Parents' Views on Silver Diamine Fluoride to Manage Early Childhood Caries

The use of silver diamine fluoride (SDF) as a nonsurgical caries management product is growing. Evidence suggests that SDF is very successful in arresting caries. However, a common concern with SDF treatment is the unaesthetic black staining. The purpose of this qualitative study was to determine parents' views following their children's treatment with SDF to manage severe early childhood caries (ECC).

Parents were interviewed as part of a mixed-method study of SDF to arrest severe ECC. Children with caries lesions in primary teeth were treated with 2 applications of 38% SDF, followed by fluoride varnish. Semistructured in-person and phone interviews were conducted with 19 parents of children in the study. Data were transcribed verbatim and manually coded and uploaded to NVivo 12 for further coding analysis.

None of the parents had previously heard about SDF, and they learned about it from the study dentist. Although parents trusted the dentist's information on SDF, they welcomed additional evidence, especially relating to product safety and effectiveness. Some parents were minimally concerned with the black staining caused by SDF treatment. It was more important that SDF arrested caries progression, minimized pain and sensitivity, and prevented dental infection. However, some parents expressed concerns related to the unaesthetic black staining. Interestingly, many parents indicated that their children were not overly concerned with the black staining. A majority of parents said that they would recommend the treatment to others.

This is the first qualitative study involving parents of children who were treated with SDF. Most parents were accepting of SDF as a nonsurgical treatment to arrest caries and minimize dentinal sensitivity secondary to caries, although some expressed concern about the black staining in anterior teeth. It is important to adequately inform parents of the negative aesthetic consequences and obtain informed consent before treatment.

This qualitative study revealed that many parents of children with severe ECC are accepting of SDF as a nonrestorative caries management option, despite the black staining of caries lesions. Dental professionals need to be aware of these parental concerns and obtain written informed consent prior to treatment. Parents also requested more information and resources on SDF on its benefits, effectiveness, and any associated risks.