Self-reported oral health-related quality of life and caries experiences of 5-year-old children in Mandalay, Myanmar.

BACKGROUND: This study aimed to examine the impact of dental caries and other potential socio-demographic factors on the oral health-related quality of life (OHRQoL) of preschool children from Myanmar. This was done using the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) as reported by both the children and their parents. METHODS: A structured questionnaire was conducted to collect demographic information about the children and their caregivers, as well as socioeconomic data. The OHRQoL was assessed by interviewing the children and their parents using the Myanmar versions of SOHO-5c and SOHO-5p, respectively. Caries experience was assessed by two calibrated examiners and recorded using the dmft index. The Poisson regression model was adopted to investigate the association between OHRQoL and dental caries including socioeconomic factors. RESULTS: A total of 454 pairs participated in the study. Among them, 64% of children and 70% of parents reported a negative impact on OHRQoL (with SOHO-5c and SOHO-5p scores exceeding 0). The mean score (SD) of the child self-report and parental version of the SOHO-5 was 1.86 (2.27) and 2.65 (3.13), respectively. Difficulties in eating and sleeping were the most commonly reported by both children and parents. The overall prevalence of dental caries was 87% (mean dmft score:5.59, SD:4.65). The final multivariate-adjusted model revealed that children with higher caries experiences were more likely to have lower OHRQoL for both child self-report (RR 4.38, 95% CI 3.16-6.14, p < 0.001) and parental report (RR 6.07, 95% CI 4.38-8.41, p < 0.001), respectively. A lower family income had a negative impact on the children's OHRQoL in child self-report (RR 1.59, 95% CI 1.26-2.04, p < 0.001) and parental report (RR 1.46, 95% CI 1.19-1.78, p < 0.001). CONCLUSION: Two-thirds of the study children and their parents perceived the negative impact on children's OHRQoL. Higher caries experience and lower family income were associated with poorer OHRQoL of 5-year-old Myanmar children.

Quality of the adaptation procedures and psychometric properties of the scale of oral health outcomes for 5-year-old children (SOHO-5): a systematic review.

PURPOSE: The aim of this study was to assess the quality of the cross-cultural adaptations and psychometric properties of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). METHODS: A systematic search was performed in three databases, PubMed, SCOPUS, and Dentistry and Oral Science Source (EBSCO). Studies relating to the cross-cultural adaptation and psychometric properties of SOHO-5 were included. The quality of cross-cultural adaptation was assessed in five aspects including translation, synthesis, back-translation, expert committee review, and pretesting. The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist was used to assess the psychometric properties in seven domains including responsiveness, internal consistency, reliability, measurement error, and structural, construct, and cross-cultural validity. RESULTS: The search identified 162 papers for screening; from these, 107 articles and 9 systematic reviews were excluded. 21 full papers were retrieved and 6 studies that met the inclusion criteria were included. Out of six, two reported all five aspects of cross-cultural adaptation procedures. Regarding the psychometric properties, none of the studies evaluated all aspects of psychometric properties. Almost all of the studies reported internal consistency (Cronbach's alpha ranging from 0.71 to 0.90), test-retest reliability (Intraclass Correlation Coefficient 0.46-0.98), and construct validity. None reported the cross-cultural validity and responsiveness of the measures. CONCLUSION: While these studies provided satisfactory results regarding the validity and reliability of SOHO-5, the majority of the included studies did not report all domains of the cross-cultural adaptations and psychometric properties. Overall, the quality of the cross-cultural adaptations and psychometric properties of the included studies is doubtful. Future research should follow the guidelines to assess all aspects of psychometric properties and adaptation procedures in cross-cultural settings.

Psychometric properties of the Thai version of the Scale of Oral Health Outcomes for 5-year-old children.

