P2.K205: Silver Diamine Fluoride to Treat Dental Caries in Pediatric Practice: Will Pediatricians Bite?

Background: Not all children are able to see a dentist by the recommended age of 1 year, and pediatricians are often the first health professionals to identify tooth decay. Limited access to early dental care may be exacerbated by family income, insurance status, and pediatric dental workforce shortages. For many families, the pediatric medical home becomes the de facto source for caries prevention. Silver diamine fluoride (SDF) is a tool that may support pediatricians in these efforts. Designated as a “breakthrough therapy” by the FDA in 2016 based on its ability to arrest cavities, SDF was assigned a Category III current procedural terminology (CPT) code in 2023, allowing pediatricians to get paid for application. While SDF is an effective tool to stop cavitated lesion progression, little is known about pediatricians’ attitudes about and current use of SDF in clinical settings.

Methods: A brief survey was administered to a convenience sample of 337 pediatricians in summer 2023 to better understand provision of preventive oral health services for children ≤5 years of age and to assess physician familiarity with SDF. Survey data was analyzed for descriptive statistics. Following the survey, 12 key informant interviews were conducted with pediatricians to explore potential facilitators and barriers to SDF application in practice settings. All survey and interview participants reported providing direct patient care.

Results: Pediatrician Survey: >75% of participants provided recommended oral health services (eg, visual exam of the mouth, oral health risk assessment, review of oral health self-management goals with families, referral to a dental home) and >30% applied fluoride varnish, < 25% were familiar with SDF and < 20% reported likelihood of implementing SDF in the future. Participants reported greater likelihood of SDF adoption with availability of a CPT code (Figure 1). Key Informant Interviews: Pediatricians expressed interest in and recognized the need for SDF as a treatment option for young children with caries but identified numerous potential obstacles including training and education; communicating with families; referral challenges; obtaining and storing SDF and related supplies; incorporating SDF into workflows; payment/fiscal concerns; and convincing colleagues to adopt SDF (Figure 2).

Conclusion: Results of a pediatrician survey and subsequent key informant interviews suggest that SDF as a treatment modality for caries is new to many pediatricians but availability of a CPT code for payment may encourage practices to adopt its use for young patients in need of care but without a dental home. While the self-selected sample and small number of interviews are limitations of this work, findings identify numerous opportunities to support pediatricians through SDF-related education and training and development of related resources for clinical and family audiences. The AAP Section on Oral Health is currently developing a guidance document for SDF application in medical settings.