Child discomfort and parental acceptability of silver diamine fluoride and alternative restorative treatment: A randomized controlled clinical trial

Objectives: To compare pain perception of young children treated with SDF and ART, as well as their parents' acceptability of both modalities. Methods: Eighty, 3 to 8-years old children, having at least one deciduous asymptomatic tooth with active caries, as defined by the ICDAS II scores 4, 5, 6 were randomly assigned into two groups; SDF for caries arresting in the test group, and ART for caries removal in the control group. Pain perception was assessed using Sound, Eye, Motor scale (SEM), whereas parental acceptability was assessed using a self-administered questionnaire. Results: Patients treated with SDF reported significantly less discomfort and pain compared to the ART group, with a mean SEM of 3.70 +/- 1.47 and 6.18 +/- 3.06, respectively (p < 0.001). A significantly higher mean parental acceptability score was detected for SDF treatment (31.85 +/- 2.30) than ART treatment (26.75 +/- 3.60), p < 0.001, with regard to the treatment duration, child comfortability and quality of treatment (p < 0.001). The only dimension showing more satisfaction for the ART treatment was esthetics of anterior teeth (p= 0.01). Conclusions: Parental acceptability was higher for the SDF caries treatment of primary teeth compared to ART treatment, especially in relation to the shorter intervention time, child comfortability and acceptance as well as quality of treatment. Clinical Significance: The shorter average time needed and the ease of application of SDF on cavitated primary lesions, in addition to parental acceptability, place SDF in an advantageous position over the ART on clinical level.