BACKGROUND: As caries prevalence in Thai preschool children is very high and its consequences have scarcely been evaluated, the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) is considered as an appropriate tool to measure the children's oral health-related quality of life (OHRQoL). AIM: To translate the SOHO-5 into Thai (Th-SOHO-5) and assess its psychometric characteristics. DESIGN: The cross-cultural adaptation of the SOHO-5 into Thai comprised forward-backward translation by experts and face validation by 20 child-parent dyads. To evaluate psychometric properties of the final version, a cross-sectional study was conducted on 306 child-parent pairs using an interview mode for children and a self-administered mode for parents. A trained investigator examined children's caries status. RESULTS: The Th-SOHO-5 showed satisfactory psychometric characteristics. Cronbach's alpha values were above 0.8 for both child and proxy reports. Overall intraclass correlation coefficients were > 0.9. Factor analysis supported a single-factor structure model of the Th-SOHO-5 and showed an excellent fit. Th-SOHO-5 scores were correlated with all global rating scales of oral health and well-being. Children with higher caries experience or caries with pulpal involvement demonstrated significantly higher Th-SOHO-5 scores. CONCLUSION: The Th-SOHO-5 possessed good reliability and validity. It can be used to evaluate the OHRQoL of preschool children in Thailand.

Tooth wear among five-year-old children in Jakarta, Indonesia.

BACKGROUND: This study aimed to evaluate the prevalence of tooth wear among preschool children in Jakarta, Indonesia, and examine the risk factors associated with its occurrence. METHODS: An epidemiological survey was conducted with a cross-sectional study design. The participants were recruited via cluster sampling. Tooth wear was clinically assessed by one examiner using the Basic Erosive Wear Examination (BEWE) criteria. The children's caries experience was also recorded. The parents of the participating children completed a self-administered questionnaire to answer demographic questions about the children and gather information about the children's diet and oral health behaviors as well as the parents' dental health-related knowledge. The data were analyzed using the Chi-square test and binary logistic regression. RESULTS: A total of 752 five-year-old children were invited to participate, with 691 (92%) enrolling in the study. Tooth wear occurred in 23% (161/691, BEWE > 0) of the participants, in which 78% (125/161) had at least one moderate tooth wear status (BEWE = 2). The consumption of citrus drinks, fruit juice, and vitamin C supplement drinks, together with the child's caries experience, the father's education level, and the family's socioeconomic status, were significantly associated with tooth wear. CONCLUSIONS: The five-year-old preschool children in Jakarta had a relatively low prevalence of tooth wear. Those consuming more acidic drinks, those with a higher socioeconomic status, and those with an absence of caries experience had a higher risk of tooth wear.

Attitude toward and awareness of medical-dental collaboration among medical and dental students in a university in Indonesia.

BACKGROUND: Medical-dental collaboration expands patients' access to health services, improves healthcare outcomes, and reduces the burden and cost of care, especially for those with chronic diseases. The aim of the present study is to investigate the attitude toward and awareness of medical-dental collaboration among medical and dental students attending the Universitas Indonesia. METHODS: All medical and dental students at the Universitas Indonesia were invited to participate in a web-based questionnaire survey that contained eight questions on attitudes toward medical-dental collaboration and two questions regarding awareness of dental-medical collaborative practices. The demographic backgrounds of all participants were obtained. The chi-square test and logistic regression analysis were employed for data analysis. RESULTS: A total of 1,432 questionnaires were distributed, and 1,137 (79%) were appropriately completed. In general, 992 (87%) students had a positive attitude toward medical-dental collaboration. Dental students had a more positive attitude than medical students (odds ratio [OR] = 2.694; p = 0.001), and senior students had a more positive attitude than junior students (OR = 2.271; p = 0.001). Most students (86%) were aware of medical-dental collaboration at the Universitas Indonesia and reported that emergency medicine, surgery, and otolaryngology were the three most common medical disciplines that entailed medical-dental collaboration. CONCLUSIONS: In general, the medical and dental students demonstrated positive attitudes and awareness of medical-dental collaboration at the Universitas Indonesia. Positive attitude and awareness can establish an essential foundation for fostering collaboration between medicine and dentistry, which is vital to improve resource efficiency and healthcare standards.

