PROMISES

PROMoting the Implementation of SDF for Effective School health

Multiple state and federal agencies recommend school-based caries prevention to increase access to dental care for underserved groups and mitigate the severe health and socioemotional consequences of untreated caries. The most common approach, school sealant programs, are effective but underutilized due to financial constraints and other logistical challenges. Silver diamine fluoride (SDF) is an innovative, efficient therapy for dental caries that holds considerable promise for sustainable caries prevention in schools. Over the past seven years, we have conducted multiple school-based pragmatic trials demonstrating that SDF (1) can be successfully incorporated into school caries prevention; (2) is similarly effective compared to dental sealants in reducing the prevalence and incidence of caries; (3) is cost-effective, particularly when provided to low-income minority populations, and (4) can be successfully applied in schools by nurses, who are equivalent in effectiveness compared to dental hygienists. This new model has the potential to greatly expand the reach and effectiveness of school-based caries prevention.

In this project, we will conduct a phase-3 translational research study and use blended implementation strategies to integrate SDF into existing school-based dental programs (SBDPs). Our proposed study is informed by a implementation pilot, which provided support for our selected strategies and demonstrated successful program outcomes. During pre-implementation we will conduct comprehensive readiness assessments, identifying local policies facilitating program uptake and developing reimbursement models for sustainable care. We will then train SBDPs to provide SDF and provide ongoing interactive technical assistance. Implementation will utilize a stepped-wedge cluster-randomized design, sequentially crossing SBDPs over into SDF utilization. Post-implementation evaluation will assess acceptability, adoption, appropriateness, and feasibility of the evidence-based intervention and include a separate resource and impact analysis. The project is guided by the PARiHS framework for implementing research into practice and uses the Proctor taxonomy for implementation outcomes.

Ultimately, the current school dental service ecosystem is insufficient to support existing demand, and there is considerable potential for scaling-up SDF adoption into care practices. Our research and implementation team is uniquely situated to facilitate the greater integration of silver diamine fluoride into school-based caries prevention.