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Parental perceptions and acceptance of silver diamine fluoride staining
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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]
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Okuji, D. M., Dinh, Y., McClure, T., & Lee, M. (2023) · medRxiv · doi:10.1101/2023.12.15.23300046
Cömert, H., & Ölmez, A. (2024) · Research Square · doi:10.21203/rs.3.rs-4095015/v1
Navaneethan, P., Mohammed, I. P., Shenoy, R. P., Junaid, J., Amanna, S., Alsughier, Z., & Kolarkodi, S. H. (2024) · JMIR Research Protocols · doi:10.2196/51087
Metadata
- Authors
- Crystal, Y. O., Janal, M. N., Hamilton, D. S., & Niederman, R.
- Affiliations
- New York University (US)
- Corresponding author
- Crystal, Yasmi O.
- 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)
- 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
- bronze
- doi.org
- 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 › General Dentistry › Dental Health and Care Utilization
- Health Sciences › Dentistry › Oral Surgery › Dental Anxiety and Anesthesia Techniques
- Health Sciences › Dentistry › General Dentistry › 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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