Erosive tooth wear among preschool children in Hong Kong.

OBJECTIVE: This study aimed to assess the prevalence of erosive tooth wear among 3- to 5-year-old children in Hong Kong and to determine the effect of socio-economic factors, dental habits, and oral hygiene on their dental erosive wear status. METHODS: Stratified random sampling was adopted. Their parents were asked to complete a questionnaire regarding their children's backgrounds. A single examiner evaluated the children for erosive tooth wear using Basic Erosive Wear Examination (BEWE) criteria. Multiple logistic regression was used to determine the relationship between erosive wear and the children's socio-economic factors, dental habits, and oral hygiene. RESULTS: 1204 children participated in this study. Prevalence of erosive tooth wear (BEWE score > 0) was 14.9%. Among these, 153 children (12.8%) had initial wear, 21 children (1.8%) had distinct tooth loss, and five (0.4%) had severe erosive wear. Prevalence of erosive wear among the 3-, 4-, and 5-year-old children was 10.7%, 15.0%, and 17.7%, respectively. Increasing age, the low education of mother and high plaque scores were risk factors of erosive wear (P < 0.05). CONCLUSION: Prevalence of erosive tooth wear is low among preschool children in Hong Kong. The erosive tooth wear prevalence increased with increasing age, lower education of mother, and poorer oral hygiene.

Risk Factors of Early Childhood Caries among Young Children in Hong Kong: A Cross-Sectional Study.

OBJECTIVE: Early childhood caries (ECC) was prevalent in Hong Kong. Children with ECC risk should be identified early for prevention. This study aimed to identify common risk factors of ECC in Hong Kong 3-year-old children. STUDY DESIGN: Sample size calculation showed at least 6,321 of 3-year-old children should be invited in this study. A consent form and a questionnaire enquiring the children's oral health behaviours and social-economic background were distributed to their parents. Children with parental consent were examined by a trained dentist. Caries status was recorded in dmft index. Chi-square test and logistic regression analysis were performed to identify the risk factors of ECC. RESULTS: A total of 5,167 children from the 6,331 children invited were examined. Among them, 1,130 children (22%) had ECC (dmft>0). Logistic regression analysis found age of starting tooth brushing, snack-intake frequency, dental visit experience, birthplace, family monthly income, primary caretaker, and mother's education level were factors associated with ECC of the children. CONCLUSIONS: Children who started tooth brushing later, had higher snack-intake frequency, were not born in Hong Kong, and whose family monthly income was lower, mother's education level was lower, primary caretaker was not domestic helper, had a statistically significant higher chance of having ECC.

The longevity of posterior restorations in primary teeth.

Data sourcesSciVerse Scopus, ISIS Web of Science, Cochrane library, Medline/PubMed. Studies published from 1996 to 2017 in English were considered.Study selectionTwo independent reviewers screened the literature. Randomised clinical trials, non-randomised clinical trials with parallel groups or single group, retrospective studies) evaluating different posterior restorations (class I, class II restorations and crowns) with different materials (amalgam, compomer, composite, glass ionomer cement, stainless steel crown) placed in primary teeth by reporting different outcomes measures (survival rate, success rate, annual failure rate).Data extraction and synthesisTwo independent reviewers extracted data. Risk of bias was assessed using the Cochrane tool. A qualitative analysis was conducted.ResultsThirty-one studies were included. Seven different materials were used for restorations: amalgam (six studies), compomer (nine studies), composite (six studies), conventional glass ionomer cement (five studies), metal-reinforced glass ionomer cement (MRGIC) (four studies), resin-modified glass ionomer cement (ten studies), and stainless steel crown (SSC) (three studies). When considering the annual failure rate (AFR), composite showed the lowest (1.7-12.9%) and MRGIC showed the highest (10.0-29.9%). For the success rate, SSC presented the highest (96.1%) and MRGIC presented the lowest (57.4%). Class I restorations and restorations placed under the use of rubber dam revealed better results in both AFR and success rate. The main reason for failure was secondary caries.ConclusionsThere is a large variation in longevity of posterior restorations in primary teeth. Secondary caries is the main reason causing failure.

