Postoperative instructions for silver diamine fluoride therapy: A scoping review of current evidence and practice.

OBJECTIVES: Silver diamine fluoride (SDF) has gained popularity in dentistry as an anti-hypersensitive and anti-caries agent. This study aims to review the postoperative instructions for SDF therapy and examine the evidence supporting these instructions in treating dentine hypersensitivity and caries control. DATA AND SOURCES: Two independent reviewers searched three electronic databases (EMBASE, PubMed, and Web of Science) to identify clinical studies that used SDF to treat dentine hypersensitivity and dental caries. Additionally, they searched Google Chrome for information from manufacturers, the department of health, national dental organisations, authoritative dental organisations, and universities regarding SDF therapy for these conditions. Data on postoperative instructions were extracted, and their impact on the treatment of dentine hypersensitivity and caries control was investigated. STUDY SELECTION: This review included 74 clinical studies, 11 sets of instructions from SDF manufacturers, and six recommendations from national dental organisations, departments of health and universities. Amongst the included records, 50 clinical studies, two manufacturers, and one department of health mentioned postoperative instructions for SDF therapy. The recommendations varied, from suggesting no specific instructions, immediate rinsing, refraining from eating or drinking for 30 to 60 min, and even avoiding brushing until the next day after SDF therapy. Notably, no clinical studies reported the effects of these postoperative instructions on the SDF treatment of dentine hypersensitivity or dental caries. CONCLUSIONS: This scoping review highlights the presence of inconsistent postoperative instructions for SDF therapy in the treatment of dentine hypersensitivity and caries control. Furthermore, there is a lack of evidence supporting the effectiveness of these instructions. CLINICAL SIGNIFICANCE: No evidence supports the postoperative instructions for SDF therapy for managing dentine hypersensitivity and dental caries. Studies are necessary to provide guidance for clinicians using SDF in their clinical practice.

Tools Evaluating Child Oral Health-Related Quality of Life.

OBJECTIVES: This study aimed to systemically review the tools developed for evaluating oral health-related quality of life (OHRQoL) in preschool children. METHODS: Two reviewers systematically searched English-language publications within PubMed, Embase, Scopus, and Web of Science. They screened the titles and abstracts and retrieved the full texts of the selected publications. Studies which developed, validated, or culturally adapted an OHRQoL tool used in preschool children were included. They recorded information regarding tool characteristics, item configuration, discriminative validation, the aim of assessment, and the target group. RESULTS: The study included 59 publications and identified 12 tools for assessing OHRQoL in preschool children. Seven tools were tailored for preschool ages. Most of the scales were generic oral health measures. Dental caries was the most commonly used oral condition for assessing a tool's discriminative validity. Eight tools required parental proxy reports. Three tools were both child-administrated and parent-administrated. One tool was designed to be answered solely by children. Ten tools assessed the oral health-related impact on children, including oral condition-related, functioning, environmental, and emotional/social domains. Four tools included items regarding the impact on both children and family. CONCLUSIONS: This review identified 12 tools developed for evaluating OHRQoL in preschool children, 7 of which were tailored for preschool age. The 12 tools were validated but incomprehensive due to the subjective and multidimensional nature of the OHRQoL concept. Researchers can choose a suitable tool for their studies by understanding the basic characteristics and item setting of the tools. Researchers can have an overview of the tools developed for evaluating OHRQoL in preschool children. They can use the findings from this review to choose a suitable tool for their studies regarding the OHRQoL in preschool children.

Dental Fear and Anxiety of Chinese Preschool Children in a School-Based Outreach Service Using Silver Diamine Fluoride for Caries Control: A Cross-Sectional Study.

