Parental perspectives on the use of silver diamine fluoride therapy to arrest early childhood caries in kindergarten outreach dental services: A qualitative study

Abstract

Objectives: This study aimed to explore parental perspectives on an outreach dental service and silver diamine fluoride (SDF) therapy to arrest and prevent early childhood caries.

Methods: This qualitative study collaborated with an outreach service offering SDF therapy to kindergarten children and oral health education to the children's parents. The study was conducted in 2018 using purposive sampling of participating parents from selected kindergartens in Hong Kong until data saturation was reached. Five parents were recruited from each kindergarten for a focus-group discussion. The data were manually coded for thematic analysis.

Results: Ten focus-group discussions with 49 parents were held to achieve data saturation. The oral health education largely met the parents' expectations regarding enriching their child's oral health knowledge, raising their child's dental awareness, and promoting parent-assisted toothbrushing. Some parents did not consent to their children undergoing SDF therapy because it permanently stains caries black, which adversely affects appearance. They were also concerned about potential toxicity of SDF. Parents who did consent preferred the arrest and prevention of dental caries over aesthetics which are temporary until the primary teeth exfoliate.

Conclusions: This outreach dental service improved parental dental knowledge. Some parents were generally satisfied with the outreach dental services, preferred caries arrest over aesthetics, and accepted SDF therapy. However, some parents worried about SDF toxicity. The results of this study provide rich, in-depth, and multi-dimensional information about parents' experiences of taking the outreach dental service and their opinions about SDF therapy.

Clinical significance: Dentists can use the arguments from this study to form a protocol for communicating with parents before SDF therapy. This study shows that outreach dental services improve dental knowledge. Some parents prefer caries arrest over aesthetics and accept SDF therapy; however, some parents worry about SDF toxicity.

Keywords: Children; Dental caries; Dental services; Early childhood caries; Qualitative research; Silver diamine fluoride.