Perspectives of children, parents and dentists on silver diamine fluoride therapy

Abstract

The global burden of dental caries presents a significant public health concern, affecting individuals across all age groups. Silver Diamine Fluoride (SDF) therapy, a non-invasive, effective, and affordable treatment, has shown promise for managing dental caries. However, its acceptance and application vary among different demographics and regions. This thesis investigated the perspectives of key stakeholders including children, parents, and dentists on SDF therapy, aiming to understand the factors influencing its acceptance and application. Assessing the impact of SDF therapy on children’s Oral Health-Related Quality of Life (OHRQoL) is a critical aspect of understanding its overall effectiveness and acceptance. A scoping review was conducted to assess existing tools developed for evaluating OHRQoL in preschool children. The review identified 12 tools, with none deemed comprehensive given the subjective and multidimensional nature of OHRQoL. The Chinese Early Childhood Oral Health Impact Scale (C-ECOHIS) was adapted in a 12-month observational study to examine the OHRQoL among Hong Kong young children receiving SDF therapy. The focus was on the change in OHRQoL among 3 to 4-year-old children participating in a kindergarten-based oral health promotion project who had caries in their upper anterior teeth. The C-ECOHIS score at baseline and 12-month examination were 4.6±5.5 and 5.0±5.6, respectively (p=0.42). The study found no significant change in OHRQoL after SDF therapy, despite tooth discoloration. However, more parents became dissatisfied with their child's dental esthetics. A qualitative study was conducted to explore parental perspectives on an outreach dental service and SDF therapy to arrest and prevent Early Childhood Caries (ECC). Parents participating in the outreach dental service were purposively sampled for focus group discussions. The data obtained was manually coded for thematic analysis. Overall, parents expressed satisfaction with the outreach dental services and acceptance of SDF therapy. However, there were concerns about SDF toxicity among some parents. Dentists' utilization of SDF varies across regions. Three studies conducted in three selected regions (Japan, Vietnam, and Hong Kong) in exploring the local dentists’ knowledge, attitude and practice towards SDF therapy were included in the thesis. The mixed-method research approach was employed, combining of quantitative (questionnaire survey) and qualitative (in-depth interview) research. The results revealed varied perspectives and adoption levels of SDF therapy. Dentists in Japan acknowledged the benefits and limitations of SDF therapy. The therapy was deemed effective, simple, painless, non-invasive, and inexpensive. Despite its limited current use due to aesthetic concerns and low ECC prevalence, the potential for SDF therapy in arresting root caries in an aging population was recognized. In Vietnam, while most of dentists were familiar with and supportive of SDF therapy, its adoption remains limited. The challenges lie in patient communication, professional awareness, and logistical issues related to procurement and distribution, especially in underserved areas. In Hong Kong, dentists recognized the merits and limitations of SDF therapy. They considered the therapy particularly useful for caries control in children, the elderly, and those with disabilities, and viewed it as cost-effective for community dental care.