Dental caries status and its associated factors among 5-year-old Hong Kong children: a cross-sectional study.

BACKGROUND: This study investigated dental caries status and its associated factors among 5-year-old children in Hong Kong. METHOD: This cross-sectional survey was conducted in 2016. It comprised a questionnaire survey and a clinical examination. Kindergarten children aged 5 were recruited using a multistage sampling method. Parents of the participating children were asked about their children's demographic information, sugary snacking behaviours, and oral health-related behaviours and about their own oral health knowledge. One trained dentist performed oral examinations on the children. Caries experience was measured using the dmft index. The relationships between the dmft scores and background information, sugary snacking behaviours, oral health-related behaviours and parental dental knowledge were studied using a zero-inflated negative binomial (ZINB) regression analysis. RESULTS: A total of 570 children were invited to participate, and 501 completed the oral examination (response rate: 88%). The prevalence of dental caries was 55%, and the mean dmft score was 2.7 ± 3.7. Decayed teeth (dt) constituted 93% of caries experience. ZINB analysis found that children who visited a dentist, who were taken care of primarily by grandparents and whose parental dental knowledge levels were moderate had higher dmft scores. Children who ate sugary snacks more than twice daily, had irregular dental attendance and lived in low-income families had a significantly higher chance of having dental caries. CONCLUSIONS: Dental caries was prevalent among 5-year-old Hong Kong children, and most of the decayed teeth were untreated. The caries prevalence of the children was related to their frequency of sugary snack intake, dental attendance and socio-economic background.

Caries remineralisation and arresting effect in children by professionally applied fluoride treatment - a systematic review.

BACKGROUND: As a low-cost and easily operated treatment, the use of professionally applied topical fluoride was approved for preventing dental caries and remineralising early enamel caries or white spot lesions. It is also used to arrest dentine caries. The aim of this study is to investigate the clinical efficacy of professional fluoride therapy in remineralising and arresting caries in children. METHOD: A systematic search of publications from 1948 to 2014 was conducted using four databases: PubMed, Cochrane Library, ISI Web of Science and Embase. The key words used were (fluoride) AND (remineralisation OR remineralization OR arresting) AND (children caries OR early childhood caries). The title and abstract of initially identified publications were screened. Clinical trials about home-use fluorides, laboratory studies, case reports, reviews, non-English articles and irrelevant studies were excluded. The full texts of the remaining papers were retrieved. Manual screening was conducted on the bibliographies of the remaining papers to identify relevant articles. RESULTS: A total of 2177 papers were found, and 17 randomised clinical trials were included in this review. Ten studies investigated the remineralising effect on early enamel caries using silicon tetrafluoride, fluoride gel, silver diamine fluoride or sodium fluoride. Seven studies reported an arresting effect on dentine caries using silver diamine fluoride or nano-silver fluoride. Meta-analysis was performed on four papers using 5 % sodium fluoride varnish to remineralise early enamel caries, and the overall percentage of remineralised enamel caries was 63.6 % (95 % CI: 36.0 % - 91.2 %; p < 0.001). Meta-analysis was also performed on five papers using 38 % silver diamine fluoride to arrest dentine caries and the overall proportion of arrested dentine caries was 65.9 % (95 % CI: 41.2 % - 90.7 %; p < 0.001). CONCLUSION: Professionally applied 5 % sodium fluoride varnish can remineralise early enamel caries and 38 % silver diamine fluoride is effective in arresting dentine caries.

Early childhood caries and its associated factors among 5-years-old Myanmar children.

