A mixed methods evaluation of the implementation of silver diamine fluoride in NHS primary dental care

BACKGROUND: The rates of dental caries in young children in England are high. Despite evidence-based guidance being available to manage dental caries for young children, this is not routinely implemented. Silver diamine fluoride (SDF) offers an alternative approach to caries management. However, its use in England is limited and there are no data on the implementation of SDF in NHS primary care, where most children are treated. AIM: Explore the factors affecting the ability to implement SDF and specifically the acceptability and feasibility of treatment with SDF from the perspectives of children, families, dentists and regional and national stakeholders. METHODS: This was a mixed methods evaluation of the implementation of SDF in NHS primary care. Qualitative interviews were carried out with parents, children, stakeholders and dental professionals regarding the implementation of SDF. The data collection and analysis were informed by the Consolidated Framework of Implementation Research and the Theoretical Framework of Acceptability. Quantitative data were collected pertaining to the dose, reach and fidelity of delivery of SDF, from a subset of participants involved in a randomised feasibility study. RESULTS: Interviews were conducted with 61 stakeholders, dental professionals, parents and children. Constructs from all the Consolidated Framework of Implementation Research domains were represented. Ease of use and child experience facilitated SDF implementation. Barriers were contracts and remuneration. SDF not requiring restorative treatment was both a barrier and facilitator simultaneously. The treatment protocol for SDF was adapted by dental professionals to add restorative care where they or their families had concerns over aesthetics or function. CONCLUSIONS: It was possible to implement SDF in NHS primary care where it addressed an unmet need for young children. However, there is professional concern around unrestored teeth and wider implementation is hampered by contractual arrangements. TRIAL REGISTRATION: Registration is at Clinaltrials.gov (NCT06092151) (date: 23/10/2023).