-aged children [8]
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