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Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs

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Background: This manuscript presents evidence-based guidance on the use of 38 percent silver diamine fluoride (SDF) for dental caries management in children and adolescents, including those with special health care needs. A guideline workgroup formed by the American Academy of Pediatric Dentistry developed guidance and an evidence-based recommendation regarding the application of 38 percent SDF to arrest cavitated caries lesions in primary teeth. Types of studies reviewed: The basis of the guideline's recommendation is evidence from an existing systematic review "Clinical trials of silver diamine fluoride in arresting caries among children: A systematic review." (JDR Clin Transl Res 2016;1[3]:201-10). A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and gray literature databases to identify randomized controlled trials and systematic reviews reporting on the effect of silver diamine fluoride and address peripheral issues such as adverse effects and cost. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of the evidence and the evidence-to-decision framework was employed to formulate a recommendation. Results: The panel made a conditional recommendation regarding the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program. After taking into consideration the low cost of the treatment and the disease burden of caries, panel members were confident that the benefits of SDF application in the target populations outweigh its possible undesirable effects. Per GRADE, this is a conditional recommendation based on low-quality evidence. Conclusions and practical implications: The guideline intends to inform the clinical practices involving the application of 38 percent SDF to enhance dental caries management outcomes in children and adolescents, including those with special health care needs. These recommended practices are based upon the best available evidence to-date. A 38 percent SDF protocol is included in Appendix II.
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Keywords: ANTI-INFECTIVE AGENTS; CARIES; CARIOSTATIC AGENTS; CLINICAL RECOMMENDATIONS; GUIDELINE; SILVER COMPOUNDS; SILVER DIAMINE FLUORIDE; TOPICAL FLUORIDES

Document Type: Short Communication

Affiliations: 1: SDF workgroup chair, is a clinical associate professor of pediatric dentistry, at NYU College of Dentistry, New York, N.Y., USA; and a pediatric dentist in private practice, in New Yersey, N.J. and New York City, N.Y., USA 2: Pediatric dental fellow, Division of Pediatric Dentistry, at the University of Maryland Dental School, Baltimore, Md., USA 3: Instructor in developmental biology, at the Harvard School of Dental Medicine/Boston Children's Hospital, Boston, Mass., USA; a pediatric dentist in private practice, New London County, Conn.; a clinical assistant professor, Department of Pediatric Dentistry, at the University of Connecticut School of Dental Medicine, Farmington, Conn.; and a MSc graduate student, Postgraduate Programme in Evidenced-Based Health Care Studies, Nuffield Department of Primary Care Health Sciences, at the University of Oxford, Oxford, UK 4: Bawden Distinguished Professor, Department of Pediatric Dentistry School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, N.C., USA 5: Instructor, Developmental Biology, at the Harvard School of Dental Medicine and Boston Children's Hospital, Boston, Mass., USA 6: Associate professor, Departments of Pediatric Dentistry, UNC School of Dentistry and Epidemiology, Gillings School of Global Public Health, at the University of North Carolina-Chapel Hill, Chapel Hill, N.C., USA 7: Professor, Department of Cariology, Restorative Sciences, and Endodontics, at the University of Michigan School of Dentistry, Ann Arbor, Mich., USA 8: Senior evidence-based dentistry manager, at the American Academy of Pediatric Dentistry, Chicago, Ill., USA;, Email: [email protected]

Publication date: September 1, 2017

More about this publication?
  • Pediatric Dentistry is the official publication of the American Academy of Pediatric Dentistry, the American Board of Pediatric Dentistry and the College of Diplomates of the American Board of Pediatric Dentistry. It is published bi-monthly and is internationally recognized as the leading journal in the area of pediatric dentistry. The journal promotes the practice, education and research specifically related to the specialty of pediatric dentistry. This peer-reviewed journal features scientific articles, case reports and abstracts of current pediatric dental research.
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