Background
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Therefore, the review question: “Is the technique for SDF application on primary dentition and it’s aesthetic outcome acceptable by parents?”
Methods
Registration
Search strategy
Eligibility criteria
Strength of reporting, quality assessment and risk of bias
Meta-analysis
Results
Search strategy results
Study characteristics
Reference | Site | Duration | Study design | Sample size | Children age | Methods/outcome definition/techniques | Groups | Results (parental acceptance) | P value | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Acceptable n (%) | Somewhat acceptable n (%) | Not sure/ neutral/ I don’t know n (%) | Somewhat unacceptable n (%) | Unacceptable n (%) | |||||||||
Kumar et al. (2019) [22] | Eight -community health centres affiliated with the NYU Langone Dental Medicine Pediatric Dentistry Residency Program that offers treatment for low SES | May–November 2017 | Cross- section | 546 caregivers | > 6 y | Questionnaire on parental perception of the black stain left by the SDF, and their level of comfort before their children received the SDF treatment (primary teeth) | Dark mark of SDF treatment: Patient < 6 y (n = 410) | 125 (30.5) | – | – | 191 (46.6) | 92 (22.4) | No comparison |
Comfort regarding SDF treatment: Patient < 6 y (n = 410) | 216 (52.7) | 125 (30.5) | 69 (16.8) | No comparison | |||||||||
Vollú et al. (2019) [26] | Pediatric Dental Clinic of UFRJ, Brazil | June 2016 and August 2017 | RCT | 67 children 34 | 2–5 y | Questionnaire on Parental aesthetic perception after two weeks of application by questions addressed to caregivers (primary molars) | Test group:(30% SDF) (n = 34) Control group: (atraumatic restorative treatment (ART) (n = 33). | 33 (97.1) 33 (100) | 1 (2.9) 0 | 0.51* | |||
Alshammari et al. (2019) [21] | Saudi Arabia | Not mentioned | Cross- section | 222 parents | Not mentioned | Before and after photos with questionnaire on parental SDF aesthetic acceptance (primary teeth photographs) | Anterior teeth | 0 (0) | 0 (0) | 0 (0) | 22 (9.9) | 200 (90.1) | P < 0.05** |
Posterior teeth | 0 (0) | 0 (0) | 7 (3.2) | 63 (28.4) | 152 (68.5) | ||||||||
Duangthip et al. (2018) [25] | 37 kindergartens in Hong Kong | Not mentioned | RCT | 888 parents | 3–4 y | Questionnaire regarding parental satisfaction with child’s dental appearance at baseline, 18, 30 months follow-up (primary teeth) | Application of 38% SDF annually: Baseline | 3 (1.4) | 98 (44.1) | 25 (11.3) | 91 (41.0) | 5 (2.3) | P > 0.05 |
18 months follow-up | 6 (2.9) | 131 (63.3) | 29 (14.0) | 35 (16.9) | 6 (2.9) | ||||||||
30 months follow-up after | 9 (4.5) | 134 (66.3) | 24 (11.9) | 32 (15.8) | 3 (1.59) | ||||||||
Application of 12% SDF annually: Baseline | 1 (0.5) | 79 (35.6) | 36 (16.2) | 98 (44.1) | 8 (3.6) 4 (1.9) | ||||||||
18 months follow-up | 15 (7.2) | 128 (61.8) | 22 (10.6) | 38 (18.4) | |||||||||
30 months follow-up | 8 (4.0) | 126 (63.6) | 21 (10.6) | 34 (17.2) | 9 (4.5) | ||||||||
Bagher et al. (2018) | King Abdulaziz University, Jeddah, Saudi Arabi | December 2017–February 2018 | Cross-section | 104 parents | ≤12 y | Before and after photos with questionnaire on parental preference (primary teeth) | Anterior primary teeth Posterior primary teeth | 17 (16.3) 33 (31.7) | 20 (19.2) 37 (35.6) | 5 (4.8) 6 (5.8) | 19 (18.3) 9 (8.7) | 43 (41.3) 19 (18.3) | P < 0.05** |
Cooperative Anterior teeth Posterior teeth Uncooperative: Anterior teeth Posterior teeth | 10 (12.3) 19 (23.4) 7 (30.4) 14 (60.9) | 13 (16) 0 (37) 7 (30.4) 7 (30.4) | 2 (2.5) 4 (3.8) 3 (13.0) 2 (8.7) | 17 (31) 9 (4.2) 2 (8.7) 0 (0) | 39 (48.1) 19 (32.4) 4 (17.4) 0 (0) | ||||||||
Crystal et al. (2017) [19] | NYU Pediatric Dental Clinic, New York, & private pediatric dentistry clinics, New Jersey, USA | Not mentioned | Cross-section | 120 parents | Not mentioned | Before and after treatment sets of photos then questionnaire to evaluate parents’ acceptance of the aesthetics (primary teeth photographs) | Anterior teeth Posterior teeth | 12*(10.17) 26 (21.67) | 23 (19.49) 55 (45.83) | - - | 29 (23.73) 13 (10.83) | 56 (46.61) 26 (21.67) | P < 0.001** |
