Parental Expressed Concerns about Silver Diamine Fluoride (SDF) Treatment

Background: The staining associated with its caries arrest may be a deterrent for the use of Silver Diamine Fluoride (SDF). This study aims to elucidate the concerns that inform parents' perceptions and acceptance of SDF as a treatment option for their child. Study Design: We analyzed qualitative data obtained through an investigation in which parents attending a pediatric dental appointment participated in a survey, which included an open-ended question to evaluate their opinions about SDF staining. Thematic analysis of the comments, offered by the subsample of participants who replied to this question (n=43), yielded insights about perception of SDF therapy. Results: Most parents who provided comments were mothers (83.7%), college graduates (72.1%), primarily white (48.8%) or Hispanic (27.9%). Six themes emerged from the thematic analysis of the parents' responses: Esthetic Concerns, Psychosocial Concerns, SDF Treatment Process, Risks and Side Effects, Situational Benefits, and Dental Treatment Process. While many of the parents' comments are related to appearance, other topics that merit consideration when discussing SDF treatment were mentioned. Conclusions: Although parents are concerned about the esthetic impact of SDF, they understand the risks of alternative treatments and welcome information that will allow them to make an informed decision. Location of the cavities and visibility of the staining appear to heavily influence the decision to accept or reject this therapy.

Silver Diamine Fluoride; Esthetics

1. Gao SS, Zhao IS, Hiraishi N, et al. Clinical Trials of Silver Diamine Fluoride in Arresting Caries among Children: A Systematic Review. JDR Clin Trans Res;1(3):201–210.2016.

2. Chibinski AC, Wambier LM, Feltrin J, Loguercio AD, Wambier DS, Reis A. Silver Diamine Fluoride Has Efficacy in Controlling Caries Progression in Primary Teeth: A Systematic Review and Meta-Analysis. Caries Res;51(5):527-41. 2017.

3. Llodra JC, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res; 84(8):721-4.2005.

4. Chu CH, Lo ECM, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. J Dent Res;81(11):767-70. 2002.

5. Fung MHT, Duangthip D, Wong MCM, Lo ECM, Chu CH. Arresting Dentine Caries with Different Concentration and Periodicity of Silver Diamine Fluoride. JDR Clin Trans Res;1(2):143-52. 2016.

6. Crystal YO, Marghalani AA, Ureles SD, et al. Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs. Pediatr Dent;39(5):135- 45. 2017.

7. Crystal YO, Niederman R. Silver Diamine Fluoride Treatment Considerations in Children’s Caries Management. Pediatr Dent;38(7):466-71. 2016.

8. Nelson T, Scott JM, Crystal YO, Berg JH, Milgrom P. Silver Diamine Fluoride in Pediatric Dentistry Training Programs: Survey of Graduate Program Directors. Pediatr Dent;38(3):212-7. 2016.

9. Crystal YO, Janal MN, Hamilton DS, Niederman R. Parental perceptions and acceptance of silver diamine fluoride staining. J Am Dent Assoc; 148(7):510-518. 2017.

10. Braun V, Clarke V. Using Thematic Analysis in Psychology. Qualitative Research in Psychology;3:77-101. 2006.

11. Raveis VH, Stone PW, Pogorzelska-Maziarz M. Applying a Qualitative Approach to Examine the Implementation of Mandatory Health Practice Change within Healthcare Institutions. SAGE Research Methods Cases. 2017.

12. Patton MQ. Qualitative Research & Evaluation Methods: Integrating Theory and Practice. Fourth Edition ed. Sage Publications Inc. Saint Paul, MN; 2015.

13. Sale JEM, Amin M, Carrasco-Labra A, et al. A practical approach to evidence-based dentistry: VIII: How to appraise an article based on a qualitative study. J Am Dent Assoc;146(8):623-30. 2015.

14. Barry MJ, Edgman-Levitan S. Shared decision making— the pinnacle of patient-centered care. N Engl J Med;366(9):780-1. 2012.

15. Sujak SL, Abdul Kadir R, Dom TN. Esthetic perception and psychosocial impact of developmental enamel defects among Malaysian adolescents. J Oral Sci;46(4):221-6. 2004.

16. Lalumandier JA, Rozier RG. Parents’ satisfaction with children’s tooth color: fluorosis as a contributing factor. J Am Dent Assoc;129(7):1000-6. 1998.

17. Shulman JD, Maupome G, Clark DC, Levy SM. Perceptions of desirable tooth color among parents, dentists and children. J Am Dent Assoc;135(5):595-604. 2004.

18. Woo D, Sheller B, Williams B, Mancl L, Grembowski D. Dentists’ and parents’ perceptions of health, esthetics, and treatment of maxillary primary incisors. Pediatr Dent;27(1):19-23. 2005.

19. Kavand G, Broffitt B, Levy SM, Warren JJ. Comparison of dental esthetic perceptions of young adolescents and their parents. J Public Health Dent;72(2):164-71. 2012.

20. Pani SC, Saffan AA, AlHobail S, Bin Salem F, AlFuraih A, AlTamimi M. Esthetic Concerns and Acceptability of Treatment Modalities in Primary Teeth: A Comparison between Children and Their Parents. Int J Dent:3163904. 2016. 21. Goncalves BM, Dias LF, Pereira CDS, et al. Impact of Dental Trauma and Esthetic Impairment on the Quality of Life of Preschool Children. Rev Paul Pediatr; 35(4):448-455. 2017.

22. Featherstone JD. Dental caries: a dynamic disease process. Aust Dent J;53(3):286-91. 2008.

23. Berkowitz RJ, Amante A, Kopycka-Kedzierawski DT, Billings RJ, Feng C. Dental caries recurrence following clinical treatment for severe early childhood caries. Pediatr Dent;33(7):510-14. 2011.

24. Ramos-Gomez FJ, Crystal YO, Domejean S, Featherstone JDB. Minimal intervention dentistry: part 3. Paediatric dental care–prevention and management protocols using caries risk assessment for infants and young children. Br Dent J;213(10):501-08. 2012.

25. ADA Council on Scientific Affairs. Professionally applied topical fluoride: evidence-based clinical recommendations. J Am Dent Assoc;137(8):1151-9. 2006.

26. Deery C. Silver lining for caries cloud? Evid Based Dent;10(3):68. 2009.

27. Olsen EA, Brambrink AM. Anesthesia for the young child undergoing ambulatory procedures: current concerns regarding harm to the developing brain. Curr Opin Anaesthesiol;26(6):677-84. 2013.

28. Patel M, McTigue DJ, Thikkurissy S, Fields HW. Parental Attitudes Toward Advanced Behavior Guidance Techniques Used in Pediatric Dentistry. Pediatr Dent;38(1):30-6. 2016.

29. Reid KI. Informed Consent in Dentistry. J Law Med Ethics;45(1):77-94. 2017.

30. Main BG, Adair SRL. The changing face of informed consent. Br Dent J;219(7):325-7. 2015.

31. Dillman DA, Smyth JD, Christian LM. Internet, Phone, Mail, and Mixed-Mode Surveys: The Tailored Design Method, 4th Edition ed. Hoboken, NJ: John Wiley & Sons; 2014.