Feasibility and Acceptability of School-based Program using Silver Diamine Fluoride

Objectives: The aim of the study was to describe the feasibility, safety and acceptability of a school-based intervention program using silver diamine fluoride (SDF) therapy for caries arrest in preschool children.
Methods: A large-scale school-based intervention program using SDF for caries management was implemented in preschool children in Hong Kong. The project was conducted from September 2017 to July 2018. Written parental consent was obtained. This program consisted of four steps: 1) identify children who had dentine caries with visual inspection and then submit the individual oral health report to their parents, 2) provide the annual application of SDF for caries arrest, 3) promote oral health by providing fluoridated toothpaste to children, 4) evaluate the process in term of participation rates, side effects, kindergarten teachers’ satisfaction.

Results: Forty one part-time dentists were recruited to provide dental treatment to 26,679 children aged 3-5 years old from 137 kindergartens. Among these, 25,751 (97%) parents gave written consent for dental examination and 22,970 (86%) allowed their children to be treated with SDF. All participating children received toothpaste as a souvenir. On the examination day, 1,498 children (6%) missed school and 181 (1%) were uncooperative, thus 24,072 children received the dental examination. Among these, 8,690 (36%) children had untreated dentine caries, and 8,061 (93%) received SDF therapy. No major adverse effect was found. After participation, 114 (85%) kindergartens returned a self-completed program evaluation questionnaire. Nearly all kindergarten teachers (99%) were satisfied or very satisfied towards the program.

Conclusions: A school-based program using SDF therapy for caries arrest is safe and feasible to be implemented in preschool children. High parental acceptability and high level of teachers’ satisfaction are observed during project implementation.