Older patients' perception of treating root caries with silver diamine fluoride - a qualitative study based on the Theoretical Domains Framework

Frontiers of Global Research Trend on Root Caries: A Bibliometric Analysis

OBJECTIVE

This study aimed to examine the global research trend and frontiers in the field of root caries.

METHODS

Two independent investigators searched the Web of Science Core Collection to include journal articles published on root caries from 1994 to 2023. They examined citation trends of the selected publications and performed bibliometric analysis using VOSviewer. Cooccurrence and cocitation analysis were used to calculate the burst strength of the most cited keywords and the most cited publications.

RESULTS

This study included 1144 publications (1004 scientific research articles and 140 review articles) for bibliometric analysis. The number of publications from 2018 to 2023 was 404, accounting for 35% (404/1144) over the last 30 years. The annual citation count showed a gradual upward trend with a surge from 2018. The cooccurrence analysis classified the publications into four clusters which were in vitro studies, prevention, microbiology, and epidemiology. Cocitation analysis revealed silver diamine fluoride, systematic review, and randomized clinical trial were the three main keywords; and their citation burst strength (period) were 17.2 (2017-2023), 9.4 (2015-2023), and 6.9 (2018-2023), respectively. Noninvasive treatment of root caries (narrative review), aetiology of root caries (narrative review), and use of silver diamine fluoride in arresting root caries (clinical trial) were the topics (publication type) of the three most cited publications; and their burst strength (period) were 8.9 (2017-2020), 5.9 (2017-2021), and 4.7 (2015-2018), respectively.

CONCLUSION

This study highlights the recent growing research interest in root caries, particularly on its microbiology, prevention, and the use of silver diamine fluoride.

Repair of partially defective restorations: Systematic review and meta-analysis of patient acceptance

OBJECTIVES

This systematic review attempted to assess patient acceptance of repairs instead of complete replacement for partially defective restorations and to identify factors affecting patients' decision-making for or against repairs.

STUDY SELECTION

Observational and qualitative studies reporting on (1) the proportion of patients accepting or preferring repairs, (2) the proportion of dentists / dental students / dental schools stating that their patients accept or prefer repairs, (3) factors affecting patients' decision-making for or against repairs.

SOURCES

Electronic databases (MEDLINE via PubMed, Scopus, EMBASE via Ovid, and Web of Science) were last searched in August 2024 (PROSPERO database: CRD42023449437).

DATA

Twenty-one sources reporting on 20 survey studies addressing individual dentists / dental students and dental schools were included. None of the included studies directly addressed patients (e.g., by interviewing patients). Of the surveyed dentists and dental students, 86.3 % (95 %-CI: 77.8-91.8 %) reported that their patients accept or prefer repairs. Dental schools rated patient acceptance as high as 93.0 % (95 %-CI: 82.3-97.4 %). None of the included studies reported factors affecting patients' decision-making for or against repairs.

CONCLUSIONS

Repairs of partially defective restorations instead of complete replacement seem to be associated with a high level of patient acceptance as most dentists, dental students, and dental schools stated that their patients accept or even prefer repairs instead of complete replacement.

CLINICAL SIGNIFICANCE

Within the shared decision-making process, dentists can expect their patients to accept or even prefer repairs instead of complete replacement.

Perspectives of patients, dental professionals, and stakeholders on the use of silver diamine fluoride for the management of dental caries: A qualitative systematic review

OBJECTIVES

This qualitative systematic review and meta-aggregation aimed to synthesise evidence regarding perceptions of patients, practitioners, and stakeholders on the use of Silver Diamine Fluoride (SDF) for the management of dental caries.

DATA

This review was reported in alignment with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and is registered with PROSPERO (CRD42023390301) and the Joanna Briggs Systematic Reviews register.

SOURCES

References were retrieved from PubMed, Web of Science, Scopus, and EMBASE using a pre-established search strategy.

STUDY SELECTION

Qualitative and mixed-methods studies examining perspectives of patients, practitioners, and/or stakeholders on the use of SDF were included. The initial search identified 650 articles eligible for inclusion, out of which 14 articles were included in the review. Reviewers synthesised findings and generated 11 distinct categories grouped into three synthesised findings: 1) Clinical use; 2) Staining; 3) Facilitators and barriers.

CONCLUSIONS

Practitioners and patients viewed SDF as a therapeutic option with multiple benefits. While aesthetic concerns may be a barrier to some groups, the acceptance of the treatment was influenced by other factors, such as trusting professional advice.

CLINICAL SIGNIFICANCE

Patient education is key for increased SDF acceptance. This systematic review can assist clinicians in addressing concerns regarding SDF therapy. Findings have the potential to inform policy decisions that address oral health inequities through patient-centred health care models.

