A multi-site service evaluation of silver diamine fluoride use for children

Timms, L., Bux, S., Maybin, L. et al. (2023). A multi-site service evaluation of silver diamine fluoride use for children. Br Dent J 235, 269–272


Silver diamine fluoride (SDF) is relatively new to the UK. During the covid-19 pandemic, the introduction of SDF into standard operating procedures helped to increase its use. It is used mostly for caries arrest in paediatric dental services as represented in this project. The main side effect of SDF is the black discolouration of carious tooth tissue; however, the majority of parents and children find the technique and the discolouration acceptable.

The research aimed:

  • To establish how SDF is being used across different paediatric dental settings in the UK.
  • To consider parental and patient views on the treatment experience and the side effect of discolouration.


A multi-site service evaluation carried out across six paediatric dentistry units covering hospital and community services. Data were collected between from 17th February 2022 to 2nd March 2022, at various time periods across the units. Children were asked to rate their satisfaction with aesthetics and treatment experience, using a five-point scale of ‘very happy’ to ‘very sad’ faces. Parents were also asked on a numbered scale of 1-5 from ‘very dissatisfied’ to ‘very satisfied’. Simple descriptive statistics were used to analyse the data.


Data was collected for 54 patients. This included patients in the age range of 2-13 years, with a mean of 4.9 years. The reason SDF was chosen was reported as: to avoid general anaesthetic (n = 25); to avoid extractions (n = 8); stabilisation (n = 25); acclimatisation (n = 24); and insufficient cooperation for other treatment (n = 17).

In total, 42 cases had SDF applied to the primary dentition. For 18 patients, this was in the anterior dentition and for 15 patients in the posterior dentition, with 9 patients having SDF applied both anteriorly and posteriorly.

In the patient’s follow-up appointment, whether or not the caries had arrested was reported. There was follow up data for 22 patients related to the success of treatment, in which 14 patients reported arrested caries, 4 had partial arrest and 3 had successful arrest of some teeth but not others.

Data from the first treatment visit with regards to the child’s experience:

  • 44.7% found the procedure ‘very easy’
  • 17.0% found it ‘easy’
  • 17.0% reported that they ‘didn’t mind’
  • 19.1% reported ‘unhappy’
  • 2.1% reported ‘very unhappy’

Children were asked to report their view on the aesthetics of the treatment at the first visit, as shown in Figure 1.

Figure 1. Pie chart demonstrating child satisfaction with aesthetics following SDF treatment at visit one.

The parents were also asked to report their view on the aesthetics of the treatment at the first visit, which are shown in Figure 2.

Figure 2: Pie chart demonstrating parental satisfaction with aesthetics immediately following SDF treatment.


In the services involved in this multi-site service evaluation, SDF is used for young patients in the primary dentition for the purpose of caries arrest. The majority of patients and parents were accepting of the discolouration side effect and the treatment experience.

Research Summary Written By: Ruhi Shah, University of Manchester – BDS3

Leave a Reply

Your email address will not be published. Required fields are marked *