Outreach Service Using Silver Diamine Fluoride to Arrest Early Childhood Caries

Early childhood caries (ECC) is prevalent and affects more than half of 5-year-old children in Hong Kong. This study aims to report the development of an outreach dental service using silver diamine fluoride (SDF) to arrest ECC amongst kindergarten children in Hong Kong. A pilot outreach service was initiated in 2008 in 14 kindergartens. The pilot service provided screening to 1,749 3- to 5-year-old children. SDF was applied to 3,262 carious teeth of 786 children with parental consent. No significant complications were reported. The pilot service's success allowed the service to expand to 100 kindergartens in 2013. From 2010 to 2019, the service delivered 161,354 dental screenings and SDF therapy on 218,333 carious primary teeth in 53,821 children. ECC prevalence amongst the participating children declined from 43% in 2010 to 34% in 2019. A follow-up of 222 3-year-old children revealed that annual SDF therapy arrested 67% of ECC over 3 years. The children's participation rate and their parents’ satisfaction rate with the service were greater than 90% each year. Moreover, the acceptance rate of SDF therapy to control ECC was 88%, although SDF stained carious lesions black. No adverse effects of SDF therapy were reported. A cross-sectional survey on a sample of 498 3- to 5-year-old children showed that 96% of the participating children had no dental fear or anxiety in this service, with encouragement and support from their peers and teachers. In 2019, the service was made available to all 1,024 kindergartens in Hong Kong. This kindergarten outreach dental service (Case Study HKU/04/003) was selected as an Impact Case Study in the thematic report “Health & Healthcare” by the Hong Kong University Grant Council (UGC). The UGC publishes thematic reports to give members of the public some concrete idea on what contributions academic research has brought to the society.