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- Title
The Effectiveness of Silver Diamine Fluoride and Fluoride Varnish in Arresting Caries in Young Children and Associated Oral Health-Related Quality of Life.
- Authors
Sihra, Rena; Schroth, Robert J.; Bertone, Mary F.; Martin, Heather; Patterson, Brayden; Mittermuller, Betty-Ann; Lee, Victor; Moffatt, Michael E. K.; Klus, Bradley; Fontana, Margherita; Robertson, Lawrence
- Abstract
Objective: To investigate the efficacy of silver diamine fluoride (SDF) with 5% fluoride varnish (FV) in treating cavitated caries in young children and to explore the association between SDF treatment and oral-health-related quality of life (OHRQoL). Methods: Children with active dentinal caries in primary teeth underwent treatment with 38% SDF and 5% FV at baseline and 4 months later. Treated lesions were assessed 4 and 8 months after baseline. Child-level analysis focused on classifying SDF treatment as completely successful if all of a child's treated lesions were arrested or incompletely successful if at least 1 lesion was not arrested. The Early Childhood Oral Health Impact Scale questionnaire was completed at second and third visits. Statistical analyses included descriptive and bivariate methods. A p value ≤ 0.05 was considered significant. Results: This pilot study enrolled 40 children with 239 caries lesions; mean age 40.2 ± 14.9 months and 45% male. Lesion arrest rates after 1 and 2 applications of SDF were 74.1% and 96.2%, respectively. Children who reportedly brushed twice daily were more likely to be in the completely successful group compared with those who brushed less (p = 0.006). Those in the completely successful group had a significantly lower mean baseline dmft score than those in the incompletely successful group (p = 0.048). No significant difference in OHRQoL was observed between the 2 groups. Conclusions: SDF with 5% FV is an effective approach to the management of early childhood caries; more than 1 application is recommended, along with regular follow up of patients and twice daily brushing. OHRQoL was not found to be affected by the level of success of SDF treatment. A common oral problem affecting the pediatric population is early childhood caries (ECC), which is defined as the presence of 1 or more decayed, missing, or filled primary teeth in children < 6 years of age.1 ECC poses treatment challenges for very young children, who are unable to cooperate in the delivery of conventional dental treatment in community-based clinical settings.2 Consequently, many children with ECC must be treated under general anesthesia. Manitoba has some of the highest rates of day surgery to treat ECC in Canada, especially in certain northern and inner-city communities.3,4 Unfortunately, although the surgical approach to managing ECC is often needed, it does not address underlying risk factors for caries. In fact, studies have found relapse rates ranging from 22% to 58.5% after treatment for ECC under general anesthesia.5,6 As a result, many children treated for ECC in this manner require repeat general anesthesia, an undesirable outcome given the risks and costs associated with this treatment modality.7 Silver diamine fluoride (SDF) represents a minimally invasive approach to the management of ECC as an alternative to surgical intervention.8 Although SDF has been successfully used in other countries for decades, it was not approved for use in Canada until 2017.9,10 To the best of our knowledge, there are no published studies investigating the use of SDF in the Canadian population, particularly in toddlers and preschool children. Although several systematic reviews support the efficacy of SDF, they all indicate that further research and clinical trials are needed to establish protocols for optimal case selection and its use.11-14 To our knowledge, only 1 other study has investigated the relation between oral-health-related quality of life (OHRQoL) and SDF treatment of ECC.15 This is an important concept to explore, as it may provide valuable insight into how children and parents perceive the effects of this treatment and how it might affect children's OHRQoL. In addition, such insight may aid in clinical decision-making regarding which patients may benefit from SDF treatment and which patients may be more appropriately managed with conventional surgical treatment. The aim of our study was twofold: to investigate the feasibility and efficacy of SDF in treating cavitated caries in young children and to explore the association between SDF treatment and OHRQoL.
- Subjects
MANITOBA; CANADA; QUALITY of life; FLUORIDE varnishes; TREATMENT effectiveness; DECIDUOUS teeth; DENTAL care
- Publication
Journal of the Canadian Dental Association, 2020, Vol 86, p1
- ISSN
0709-8936
- Publication type
Article