Non-inferiority of silver diamine fluoride for caries prevention when applied by nurses compared to dental hygienists: Results from the CariedAway school-based clinical trial

BackgroundThe sustainability of school-based oral health programs depends on the utilization of effective, efficient treatments and the availability of a trained clinical workforce. The objective of this study was to determine whether registered nurses are comparable to dental hygienists in the application and effectiveness of silver diamine fluoride (SDF) for the prevention of dental caries. MethodsCariedAway was a school-based study of SDF versus dental sealants and atraumatic restorations. Within the SDF arm, subjects were treated by either a licensed dental hygienist or a registered nurse, both under the supervision of a pediatric dentist. Although initial treatment assignment in CariedAway was randomized, assignment to provider was not. The proportion of children who remained caries free after two years was assessed for non-inferiority using two-group proportion tests, adjusting for the clustering effect of schools. Results417 children were analyzed including 298 treated by hygienists and 119 by nurses. The proportion of caries-free individuals was 0.812 and 0.798 for hygienists and nurses, respectively, for a difference of 0.014 (95% CI = -0.07, 0.098) and within the pre-determined non-inferiority margin. ConclusionsNurses may be effective in treating children with silver diamine fluoride in school-based oral health programs.