Cost-efficacy of silver diammine fluoride in controlling caries lesion progression on erupting permanent molars: a randomized clinical trial

Author(s)

Luciana Pion Antonio

• Document type: Master's Dissertation
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Odontologia (FO/SDO)
• Defense date: 2016-12-16

Examining board members

Mariana Minatel Braga Fraga; Clarissa Calil Bonifácio; Jose Carlos Pettorossi Imparato; Branca Heloisa de Oliveira Martins Vieira

• Advisor: Mariana Minatel Braga Fraga

Abstract

Although Silver Diamine Fluoride (SDF) has been showed good results in controlling caries lesions, many dentists in Brazil can avoid its use possibly underestimating its indications nowadays due to the staining caused by its usage. On the other hand, treatment with SDF is a simple, non-invasive and quick procedure and it does not require expensive equipment or infrastructure support for its implementation. A randomized clinical trial with two-arm parallel groups was conducted, comparing the treatment of enamel caries lesions with 30% SDF versus cross-toothbrushing technique (usually indicated in pediatric dental clinic and that requires a modification of the toothbrush position to be performed), on occlusal surfaces of erupting first permanent molars. Since both active groups (treatment with SDF and cross tooth-brushing technique instructions) use different procedures and patients can be influenced and neglect the brushing instructions, it was decided to include a placebo application in the cross-toothbrushing technique group, simulating the SDF treatment. Therefore, it was provided a similar treatment for participants in both groups so they could feel equally treated by the operator. Thus, the aim for the first chapter of this dissertation was to describe this new methodology, using the placebo treatment and making cost, acceptability and adherence to the proposed treatment analyses. The validity of using this placebo, created to simulate SDF applications, is important to fulfill the role expected for this type of measure, as well as being well accepted by the participants and show its feasibility to be included in an efficacy study. The second chapter aims to demonstrate the cost-efficacy and the real possibility of promoting the use of SDF in clinical practice for the control of active enamel caries lesions on occlusal surfaces of first erupting permanent molars. Other patient-centered outcomes, as the caregivers\' acceptability and perception about the received treatment (related to their children´s oral health and aesthetics), were also evaluated. Aspects related to the impact of possible chosen outcomes were also discussed. Although similar effects were found between groups, both proposed techniques differed in treatment adherence and cost for implementation. These factors should be considered when making treatment decisions. Furthermore, regarding the possible tooth staining caused by SDF, no impact was found on caregivers\' perspective. Finally, this study may contribute, in terms of study design methodology, by discussing important aspects in the conception and interpretation of results in studies of clinical efficacy. Besides, it could also help to underlie the possibility of a good acceptance of SDF by parents, commonly questioned by some experts. However, longer follow-up and more robust outcomes analysis are critical for SDF large-scale implementation. (AU)

• FAPESP's process: 14/06925-9 - Cost-effectiveness and acceptability of silver diamine fluoride in arresting initial caries lesions on erupting molars: randomized controlled clinical trial
• Grantee: Luciana Pion Antonio
• Support Opportunities: Scholarships in Brazil - Master