# Silver diamine fluoride for the management of dental caries in children in primary dental care: protocol for a feasibility study

## TL;DR

This study explores whether a non-invasive treatment for childhood tooth decay, called silver diamine fluoride, can be effectively tested in UK dental care.

## Contribution

The study investigates the feasibility of conducting a randomized trial on silver diamine fluoride in UK primary dental care.

## Key findings

- The study will assess the feasibility of a randomized trial comparing silver diamine fluoride to usual care for managing dental caries in children.
- It will explore acceptability, implementation, and barriers to using silver diamine fluoride in UK dental settings.
- The research includes a process evaluation to inform future implementation strategies.

## Abstract

Dental caries remains a significant problem in England, affecting 11% of 3-year-olds and 23% of 5-year-olds. While current approaches have been extensively investigated, their ability to (1) control pain and infection; (2) prevent hospital admissions, and (3) be implemented within the National Health Service (NHS) contractual arrangements, remains unsatisfactory. Silver diamine fluoride (SDF) is an alternative, non-invasive approach that has proven efficacy in arresting caries progression in primary teeth, principally from studies conducted outside of Europe. Its use in primary dental care in the UK is limited, despite the acknowledged need.

The clinical and cost-effectiveness of SDF has not been compared to usual care in the UK. Before a pragmatic randomised controlled trial (RCT) can be conducted to compare SDF to usual care for caries management in young children, there are several uncertainties that require investigation. This study aims to establish whether such an RCT is feasible.

This mixed-method parallel design study is a feasibility study with an embedded process evaluation, to compare SDF with usual treatment in primary dental care in the UK. It will be individually randomised, with 13 dentists and therapists, in 8 different dental primary care sites with a sample size of 80 child participants aged 1–8 years old. The aim will be to recruit ten participants per site with equal arm allocation. Follow-up will be for 1 year. The study will inform whether an RCT is feasible by resolving several key uncertainties. The acceptability and implementation of SDF and the research processes will be explored. Patient and Public Involvement and Engagement representatives will be involved throughout recruitment and retention strategies, participant documentation, analysis, engagement and dissemination.

The ability to conduct an RCT will be evaluated. If feasible, this RCT has the potential to evaluate the effectiveness of a non-invasive approach for the management of untreated caries in young children. A feasibility study also offers the opportunity to consider factors associated with the implementation of SDF at an early stage through a process evaluation that will inform the definitive trial and an implementation strategy for SDF by identifying relevant barriers and facilitators.

ClinicalTrials.gov identifier: NCT06092151. Date: 19/10/2023.

The online version contains supplementary material available at 10.1186/s40814-024-01519-y.