Limited data are available regarding the patient-based outcomes of SDF therapy in the kindergarten setting. This study aims to evaluate the dental fear and anxiety (DFA) of preschool children after participating in a school-based outreach service using SDF to arrest early childhood caries (ECC). The study recruited 3- to 5-year-old children with untreated ECC. A trained dentist performed a dental examination and applied SDF therapy to the carious lesions. ECC experience was measured using the dmft index. Questionnaires for parents were used to collect the children's demographic information and their dental treatment experiences. The children's DFA before and immediately after SDF therapy was assessed using the self-reported Facial Image Scale (FIS) on a Likert scale of 1 (very happy) to 5 (very distressed). The association between the children's DFA after SDF therapy and the potentially related factors, including demographic background, caries experience, and DFA before SDF therapy, were analysed using bivariate analysis. Three hundred and forty children (187 boys, 55%) joined this study. Their mean (SD) age and dmft scores were 4.8 (0.9) and 4.6 (3.6), respectively. Most of them (269/340, 79%) never had a dental visit. After SDF therapy, 86% (294/340) of the children exhibited no or low DFA (FIS ≤ 3), whereas 14% (46/340) reported high DFA (FIS > 3). No factor was associated with children's DFA after SDF therapy (p > 0.05). This study showed most preschool children with ECC exhibited no or low DFA after SDF therapy in a school setting.

Principals' Perspectives on Joining a Kindergarten Outreach Dental Service: A Qualitative Study.

In this qualitative study, the researchers explored principals' perspectives on a free outreach dental service with silver diamine fluoride (SDF) therapy for children in kindergarten. Two researchers recruited kindergarten principals using purposive sampling. They conducted individual semi-structured interviews to collect the principals' perspectives regarding their adoption of and experience with the service. They manually transcribed the interview verbatim into text and followed a thematic approach for data analysis. The researchers interviewed eight principals. The principals identified the prevalent caries status and importance of oral health promotion for kindergarten children. They acknowledged that the service enhanced dental knowledge, fostered oral hygiene practice and improved children's oral health. To adopt this service, they needed to ensure adequate capacity to perform the service. They had no concern with staining by SDF because the parents were informed and consented to the SDF therapy. They appreciated the free service provided by a professional team managed by a reputable university. In conclusion, the principals were generally satisfied with the outreach dental service. They realised the necessity of oral health promotion. They found that parents accepted the SDF therapy although the SDF stained their children's carious teeth. They needed support from their teachers and the children's parents to run the service.

Parental perspectives on the use of silver diamine fluoride therapy to arrest early childhood caries in kindergarten outreach dental services: A qualitative study.

OBJECTIVES: This study aimed to explore parental perspectives on an outreach dental service and silver diamine fluoride (SDF) therapy to arrest and prevent early childhood caries. METHODS: This qualitative study collaborated with an outreach service offering SDF therapy to kindergarten children and oral health education to the children's parents. The study was conducted in 2018 using purposive sampling of participating parents from selected kindergartens in Hong Kong until data saturation was reached. Five parents were recruited from each kindergarten for a focus-group discussion. The data were manually coded for thematic analysis. RESULTS: Ten focus-group discussions with 49 parents were held to achieve data saturation. The oral health education largely met the parents' expectations regarding enriching their child's oral health knowledge, raising their child's dental awareness, and promoting parent-assisted toothbrushing. Some parents did not consent to their children undergoing SDF therapy because it permanently stains caries black, which adversely affects appearance. They were also concerned about potential toxicity of SDF. Parents who did consent preferred the arrest and prevention of dental caries over aesthetics which are temporary until the primary teeth exfoliate. CONCLUSIONS: This outreach dental service improved parental dental knowledge. Some parents were generally satisfied with the outreach dental services, preferred caries arrest over aesthetics, and accepted SDF therapy. However, some parents worried about SDF toxicity. The results of this study provide rich, in-depth, and multi-dimensional information about parents' experiences of taking the outreach dental service and their opinions about SDF therapy. CLINICAL SIGNIFICANCE: Dentists can use the arguments from this study to form a protocol for communicating with parents before SDF therapy. This study shows that outreach dental services improve dental knowledge. Some parents prefer caries arrest over aesthetics and accept SDF therapy; however, some parents worry about SDF toxicity.

