Abstract

BackgroundDespite evidence that Silver Diamine Fluoride (SDF) can be effective in managing carious lesions in primary teeth, the use of SDF in the UK remains limited. This study explored dental professionals’ views and experiences of using SDF for managing carious lesions in children. In addition, it explored what they perceived to be the advantages, disadvantages, barriers and enablers to the use of SDF in practice.MethodsFifteen semi-structured face-to-face or over-the-phone interviews were conducted with 14 dental professionals from NHS Tayside and NHS Grampian in Scotland. Interviews were transcribed verbatim, coded and analysed using a thematic approach.ResultsThirteen of 14 dental professionals interviewed were familiar with, or had some existing knowledge of, SDF. Four had used it to treat patients. The majority of participants thought that the main advantage of SDF was that it required minimal patient cooperation. SDF was also perceived as a simple, pain-free and non-invasive treatment approach that could help acclimatise children to the dental environment. However, SDF-induced black staining of arrested carious lesions was most commonly reported as the main disadvantage and greatest barrier to using it in practice. Participants believed that this discolouration would concern some parents who may fear that the black appearance may instigate bullying at school and that others may judge parents as neglecting their child’s oral health. Participants thought that education of clinicians about SDF use and information sheets for parents would enhance the uptake of SDF in dental practice. Participants believed that younger children might not be as bothered by the discolouration as older ones and they anticipated greater acceptance of SDF for posterior primary teeth by both parents and children.ConclusionDental professionals were aware that SDF can be used for arresting carious lesions. They pointed out that the staining effect of carious lesions is a major disadvantage and had preconceived ideas that this could be a barrier for many parents. Participants considered the application process to be simple and non-invasive and requires a minimum level of child cooperation. Participants appreciated the potential of SDF in paediatric dentistry and suggested actions that could help overcome the barriers they highlighted.

Highlights

  • Despite evidence that Silver Diamine Fluoride (SDF) can be effective in managing carious lesions in primary teeth, the use of SDF in the UK remains limited

  • This paper presents the findings from a qualitative study undertaken with Dental professional (DP) to explore their views, including their perceived barriers and enablers, to the use of SDF for the management of dental carious lesions in the primary dentition

  • Some DPs interviewed during this study suggested that SDF would be more comfortable for the child due to the simple application process involved, whereas the Hall Technique (HT) can be uncomfortable when seating the crowns

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Summary

Introduction

Despite evidence that Silver Diamine Fluoride (SDF) can be effective in managing carious lesions in primary teeth, the use of SDF in the UK remains limited. Silver nitrate was first reported as effective in arresting carious lesions in the 1840s [5] and G.V Black described protocols for its use in the early 1900s [6]. This paved the way for another silver product; silver diamine fluoride (SDF) to be developed. Silver diamine fluoride was first explored as a treatment option for managing carious lesions in Japan in 1969 [7]. Fluoride can promote remineralisation by forming fluorohydroxyapatite with reduced solubility It can inhibit matrix metalloproteinases activities and dentine collagen degradation [10]

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