P2.204: Pediatricians Can Apply Silver Diamine Fluoride to Stop Cavity Progression

Background: Early Childhood Caries (ECC) is the most common childhood infectious disease. Left untreated, ECC may progress to require operative treatment under general anesthesia which has significant health risks and financial costs. ECC also has health equity implications as ECC disproportionately affect children living in poverty. Silver Diamine Fluoride (SDF) is a topical medication whose application is painless and simple. SDF treatment can arrest up to 90% of caries and was approved in 2016 by the FDA as a “breakthrough treatment”. SDF is now used routinely by dentists, but dental access is problematic for many children. We sought to increase access to SDF by training pediatricians to apply SDF in primary care clinics.

Methods: A 90-minute SDF didactic training program was developed that included reading and video materials. Five supervised SDF applications were required for credentialing. An equipment basket of SDF supplies was compiled, and a standardized consent form with before-and-after SDF pictures was created. An EMR template was added to capture clinical information and includes billing codes, including the new AMA procedure code “0792T” for SDF application in a medical setting. Patients receiving SDF application were seen in a “Cavity Clinic” which was held 1-2 half days/month in our pediatric primary care clinic.

Results: In the first 12 months of our program two physicians were credentialed and 57 unique patients received SDF treatment with 7 patients having a second SDF treatment. Despite having active caries, only 15% of patients had seen a dentist prior to being seen in our Cavity Clinic, confirming dental access as a problem. The average age range at the first application of SDF was 35 months; 25% of patients were aged < 2 years old, 66% were aged 2–4 years old. SDF was applied to 6 teeth on average. Forty-four percent of patients had SDF applied to < 5 teeth, 39% had SDF applied to < 10 teeth and 17% had SDF applied to ≥ 10 teeth. There were no adverse outcomes. One patient with deep pulpitis did require urgent referral for tooth extraction. After being seen in Cavity Clinic 40% of patients were successfully referred to a pediatric dentist. In follow up, 11 of 57 patients eventually required operative repair. Patents who required operative repair had SDF applied to 9 teeth on average. No patient who received two SDF treatments required operative repair.

Conclusion: An SDF program was successfully implemented in an outpatient pediatric clinic. Training is simple, supplies are easy to obtain, and the visits are billable. With few pediatric dentists serving rural and impoverished families, SDF access via medical clinics will bring this highly effective treatment to at-risk children, help arrest ECC, and avoid operative repair.