The Older Adults' Intention to Use Silver Diamine Fluoride for Dental Caries Treatment

Purpose

This study aimed to determine the intention of older adults to use silver diamine fluoride (SDF) for treating tooth decay.

Patients and Methods

A group of Thai-speaking individuals between the ages of 60 and 90 were asked to participate in the study. They were provided with information about SDF and then asked to complete a questionnaire based on the Theory of Reason Action (TRA). The questionnaire consisted of 23 questions divided into seven constructs aimed at determining the determinants of the intention to use SDF. These constructs were behavioral belief, evaluation of behavioral outcome, normative belief, motivation to comply, attitude towards behavior, subjective norm, and intention. The responses were rated on a 4-point Likert scale ranging from 1 (Strongly disagree) to 4 (Strongly agree). The characteristics and TRA scores of the participants were analyzed and compared based on their intention to use SDF, using the Chi-square test and t-test. Multiple logistic regression was employed to determine the determinants of the intention to use SDF.

Results

The study involved 588 participants, with an average age of 65.3 years (SD= 5.53). Of the participants, 52.7% were women, 58.1% were unemployed or retired, 80.8% lived with family, 63.4% had less than sixth-grade education, 62.9% had a monthly family income of less than 10,000 baht, and 63.6% had underlying diseases. The study found that 82.7% of the participants intended to use SDF for dental caries treatment, with an average score of 2.86 out of 4. The study also found that age, family income, underlying diseases, dental health problems, and fear of the dentist significantly affected their intention. Behavioral beliefs and evaluations of behavioral outcomes significantly affected the intention to use SDF treatment.

Conclusion

Most older adults in the study intended to use SDF for dental caries treatment.

Acceptance of silver diamine fluoride use in community dwelling older adults, nursing home residents, and caregivers

OBJECTIVES

To compare the level of acceptance of silver diamine fluoride (SDF) treatment between different functional groups of older adults aged 65-years-old and above.

METHODS

Three groups were recruited representing functionally-independent ("Community dwelling"), frail ("Nursing home"), and functionally-dependent older adults ("Caregiver": proxy respondent involved in caring for an older adult of all functional levels). Participants viewed a video on SDF and an interviewer-led questionnaire collected demographics, dental experience and perception on SDF use.

RESULTS

The study recruited 201 participants (100 "Community dwelling", 51 "Nursing home", 50 "Caregiver"). Overall, 73 % of participants were accepting of SDF treatment. Those in the "Community dwelling" group were most accepting (85 %), followed by the "Nursing home" group (61 %) and "Caregiver" group (60 %) (p<0.001). Participants were more accepting of SDF use on posterior (73 %) compared to anterior teeth (46 %). They were more accepting when SDF was presented as a treatment to avoid infection and pain (87 %), and general anesthesia (78 %). In a regression analysis, "Nursing home" and "Caregiver" participants were three times less likely to accept SDF (OR 0.27 [95 % CI: 0.13 to 0.60], and OR 0.27 [95 % CI: 0.12 to 0.58] respectively) compared to "Community dwelling" participants. After adjusting for other factors, only the "Caregiver" group remained significant (Adjusted OR 0.32 [95 % CI: 0.13 to 0.78]).

CONCLUSIONS

Older adults were accepting of SDF and this treatment modality has the potential to be a routine treatment option in dental caries management in this population. However, this was less certain among frail and functionally dependent older adults.

CLINICAL SIGNIFICANCE

An SDF program to manage caries is likely to be well-received by functionally-independent older adults. However, the acceptance among frail and functionally-dependent older adults were lower even though SDF is mostly likely to benefit these populations. There is a need to investigate this relatively lower levels of acceptance.

Evaluation and management of dry mouth and its complications in rheumatology practice

INTRODUCTION

The symptom of dry mouth has multiple potential etiologies and can be a diagnostic clue to the presence of common systemic diseases encountered in rheumatology practice. The presence of decreased saliva flow (i.e. salivary hypofunction) defines a subset of dry mouth patients in whom there may be reversible drug effects, an iatrogenic insult such as head and neck irradiation, or a disease that directly involves the salivary glands (e.g. Sjögren's disease). The assessment of salivary hypofunction includes sialometry, salivary gland imaging, salivary gland biopsy, and an assessment for relevant systemic diseases. Optimal management of dry mouth requires accurate definition of its cause, followed by general measures that serve to alleviate its symptoms and prevent its complications.

AREAS COVERED

Through a literature search on xerostomia and salivary hypofunction, we provide an overview of the causes of dry mouth, highlight the potential impact of salivary hypofunction on oral and systemic health, detail routine evaluation methods and treatment strategies, and emphasize the importance of collaboration with oral health care providers.

EXPERT OPINION

Our Expert Opinion is provided on unmet needs in the management of dry mouth and relevant research progress in the field.