Integrating silver diamine fluoride into school-based oral health programs: A pilot study

Objective: Current approaches to school-based caries prevention can increase access to oral healthcare, but are often limited by costs and other logistical challenges. Evidence from large pragmatic trials support the use of silver diamine fluoride (SDF) to prevent and control caries in school dental programs. In this pilot, we developed implementation strategies and integrated SDF into an existing school-based dental program, Smiles For Students (SFS). Methods: This was a single-group observational pilot. Using a school-based SDF implementation toolkit, SFS clinicians received training in clinical protocols as well as ongoing interactive technical assistance to support SDF integration. SDF was then implemented into existing clinical workflows. Results: Following training and implementation, the Smiles For Students program saw a 23 % increase in the number of patients served, a 53 % decrease in the per-child treatment time, a 45 % decrease in labor costs despite increased enrollment, and a 24 % decrease in supply costs. Qualitative feedback indicated strong support for simplified clinical protocols, reduction in cumbersome supplies and materials, and increased flexibility with space and resources. Conclusions: In a pilot implementation project in which SDF was integrated into an existing school-based dental program serving 16 schools, multiple logistical and economic challenges were mitigated and program clinicians utilized both sealants and SDF to meet the needs of participating children.