Cooperative Anterior teeth Posterior teeth Uncooperative: Anterior teeth Posterior teeth | 36 (29.7) 81 (67.5) 72 (60.3) 82 (68.5) | - - - - | 48 (39.6) 38 (31.5) Not mentioned Not mentioned | ||||||||||
Clements et al. (2017) | Community dental clinic, Oregon, USA | Not mentioned | Clinical study | 30 parents | 2–5 y | Parent Acceptability Questionnaire for Silver Diamine Fluoride (SDF) Treatment (discoloration, easy application process, pain, taste) (primary teeth) | SDF application is an easy process I am comfortable with discoloration of cavities after SDF placement SDF application was pain free for my child The taste of SDF was acceptable to my child | 19 (63.3) 16 (53.3) 21 (70.0) 19 (63.3) | 8 (26.7) 10 (33.3) 7 (23.3) 7 (23.3) | 3 (10.0) 3 (10.0) 2 (6.7) 4 (13.3) | 0 1 (3.3) 0 0 | 0 0 0 0 | No comparison |
Belotti et al. (2016) [23] | Odontopediatrics clinic in the Federal University of the Espírito Santo, Brazil | Not mentioned | Clinical trial (CT) | 14 parents | 4–10 y | Photographs were taken before and after SDF treatment. Looking the photographs, parents respond a questionnaire to evaluate the aesthetics acceptability (primary molars) | Noticing aesthetic difference Negatively interferes with aesthetics | 9* (64.3) 0 (0) | 1 (7.1) - | 4 (28.6) 14 (100) | No comparison | ||
Zhi et al. (2012) [24] | kindergartens Guangzhou, Guangdong Province in southern China | 2007–2009 | RCT | 212 parents | Not mentioned | Questionnaire on parent aesthetic satisfaction at base line and after 24 months (primary teeth) | Gp1: annual application of SDF, Gp2: semi-annual application of SDF Gp3: annual application of glass ionomer | 95* (45%) of the parents were satisfied with the appearance of their child’s teeth at the 24-month evaluation | P > 0.05 | ||||
Triches et al. (2009) | UNIPAR’s (State University of Paraná, Brazil) Baby Clinic in the city of Cascavel, PR, Brazil | March–December 2007 | Case-control | 50 parents | 0–3 y | Questionnaire on parent aesthetic satisfaction and the effect of instructions about the procedure with post-treatment picture of primary teeth, while the other group showed only a post-treatment picture (primary teeth) | With instructions Without instructions | 2 (8) 7 (28) | 15 (60) 11 (44) | 5 (20) - | 1 (4) 6 (24) | 2 (8) 1 (4) | 0.08* |
Parental acceptance of SDF and meta-analysis
Tooth location (anterior vs. posterior)
Patient cooperation (cooperative vs. uncooperative)
Follow-up and concentration
Taste, and SDF application
Instruction lecture before application of SDF
Strength of reporting, quality assessment and risk of bias
Domain | Zhi et al. (2012) | Belotti et al. (2016) | Clements et al. (2017) | Duangthip et al. (2017) | Vollú et al.(2019) |
---|---|---|---|---|---|
Selection bias Random sequence generation | – | + | + | – | – |
Selection bias Allocation concealment | + | + | + | – | – |
Reporting bias Selective reporting | + | + | + | – | – |
Other bias Other sources of bias | + | + | + | – | – |
Performance bias Blinding (participants and personnel) | + | ? | + | – | + |
Detection bias Blinding (outcome assessment) | + | ? | + | ? | + |
Attrition bias Incomplete outcome data | + | ? | – | – | – |
Category of evidence and strength of recommendation of the included articles
Topic | Recommendation | Evidence Category | Recommendation Strength |
---|---|---|---|
Tooth location (anterior vs. posterior) | Parental preference of SDF in posterior teeth is higher than anterior teeth. | III*** | C^^^ |
Patient’s cooperation (cooperative vs. uncooperative) | Parental preference of SDF use in anterior teeth for non-cooperative children is higher than in cooperative children. | III*** | C^^^ |
Follow-up | Parental acceptance rate for SDF use increased with time. | Ib* | A^ |
Concentration | No difference in parental acceptance between 12 and 38% SDF concentrations. | Ib* | A^ |
Taste, appearance, application, and amount of discomfort | Most parents found the taste, appearance, application process, and amount of discomfort to their children acceptable. | IIa** | B^^ |
Instruction lecture before application of SDF^^^^ | The group that received an instruction lecture had a lower resistance to SDF treatment compared to the non-instruction group. | III*** | C^^^ |