Introduction: Children's oral health plays a crucial role in their overall well-being and there is a significant gap in our understanding of early childhood caries (ECC) in Myanmar. This study aims to bridge this knowledge deficit by investigating the prevalence, causes, and potential interventions for ECC in the Myanmar population, providing crucial insights for future dental health policies and practices. Methods: Generally healthy 5-year-old kindergarten children from 7 districts in city were recruited. ECC was assessed through clinical examinations using decayed, missed, filled teeth (dmft). Additionally, demographic data of the children and their caregivers, along with information about the children's oral health-related behaviors, were gathered using a structured questionnaire. Results: Out of the 496 children, the overall prevalence of dental caries was 87.1% (mean dmft score: 5.57, SD: 4.6). Caries experience was categorized as severe (45.8%) and non-severe (41.3%). Decayed teeth constituted the major component of the dmft index (97.8%). Multiple logistic regression analysis revealed two significant factors associated with ECC prevalence: late toothbrushing initiation (OR: 2.54, p = 0.001) and dental visit experience (OR: 2.46, p = 0.010). Discussion: The study highlights the alarming ECC prevalence in 5-year-old children in Mandalay, Myanmar, with mostly untreated decayed teeth. The findings emphasize early preventive oral health measures for young children to reduce ECC burden in Myanmar.

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.

Knowledge, Attitudes, and Practices towards Silver Diamine Fluoride among Dentists in Vietnam.

Silver diamine fluoride (SDF) is a topical solution used for managing dental caries. The mixed-methods study consists of a quantitative study (questionnaire survey) and a qualitative study (in-depth interview) to explore the knowledge, attitudes, and practices towards SDF among dentists in Vietnam. A descriptive approach and a thematic approach were performed to analyze data, respectively. The questionnaire survey invited 436 licensed dentists registered for the national annual dental meeting and 226 dentists participated (response rate: 52%). Among them, 174 (77%, 174/226) dentists knew SDF, and 69 (40%, 69/174) dentists used SDF for caries management. Most of them considered SDF therapy as non-invasive (84%, 146/174) and simple (80%, 140/174). However, most of them expressed concern that SDF could discolor the tooth (74%, 128/174). Their most preferred teeth for SDF therapy were primary posterior teeth (92%, 160/174). The in-depth interview consulted 16 dentists to reach data saturation. They learned about SDF from outside curriculum resources as an effective anti-caries agent. They understood the advantages (simple, non-invasive, timesaving) and disadvantages (tooth discoloring, ammonia odor) of SDF. They used SDF to arrest caries in uncooperative children in the clinic and people living in rural areas in outreach services. Most dentists in Vietnam are supportive of SDF therapy, and they know its advantages and disadvantages for caries management. The results addressed the aim of the study to investigate Vietnamese dentists' perspectives towards SDF.

A pilot study on the global practice of informed consent in paediatric dentistry.

Background: Conducting oral treatment early in the disease course, is encouraged for better health outcomes. Obtaining informed consent is an essential part of medical practice, protecting the legal rights of patients and guiding the ethical practice of medicine. In practice, consent means different things in different contexts. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) is becoming popular and cost effective methods to manage carious lesions, however, cause black discolouration of lesions treated. Obtaining informed consent and assent is crucial for any dental treatment-and has specific relevance with SDF/ SF treatments. Methods: The aim of this paper is to describe informed consent regulations for dental care in a selection of countries, focusing on children and patients with special health care needs. An online survey was shared with a convenience sample of dental professionals from 13 countries. The information was explored and the processes of consent were compared. Results: Findings suggest that there are variations in terms of informed consent for medical practice. In Tanzania, South Africa, India, Kenya, Malaysia and Brazil age is the determining factor for competence and the ability to give self-consent. In other countries, other factors are considered alongside age. For example, in Singapore, the United Kingdom, and the United States the principle of Gillick Competence is applied. Many countries' laws and regulations do not specify when a dentist may overrule general consent to act in the "best interest" of the patient. Conclusion: It is recommended that it is clarified globally when a dentist may act in the "best interest" of the patient, and that guidance is produced to indicate what constitutes a dental emergency. The insights gathered provide insights on international practice of obtaining informed consent and to identify areas for change, to more efficient and ethical treatment for children and patients with special needs. A larger follow up study is recommended to include more or all countries.

