Investigation on the use and effectiveness of Silver Diamino Fluoride through a research of opinion and a Randomized Controlled Trial

The objective of the present study was to investigate the knowledge, attitudes and practices of the dentists from Rio de Janeiro (RJ) concerning silver diamine fluoride (SDF) through an opinion survey; as well as its effectiveness in arresting dental caries lesions in primary molars of preschool children, through a randomized controlled clinical trial. A Google Forms questionnaire was sent to dentists (n=10,500) to determine the association between the use of SDF and the dentists' workplace, experience, specialty, among others. A logistic regression model was performed. Preschoolers with at least one active caries lesion on the occlusal surface of primary molars, without clinical and radiographic signs of pulp involvement or symptoms, were randomly assigned into the groups: test - SDF and control - atraumatic restorative treatment (ART). The decayed, missing and filled primary teeth (dmf-t) and International Caries Detection and Assessment System (ICDAS) indexes were followed for diagnosis and caries activity of the lesions. Clinical success was assessed after 3, 6 and 12 months of follow-up, to detect caries lesion arrestment. As secondary outcomes, the time of treatment, adverse events and aesthetic perception, the child's anxiety and the oral health-related quality of life (OHRQoL) were investigated. The validated Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS) was used to evaluate the OHRQoL. Specific statistical tests, including the Bootstrap analysis, were employed. From 409 respondents, 13.2% used SDF. Working at universities increased the chance of using SDF by 2.29 times (p=0.018), compared to a private office. Each training year, the chance of SDF usage increased by 3% (p=0.008). Pediatric dentists are more likely to use SDF (OR=6.76,p<0.001). The majority (75.9%) indicated SDF for noncompliant patients. The main barrier for non-users was a lack of knowledge (58.3%), while for users, tooth staining (90.7%) and parental acceptance (64.8%) were the complaints. For the clinical trial, 68 patients [3.62(1.07) years] were randomly allocated to the DFP (n=34) and ART (n=34) groups. The mean number of teeth treated per child was 2.42 (1.04) in the SDF group and 2.09(1.18) in the ART group (p=0.074). The mean of the arrested lesion difference between the groups was 0.04 (0.02) at 3 months; 0.06 (0.06) at 6 months and 0 (0.09) at 12 months. The lowest treatment time was observed in the SDF group (p<0.001), but there was no difference in the percentage of adverse effects and aesthetic perception (p=0.709), nor in the change of anxiety (p=0.155). There was a smaller impact on OHRQoL in the ART group, considering the family section (ES=0.86) and the parents' distress subscale (ES=0.83). SDF is not a common product used by dentists from RJ. It should be more widespread so that lack of scientific knowledge would cease to be a problem in the use of SDF in arresting dental caries. The time of treatment with SDF was smaller compared to that of the ART. However, it was similar to ART in terms of caries lesion arrestment, anxiety, adverse events and aesthetic perception, and quality of life.