Silver Diamine Fluoride (SDF) Discussing Indications and Obtaining Informed Consent

Although application of SDF in the primary care setting is not definitive disease management, it provides a new option for families, one that may be completely unfamiliar to them. 

Discussing Indications, Process, and Outcomes

When a patient is a good candidate for SDF based on the dental history and the Options Diagram, walk parents and caregivers through your process for arriving at a recommendation to apply SDF. Discuss the advantages and disadvantages of SDF and explain the application process and expected outcomes. 

Explaining and Obtaining Informed Consent 

Once the joint decision to apply SDF has been made, you will need to obtain informed consent. 

Consent forms should be written using plain language so they are easy to understand, particularly for those with low health literacy, and should be provided in a format that is culturally and linguistically appropriate.  

When SDF application is planned for a separate day, consider sending information and consent forms home for review so that other family members, when appropriate, can be included in the decision-making process. 

To properly obtain informed consent, incorporate the following into your consent form for parents and caregivers. (These examples are adapted from the AAP policy statement Informed Consent in Decision-Making in Pediatric Practice.) 

• The nature of the illness or condition
• Explanation of SDF and statement of purpose for use
• Proposed diagnostic steps and/or treatments and the probability of their success
• The potential risks, benefits, and uncertainties of the proposed treatment and alternative treatments, including no treatment other than comfort measures
• Pictures that demonstrate staining
• Assurance that parents/caregivers understand all of the above
• Patient name and date of birth
• Caregiver signature
• Provider signature
• Date of signed consent 

Allow time to answer any questions about both the informed consent process and the treatment options you have offered.