Efficacy of silver diamine fluoride versus silver diamine fluoride & fluoride varnish in arresting dental caries in special children

Dental caries has beenaround for time immemorial. It is a microbial infectious disease and probablythe most significant chronic childhood disease prevalent globally. It can leadto a high level of morbidity and affect the quality of life in many ways. It isa secular infectious disease cutting across all sections of society in bothdeveloped and developing nations. Some of the consequences of untreated lesionsare pain, swelling, fever, inability to eat, malnutrition, difficulty in speechand tooth loss.

A lot has changed inthe recent past in understanding the science of dental caries, its preventionand treatment but data from across the world shows that dental caries remains aserious disease globally.

The level of awarenessin caregivers (parents and non dental healthcare providers) regarding thesymptoms, treatment (especially of untreated lesions) and prevention of dentalcaries remains low. This leads to a huge burden of care on the society.

Special health careneeds children are at a much higher risk of developing dental caries because oftheir inherent challenges of carrying our even simple acts like tooth brushing.Added to this is also the fact that most of the parents of special children maybe focused on seeking and providing seemingly more important medical care totheir child/children which leads to a neglect of dental care. Medical care inspecial children may also involve administering medications in a sweetenedsyrup form which are mostly sugar based. Lack of awareness regarding cariesprevention amongst parents leads to dental caries in such children. Specialchildren are often on pureed diets which are more cariogenic and need specialpreventive protocols often found missing. Added to these is the fact thatspecial children need a different approach for their dental treatment and hencenot all dentists are able to competently treat special children. More oftenthan not this also entails higher treatment costs which become a constraint formany parents leading to a neglect of dental caries. This may become a viciouscycle and end in serious morbidity and tooth loss.

Over time numerouspreventive strategies and protocols have been tried and tested by the dentalfraternity of researchers and clinicians. Literature is replete with manyexamples and two stand out in recent times. These are topical application offluoride varnish (FV) and silver diamine fluoride (SDF). Many studies have beenconducted on both the protocols and there are meta analysis and systematicreviews too, explaining the evidence on their efficacy. Both protocols work.

Traditionally fluoride varnish has beenextensively used in the prevention of dental caries. SDF has proven itself tobe a effective measure in arresting decay, hence the interest in its use inspecial children. Very few relevant studies exist in the literature where inSDF has been studied in special children, either alone or with fluoridevarnish.

This trial will try and bridge this gap.