Antibiofilm and mechanical properties of silver nanowire-modified glass ionomer cement.

BACKGROUND: Glass ionomer cement (GIC) is a commonly used restorative material in dentistry, but GIC does not have significant antibiofilm effects and its mechanical strength is limited. OBJECTIVE: To investigate the antibiofilm and mechanical properties of a newly developed silver nanowire (AgNW) modified GIC. METHODS: GICs were modified with different nanosilver formulations including 0.05%wt AgNW, 0.5%wt AgNW, 0.05%wt silver nanoparticle (AgNP) and 0.5%wt AgNP. Biofilms of Streptococcus mutans were cultured for 72 h on GIC specimens. Scanning electron microscopy (SEM) was conducted to observe the accumulation and morphology of Streptococcus mutans on the material surfaces. Another set of biofilm/specimens was treated with SYTO-9 and the biofilm development was evaluated by quantifying the visible stain with an inverted fluorescence microscope. The compressive strength of the specimens was assessed according to ISO 9917-1:2007. The colour of GICs was compared using the VITA Easyshade system. RESULTS: SEM images showed that fewer biofilms were accumulated on nanosilver-modified GICs. The Streptococcus mutans quantity was significantly lower in all nanosilver-modified groups compared to conventional GIC (p<0.0001). GIC modified with 0.5% AgNP showed slightly lower compressive strength than the negative control (58.3 ± 12.9 MPa vs 78.3 ± 13.8 MPa); but there is no significant difference between all study groups. The colour change between AgNW-modified GIC and conventional GIC was significantly lower than that between AgNP-modified GIC and conventional GIC. CONCLUSION: AgNW-modified GIC showed superior antibiofilm effect and comparable compressive strength to conventional GIC. In addition, the complement of AgNW would not influence the colour stability of GIC as much as AgNP. CLINICAL SIGNIFICANCE: This study developed a novel AgNW-modified GIC material. It showed good antibiofilm and mechanical properties and would not influence the colour stability of GIC. The AgNW-modified GIC has a large potential for clinical use and biomedical application.

Cross-cultural adaptation and psychometric properties of the Myanmar version of the scale of oral health outcomes for 5-year-old children.

OBJECTIVE: The aim of this study was to cross-culturally adapt the child's self-report and parental report of the scale of oral health outcomes for 5-year-old children (SOHO-5) for use in Myanmar (Burmese-speaking) population and to assess the reliability and validity of the Myanmar version. MATERIALS AND METHODS: The forward-backward translation method was used to develop the Myanmar SOHO-5 version and the final questionnaires were tested on 173 five years old children and their parents for reliability and validity. A single dentist examined the caries experience of the children (Kappa:0.90). The structural validity was assessed through confirmatory factor analysis. The internal consistency and test-retest reliability (1-2 weeks) were evaluated using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. The association between SOHO-5 scores and additional global rating questions for child oral health status (convergent validity) and the differences between the total SOHO-5 score of children with caries and children without caries (discriminant validity) were investigated. RESULTS: A confirmatory factor analysis indicated a good fit for the one-factor structure of the SOHO-5. Cronbach's alpha coefficient values for internal consistency were 0.82 for the children's report and 0.79 for the parental report. The ICCs were 0.90 and 0.89 for the total scores of the children and parental versions in the test-retest reliability analysis. The total SOHO-5 scores for both reports were significantly associated with the global rating questions except for the 'impact on children's general health' question in the parental report. Furthermore, the Myanmar version discriminated between the children with and without caries experiences (p < 0.001). CONCLUSION: This study provided evidence that both children and parental reports of the Myanmar SOHO-5 version have good reliability and validity to assess the OHRQoL of 5-year-old children in a Burmese-speaking population.

