Negative Clinical Outcomes Between Silver Diamine Fluoride, Sedation, and General Anesthesia Treatment for Children with Early Childhood Caries: A Cohort Study

PurposeThis study compared the wait-time for treatment completion and pre- and post-treatment outcomes of treating early childhood caries with silver diamine fluoride, sedation, and general anesthesia. MethodsThis retrospective study examined children with early childhood caries treated with either silver diamine fluoride, sedation, or general anesthesia at federally qualified health centers. Demographics, wait-time for treatment completion, and pre- and post-treatment clinical outcomes were compared with analysis of variance for continuous variables and the Chi-square test for categorical variables. This study was reviewed and approved by Southcentral Foundation Research Review. ResultsThe outcomes between the silver diamine fluoride, sedation, and general anesthesia groups were respectively: 1) average wait-times to complete treatment at 49.6, 62.5, and 116.3 days, 2) mean number of pre-treatment visits at 1.08, 1.25, and 1.61, 3) mean number of post-treatment visits at 1.41, 1.29, and 1.45. Multiple negative outcomes were identified when the sedation and general anesthesia groups were compared with the silver diamine fluoride reference group for 1) pre-treatment visits with un-planned visits (for general anesthesia only), pain, intra-oral swelling, and prescriptions for pain and antibiotic medications (general anesthesia only) and 2) post-treatment visits with new carious lesions on permanent molars, new carious lesions on primary teeth (sedation only), intra-oral swelling (sedation only only), broken restorations, displaced restorations, and pulpal therapy (sedation only). ConclusionsSilver diamine fluoride provides timely and effective caries management with lower wait-time for treatment completion, clinical outcomes consistent with minimally invasive treatment, and mitigation for the risk of negative pre- and post-operative clinical outcomes compared to treatment under sedation or general anesthesia.