Parental Acceptance of Silver Diammine Fluoride for Managing Early Childhood Caries: A Mixed Method Study

Purpose: To explore parents' perceptions, acceptance and concerns regarding the use of silver diammine fluordie (SDF) to manage early childhood caries (ECC). Methods: The authors conducted interviews with 39 parents whose children had participated in a randomized clinical trial using SDF to manage ECC. A mixed-methods design was employed: thematic analysis for open-ended responses and descriptive analysis for closed-ended questions. Results: Parental acceptance of SDF was strongly linked to trust in the dentist (100%), its painless application (97.4%), absence of anesthesia, needles or drilling (92.3%), and its ability to reduce pain (97.4%). Most parents appreciated the fast treatment (89.7%) and limited alternatives during the pandemic (89.7%). Nearly all participants (94.9%) reported they would choose SDF again, with higher acceptance for posterior teeth (87.2% vs. 69.2% for anterior teeth). Additionally, 74.4% preferred SDF over restorations. Thematic analysis highlighted 4 key areas: (1) acceptance of SDF, (2) pain and comfort, (3) reactions to color change and (4) concerns and uncertainties. Conclusions: Parents valued SDF as a safe, effective and non-invasive option for managing ECC, particularly given its ability to avoid drilling, needles and anesthesia. However, esthetic concerns about staining underscored the need for clear provider-parent communication and ongoing education about treatment limitations and the importance of follow-up applications for successful caries arrest.