A Time-Bound Clinical Framework for Silver Diamine Fluoride as Interim Stabilization in Severe Early Childhood Caries: Bridging Preservation to Precision with Equity and Accountability.

Purpose: To provide an evidence-calibrated, time-bound clinical framework for using 38% silver diamine fluoride (SDF) as interim stabilization for severe early childhood caries (SECC) in young children, addressing gaps in existing guidelines regarding treatment duration, exit criteria, equity, and system accountability.

Methods

This framework was developed from the American Academy of Pediatric Dentistry (AAPD) guidance (2017-2025), the 2024 Cochrane review, real-world utilization studies, and a narrative review proposing a preservation-to-precision heuristic. Recommendations are expressed using GRADE terminology.

Results

The framework includes ten recommendations, a systems drift principle, explicit time thresholds (<6 months, 6-12 months, >12 months), a 12-month reassessment mandate, equity guardrails, a bridge vs. destination consent model, and a future research agenda. A clinical vignette contrasts appropriate short-term bridging with prolonged temporization due to access barriers.

Conclusions

SDF is conditionally recommended for caries arrest in primary teeth. In children with SECC, SDF should be used within a documented, time-bound preservation-to-precision pathway. SDF should not become an open-ended substitute for definitive restorative care. Explicit equity implementation prevents the framework from penalizing underserved children.