Caries Prevention Using Silver Diamine Fluoride: A 12-Month Clinical Trial.

OBJECTIVE: This clinical trial aimed to compare the caries-preventive effect of annual application of 38% silver diamine fluoride solution (SDF) with 5% sodium fluoride varnish (FV) to the anterior primary teeth of children. The hypothesis was that SDF was superior to FV at 1 year. Secondary objectives were to determine the child's cooperation and the parent's satisfaction and assess adverse effects. METHOD: We recruited 688 3- to 4-year-old children and randomly allocated them to receive SDF or FV (positive control) on their 6 upper anterior teeth. Tooth-surface status was recorded using the decayed, missing, and filled surfaces index. A trained observer rated the child's cooperation as "totally cooperative" or "not totally cooperative." We used a questionnaire to determine the parent's satisfaction as "satisfied," "neutral," or "dissatisfied." Adverse effects (yes/no) were evaluated 1 day and about 1 year after treatment. RESULTS: Of the children, 434 (SDF, n = 209; FV, n = 225) completed the trial. The mean new decayed tooth surfaces developed for SDF and FV groups were 0.4 ± 1.5 and 0.4 ± 1.3, respectively (P = .65). Child's cooperation for SDF and FV therapy was 71% (244/344) and 70% (241/344), respectively (P = .89). Parent's satisfaction for SDF and FV therapy was 71% (148/209) and 69% (155/225), respectively (P = .29). Adverse effects were found neither at 1 day nor at about 1 year after treatment for either treatment arm. CONCLUSIONS: SDF is not superior to FV for caries prevention in primary upper anterior teeth at 1-year follow-up. Child's cooperation and parent's satisfaction were similarly high with SDF and FV therapy at 1-year follow-up. Neither short-term nor long-term adverse effects were observed. This study is registered at ClinicalTrials.gov (NCT04399369).

Effectiveness of Silver Diamine Fluoride for Preventing Occlusal Caries in the Primary Teeth of Preschool Children: Protocol for a Randomized Controlled Trial.

BACKGROUND: Tooth decay is a significant public health problem globally. The caries-arrest effectiveness of 38% silver diamine fluoride (SDF) has been well documented. However, information on the caries-preventive effect of SDF on primary teeth is insufficient. OBJECTIVE: The aim of this trial is to investigate the effectiveness of semiannual application of 38% SDF and that of 5% sodium fluoride (NaF) varnish when compared with placebo control for preventing occlusal caries in the primary molars of preschool children over 30 months. METHODS: This 3-arm, parallel design, double-blind, randomized controlled trial involves 791 preschool children. Children are randomly allocated to receive 1 of 3 interventions as follows: Group 1, 38% SDF; Group 2, 5% NaF varnish; and Group 3, placebo control (tonic water). The intervention and dental examination will be carried out every 6 months. A parent-administered questionnaire, including the children's demographic background and oral health-related behaviors, has been collected at baseline. Follow-up examinations to detect new caries development will be conducted every 6 months by a masked examiner. Caries development will be diagnosed at the cavitation level. Chi-square tests and logistic regression analyses will be adopted. A 2-level logistic regression analysis will be performed to investigate the effects of the study interventions and other potential confounding factors on the development of occlusal caries. RESULTS: This study was started on September 1, 2020, and the recruitment process ended on September 30, 2021. At present, a total of 791 children are participating in the study. This 30-month clinical trial is expected to be completed in March 2024. CONCLUSIONS: If SDF application is more effective than NaF varnish for preventing caries on occlusal surfaces of primary teeth, it can be a preferred choice for caries prevention in a kindergarten-based program. Results of this trial will provide valuable clinical evidence for the development of oral health strategies and policies on the promotion of child oral health. TRIAL REGISTRATION: HKU Clinical Registry HKUCTR-2844, https://tinyurl.com/bdhz9yuk; ClinicalTrials.gov NCT05084001, https://clinicaltrials.gov/ct2/show/NCT05084001. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35145.