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Cited by 243Dental Health and Care UtilizationDental Anxiety and Anesthesia TechniquesDental materials and restorations

Parental perceptions and acceptance of silver diamine fluoride staining

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Crystal, Yasmi O., Janal, Malvin N., Hamilton, Dylan S., Niederman, Richard·2017·The Journal of the American Dental Association
DOI 10.1016/j.adaj.2017.03.013PMC PMC6771934
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Abstract

Background The caries arrest that can be achieved by using silver diamine fluoride (SDF) offers a minimally invasive and inexpensive alternative to traditional restorative caries treatment. The authors evaluated how the dentinal staining that is associated with SDF influences the acceptance of this treatment among parents of young children in the New York City metropolitan area.Methods The authors invited the parents of children who had experienced dental caries and who had appointments at the New York University Pediatric Dentistry Clinic and at several private clinics in New Jersey to participate in a Web-based survey designed to assess parents' demographics, perceptions of photographs of SDF-treated carious teeth, and acceptability of treatment in different behavior management scenarios.Results Ninety-eight mothers and 22 fathers from diverse backgrounds participated. Most parents (67.5%) judged SDF staining on the posterior teeth to be esthetically tolerable, but only 29.7% of parents made this same judgment about anterior teeth (P < .001). In the absence of their child having behavioral barriers to conventional restorations, 53.6% of parents reported that they were likely to choose SDF to treat their child's posterior teeth, but only 26.9% of parents were likely to choose SDF to treat their child's anterior teeth. As the number of children's behavioral barriers increased, so did the parents' level of acceptance. In extreme cases, in which parents had to decide whether their children should undergo general anesthesia during treatment, parents' acceptance rate of SDF as a treatment method increased to 68.5% on posterior teeth and to 60.3% on anterior teeth. Parents' acceptance of the treatment also varied according to their socioeconomic status.Conclusions Staining on posterior teeth was more acceptable than staining on anterior teeth. Although staining on anterior teeth was undesirable, most parents preferred this option to advanced behavioral techniques such as sedation or general anesthesia.Practical implications Clinicians need to understand parental sensitivities regarding the staining effect of SDF to plan adequately for the use of SDF as a method of caries management in pediatric patients.

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  • A significant drawback of silver diamine fluoride is the enduring black discoloration of carious lesions.

    “Although SDF exhibits considerable clinical efficacy, a significant drawback is the enduring black discoloration of carious lesions.”

    From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [11]

    The Practical Implications section says SDF causes dark staining of carious enamel and dentin that may significantly deter its use; the Discussion also documents parents’ esthetic concerns. The passages support staining as a drawback, but do not establish that the discoloration is enduring or specifically black. (LLM, conf=0.84)

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  • Parental concerns about silver diamine fluoride's aesthetic effects, inconsistencies in clinician training, and limited long-term data on novel bioactive materials hinder widespread implementation of minimally invasive dentistry.

    “Parental concerns about SDF’s aesthetic effects (e.g., irreversible black staining), inconsistencies in clinician training, and limited long-term data on novel bioactive materials hinder widespread implementation [11,12].”

    From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [11]

    The Practical Implications section says SDF staining may deter its use, and the Discussion reports that some parents found the treatment unacceptable on aesthetic grounds. The paper does not establish that inconsistent clinician training or limited long-term data on novel bioactive materials hinder implementation. (LLM, conf=0.88)

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  • In a survey, 56% of parents harbored reservations regarding the use of silver diamine fluoride, especially in relation to anterior teeth.

    “A survey investigating parental acceptance of silver diamine fluoride indicated that 56% of parents harbored reservations regarding its use, especially in relation to anterior teeth [11].”

    From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [11]

    The Results report lower parental acceptance of SDF staining on anterior than posterior teeth, supporting the claim that reservations were especially pronounced for anterior teeth. But the paper does not report that 56% of parents had reservations; its reported percentages vary by tooth location and treatment circumstances. (LLM, conf=0.86)

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2 of the 21 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [2]Niederman R, Feres M, Ogunbodede E. Dentistry In: Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN, eds. Essential Surgery. Washington, DC: World Bank; 2015: 173– 195. Disease Control Priorities; vol. 1, 3rd ed.

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Authors
Crystal, Y. O., Janal, M. N., Hamilton, D. S., & Niederman, R.
Affiliations
New York University (US)
Corresponding author
Crystal, Yasmi O.
ORCID
Venue
The Journal of the American Dental Association
Publisher
Elsevier BV
Published
2017-07
Volume
148
Issue
7
Pages
510-518.e4
ISSN
0002-8177 (ISSN-L)
DOI
10.1016/j.adaj.2017.03.013
PMC
PMC6771934
OpenAlex
W2609520143
Cited by
243
References
21
Citations by year
2026: 14 · 2025: 20 · 2024: 30 · 2023: 27 · 2022: 35 · 2021: 39 · 2020: 41 · 2019: 15 · 2018: 19 · 2017: 3
FWCI
29.43
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Journal of the American Dental Association (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • York University
  • Rural Development Administration
  • National Institutes of Health (UL1TR001445)
  • National Center for Advancing Translational Sciences
  • National Institute on Minority Health and Health Disparities (U24 006964, U24MD006964, R01MD011526)
Topics
  • Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
  • Health Sciences › Dentistry › Oral Surgery › Dental Anxiety and Anesthesia Techniques
  • Health Sciences › Dentistry › Orthodontics › Dental materials and restorations
Keywords
silver diamine fluoride, parental acceptance, dental caries in children, caries arrest, behavior management, general anesthesia, sedation, socioeconomic status
MeSH terms
Adult, Quaternary Ammonium Compounds, Cariostatic Agents, Dental Caries, Female, Fluorides, Topical, Humans, Male, Middle Aged, New York City, Parents, Surveys and Questionnaires, Tooth Discoloration, Tooth, Deciduous, Silver Compounds

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