Perceptions of Registered Dental Hygienists in Alternative Practice Regarding Silver Diamine Fluoride

J Dent Hyg. 2017 Aug;91(4):53-60.


Purpose: Silver diamine fluoride (SDF) is an inexpensive, non-invasive, antimicrobial liquid used to treat carious lesions and decrease sensitivity. The purpose of this study was to assess the perceptions of registered dental hygienists in alternative practice (RDHAP) regarding the use of SDF to treat dental caries.Methods: A 16-item survey designed to evaluate RDHAP's familiarity and perceptions of SDF was electronically distributed to 222 RDHAPs practicing in the state of California. A survey research software program collected and tabulated responses, calculated response frequencies for each survey item, and determined statistical relationships among variables, using cross tabulation analysis.Results: The response rate was 46% (n=103). Over half the respondents, 54%, were unfamiliar with SDF. After describing SDF's properties and uses, 78% of respondents agreed that applying SDF to treat dental caries would be within the scope of practice of a RDHAP. Respondents agreed that patients or parents of patients would be interested in using SDF because it provides an alternative to removing tooth structure with a dental drill in order to place restorative material (82%), less expensive than restorative treatment (82%), applied like a varnish and time efficient (86%), and utilized without local anesthesia (91%). Over 56% of the respondents agreed that many patients or guardians of patients would object to the permanent black staining of the carious lesion treated with SDF. The respondents' employment/practice settings were related statistically (p<0.01) to their agreement that SDF is within the RDHAP scope of practice and their disagreement the question that patients would not accept SDF treatment due to the black staining (p=0.03). Eighty-eight percent of the respondents felt that the advantages of SDF outweigh the disadvantages for their patient populations.Conclusions: SDF would be a useful therapeutic agent for the treatment of dental caries for RDHAP practitioners treating underserved populations.

Keywords: alternative practice; dental caries; preventive products; registered dental hygienist in alternative practice; silver diamine fluoride; special needs patients.

MeSH terms

  • Attitude of Health Personnel*
  • California
  • Cariostatic Agents / therapeutic use
  • Cross-Sectional Studies
  • Dental Caries / prevention & control
  • Dental Caries / therapy*
  • Dental Hygienists / education
  • Dental Hygienists / psychology*
  • Evidence-Based Dentistry
  • Fluorides, Topical / therapeutic use
  • Health Education, Dental
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Perception*
  • Quaternary Ammonium Compounds / therapeutic use*
  • Silver Compounds
  • Surveys and Questionnaires


  • Cariostatic Agents
  • Fluorides, Topical
  • Quaternary Ammonium Compounds
  • Silver Compounds
  • silver diamine fluoride