Silver Diamine Fluoride in Oral Health Policy: A Strategic Pathway to Improve Access and Equity

To examine the potential role of silver diamine fluoride (SDF) as a public health intervention and propose a practical policy framework for its equitable integration into oral healthcare systems.

A policy-oriented narrative synthesis of current evidence was undertaken, drawing on systematic reviews, clinical trials, economic evaluations, professional guidance, and implementation literature. Evidence was considered across clinical, workforce, economic, regulatory, and equity domains to identify barriers to SDF uptake and the policy actions required for effective implementation.

SDF is an effective, minimally invasive, and comparatively low-cost intervention for arresting active carious lesions. Its simple application, limited equipment requirements, and suitability for community-based delivery make it particularly relevant for children, older adults, people with special healthcare needs, and populations facing financial, geographic, or physical barriers to conventional dental care. However, broader implementation remains constrained by regulatory ambiguity, limited reimbursement and procurement pathways, workforce training gaps, aesthetic concerns, inconsistent consent and follow-up processes, and fragmented governance. A six-pillar framework is proposed, encompassing financing and procurement; regulatory clarity and professional scope; workforce training; patient communication, consent, and program monitoring; research and evaluation; and governance and intersectoral collaboration.

The principal challenge to wider SDF integration is no longer the absence of supporting evidence but persistent policy and health-system barriers. Incorporating SDF into oral health policy, alongside appropriate clinical protocols, referral pathways, financing, workforce preparation, and monitoring, could expand access to minimally invasive care and support more equitable, accessible, and sustainable oral health systems.