Knowledge, Practices and Attitudes towards Silver Diamine Fluoride Therapy among Dentists in Japan: A Mixed Methods Study.

In 2021, the World Health Organization included silver diamine fluoride (SDF) as an essential medicine to manage caries in adults and children. SDF was developed in the 1960s, but its use for children became unpopular in Japan because of the decline and low prevalence of early childhood caries. This mixed methods study explored the knowledge, practices and attitudes towards SDF therapy among dentists promoting fluoride use in Japan. It also investigated senior dentists' perceptions of SDF therapy in Japan. The quantitative study invited all 173 members of the largest organisation promoting fluoride use in Japan to complete a web-based questionnaire survey. Sixty (60/173; 35%) dentists promoting fluoride use in Japan completed the questionnaire survey. All dentists knew of SDF treatment, and 50 (50/60; 83%) used SDF for dental care. Fifty-nine dentists (59/60; 98%) agreed that SDF therapy was simple and quick. All 60 dentists agreed that SDF was effective to arrest caries; 51 dentists (51/60; 85%) agreed that SDF was effective to prevent caries. Most dentists (51/60; 85%) were concerned about SDF's unaesthetic staining. Fifty-seven dentists (57/60; 95%) used SDF to arrest primary posterior teeth, and 52 dentists (52/60; 87%) used SDF to arrest root caries. However, 25 dentists (25/60; 42%) did not use SDF to prevent caries in permanent teeth. The qualitative study interviewed 12 senior dentists using snowball sampling and achieved data saturation. The dentists opined that SDF therapy was effective, simple, painless, non-invasive and inexpensive. SDF is seldom used in Japan at present because of the unaesthetic black staining and the low prevalence of early childhood caries; however, it can regain popularity by arresting root caries in the aging population.

A Concise Review on Qualitative Research in Dentistry.

Qualitative research collects non-numerical data that explores human behaviour, attitudes, beliefs and personality characteristics unamendable to quantitative research. The qualitative research questions are open-ended, evolving and non-directional. The study design is flexible and iterative. Purposive sampling is commonly used. The sample size is determined by theoretical saturation. Data collection is generally through in-depth interviews, focus groups and observations. Qualitative research commonly uses thematic analysis and framework analysis, although there is no consensus on analysing qualitative data. The reporting format can be comprehensive, a summary, developmental or selective, subject to the research question. Qualitative research's potential functions are to describe the form or nature of what exists (contextual), to examine the reasons for or associations between what exists (explanatory), to appraise the effectiveness of what exists (evaluative), and to aid the development of strategies (generative). Qualitative research can be time consuming to conduct because it explores evolving questions; difficult to generalise because it recruits limited participants; and arduous when it comes to making systematic comparisons because responses are subjective. However, qualitative research can provide depth and detail, create openness, simulate people's individual experiences and avoid pre-judgements. This concise review provides an overview and suggestions for dental researchers when conducting a qualitative study.

A Kindergarten-Based Oral Health Preventive Approach for Hong Kong Preschool Children.

Early childhood caries (ECC) remains the single most common chronic childhood disease. Untreated caries can cause tooth loss and compromised dentition. Severe ECC can also influence nutrition intake, cognitive development, general health and quality of life. In Hong Kong, approximately half of 5-year-old children suffer from ECC, and more than 90% of these caries remain untreated. Thus, the development of effective strategies for promoting the oral health of preschool children is warranted. The Faculty of Dentistry of the University of Hong Kong has provided kindergarten-based dental outreach services to selected kindergartens since 2008. In 2020, the project expanded to serve all kindergarten children in Hong Kong. The aim of the service is to improve oral health through the prevention and control of ECC among preschool children. The service provides dental screening and silver diamine fluoride treatment for ECC management. In addition, the parents receive oral health talks, and teachers receive training in delivering regular oral health education at kindergarten. The objectives of this service are to improve oral and general health of preschool children, develop the children's good oral health-related behaviours, maintain the children's psychological well-being and reduce the burden on their family. This paper describes this kindergarten-based dental outreach service.