Permanent discolouration important barrier to acceptance of SDF treatment for visible root caries by elderly

Caries treatment with silver diamine fluoride (SDF) is effective, but often leads to irreversible tooth discoloration. This study aimed to investigate older patients’ perceptions of root caries treatment with SDF and to identify factors that influence their decision process.

Fifteen interviews were conducted in older patients (mean, min/max: 83, 71/92 years) with root caries experience, following a semi-structured interview-guide based on the domains of the Theoretical Domains Framework (TDF) including three case vignettes of SDF treatment. Transcripts of the interviews were used to perform deductive and inductive content analysis along the TDF and Capability-Opportunity-Motivation-Behavior model (COM-B) to assess influential factors.

Results

All Theoretical Domains Framework (TDF) domains and behavior determinants of the COM-B were covered, identifying twenty-two barriers, facilitators and conflicting themes. Main barriers for consenting to SDF treatment were patients’ perceptions of permanent staining of visible root caries lesions, as well as preconceptions about those of others and lack of knowledge about root caries and SDF. Main facilitators were trust in advice given by dentists, especially regarding new treatment options, that aesthetics were less important in non-visible areas and the importance of tooth preservation and feasibility of treatments when immobile or in need of care.

Permanent discoloration is an important barrier to older patients’ acceptance of silver diamine fluoride (SDF) treatment for visible root caries. However, patients appear to accept silver diamine fluoride (SDF) treatment under certain conditions, including less visible lesions or in comparison to more invasive treatment options.

Reference:

Wiebke Sommerfeldt, Paul Gellert, Anne Müller, Nirina Götze, Gerd Göstemeyer,

Older patients’ perception of treating root caries with silver diamine fluoride – a qualitative study based on the Theoretical Domains Framework, Journal of Dentistry, Volume 130, 2023, 104408, ISSN 0300-5712, https://doi.org/10.1016/j.jdent.2022.104408