Equity or Two-Tier Care? Guardrails for Silver Diamine Fluoride and Delegated Early Childhood Caries Pathways.
Early childhood caries (ECC) is a complex, multifactorial disease shaped by biofilm ecology, host susceptibility, diet and behaviors, and structural determinants of health. Silver diamine fluoride (SDF) is an effective non-restorative option for arresting cavitated lesions in many settings and can s...
| Publicado en: | Children Vol. 13; no. 3; pp. 386 - 396 |
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| Autor principal: | |
| Formato: | tables/charts Journal Article |
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MDPI
Mar2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=192663949&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 192663949 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 22279067 LW6K jtl: Children issn: 22279067 maglogo: N pubinfo: dt: Mar2026 vid: 13 iid: 3 pid: 97109 pub: MDPI artinfo: ui: 192663949 192663949 192663949 10.3390/children13030386 192663949 ppf: 386 ppct: 10 formats: tig: atl: Equity or Two-Tier Care? Guardrails for Silver Diamine Fluoride and Delegated Early Childhood Caries Pathways. aug: au: Baghdadi, Ziad D. affil: Centre for Community Oral Health, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB R3B 0L8, Canada sug: subj: Dental Caries Drug Therapy Silver Compounds Therapeutic Use Fluorides Therapeutic Use Dental Care for Children Pediatric Dentistry Dental Caries Risk Factors Risk Assessment Implementation Science Health Services Accessibility Dental Health Services Quality of Life Child Child: 6-12 years ab: Early childhood caries (ECC) is a complex, multifactorial disease shaped by biofilm ecology, host susceptibility, diet and behaviors, and structural determinants of health. Silver diamine fluoride (SDF) is an effective non-restorative option for arresting cavitated lesions in many settings and can support access when definitive care is delayed. However, translating short-horizon "arrest" outcomes into broad policy claims—that SDF-first, delegated pathways can substitute for dentist-led diagnosis and comprehensive rehabilitation—risks institutionalizing a two-tier standard of care for children facing the greatest access barriers. This perspective critically appraises evidence-to-implementation pathways for SDF and delegated ECC management, using risk-of-bias and reporting guidance as interpretive tools and drawing on pragmatic regimen trials, microbiome substudies, oral health-related quality of life (OHRQoL) analyses, and implementation work including the Canadian Caries Risk Assessment Tool (CCRAT) in primary care. We explicitly distinguish what studies demonstrate (e.g., feasibility and short-term arrest differences by reapplication interval) from what they do not establish (e.g., long-term tooth survival, pulpal outcomes, definitive treatment completion, and equity impacts). We propose practical guardrails that position SDF as interim management within a continuum of care: dentist-led diagnosis and escalation when pulpal risk is suspected; time-bound referral pathways with completion tracking; protocolized follow-up aligned with lesion/risk status; outcome sets that extend beyond "arrest" to include pain, function, OHRQoL, tooth survival, and equity stratification; and lesion-site sampling plus preregistered analyses when mechanistic claims are advanced. pubtype: Academic Journal doctype: tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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