Parental perceptions and acceptance of silver diamine fluoride staining

Abstract

Background: The caries arrest that can be achieved by using silver diamine fluoride (SDF) offers a minimally invasive and inexpensive alternative to traditional restorative caries treatment. The authors evaluated how the dentinal staining that is associated with SDF influences the acceptance of this treatment among parents of young children in the New York City metropolitan area.

Methods: The authors invited the parents of children who had experienced dental caries and who had appointments at the New York University Pediatric Dentistry Clinic and at several private clinics in New Jersey to participate in a Web-based survey designed to assess parents' demographics, perceptions of photographs of SDF-treated carious teeth, and acceptability of treatment in different behavior management scenarios.

Results: Ninety-eight mothers and 22 fathers from diverse backgrounds participated. Most parents (67.5%) judged SDF staining on the posterior teeth to be esthetically tolerable, but only 29.7% of parents made this same judgment about anterior teeth (P < .001). In the absence of their child having behavioral barriers to conventional restorations, 53.6% of parents reported that they were likely to choose SDF to treat their child's posterior teeth, but only 26.9% of parents were likely to choose SDF to treat their child's anterior teeth. As the number of children's behavioral barriers increased, so did the parents' level of acceptance. In extreme cases, in which parents had to decide whether their children should undergo general anesthesia during treatment, parents' acceptance rate of SDF as a treatment method increased to 68.5% on posterior teeth and to 60.3% on anterior teeth. Parents' acceptance of the treatment also varied according to their socioeconomic status.

Conclusions: Staining on posterior teeth was more acceptable than staining on anterior teeth. Although staining on anterior teeth was undesirable, most parents preferred this option to advanced behavioral techniques such as sedation or general anesthesia.

Practical implications: Clinicians need to understand parental sensitivities regarding the staining effect of SDF to plan adequately for the use of SDF as a method of caries management in pediatric patients.

Keywords: Caries arrest; dental esthetics; parental perceptions; silver diamine fluoride.

Figure 1.

Percentage of acceptability on the basis of staining only.

Figure 2.

Acceptance according to behavior for treatment. In the rating scale, a score of 1 indicated “unacceptable” and 4 indicated “acceptable.” Error bars indicated 95% confidence intervals. GA: General anesthesia.

Figure 3.

Acceptance of treatment according to level of education. In the rating scale, a score of 1 indicated “unacceptable” and 4 indicated “acceptable.” Error bars indicated 95% confidence intervals.

Figure 4.

Acceptance of treatment according to level of income. In the rating scale, a score of 1 indicated “unacceptable” and 4 indicated “acceptable.” Error bars indicated 95% confidence intervals.

Figure 5.

Effects of education on treatment acceptance. In the rating scale, a score of 1 indicated “unacceptable” and 4 indicated “acceptable.” Error bars indicated 95% confidence intervals. GA: General anesthesia.

Figure 6.

Effects of ethnicity on treatment acceptance. In the rating scale, a score of 1 indicated “unacceptable” and 4 indicated “acceptable.” Error bars indicated 95% confidence intervals. GA: General anesthesia.

eFigure 1.

Posterior teeth before (left) and after (right) treatment.

eFigure 2.

Anterior teeth before (left) and after (right) treatment.

eFigure 3.

Anterior and posterior teeth before (left) and after (right) treatment.

eFigure 4.

Anterior teeth before (left) and after (right) treatment.

eFigure 5.

Posterior teeth before (left) and after (right) treatment.