The Effectiveness of the Use of Silver Fluoride and Teledentistry to Manage and Prevent Childhood Caries Among Aboriginal Children in Remote Communities: Protocol for a Cluster Randomized Controlled Trial
Date
2025
Authors
Arrow, P.
Piggott, S.
Anderson, L.
Bessarab, D.
Jamieson, L.
Atkinson, D.
Ngo, H.
Kularatna, S.
Tonmukayakul, U.
Nanda, S.
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Journal article
Citation
JMIR Research Protocols, 2025; 14:e72227-1-e72227-11
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Peter Arrow, Susan Piggott, Lorraine Anderson, Dawn Bessarab, Lisa Jamieson, David Atkinson, Hien Ngo, Sanjeewa Kularatna, Utsana Tonmukayakul, Soniya Nanda, Jilen Patel, Lorraine Powell, Mohamed Estai
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Abstract
Background: Australian Aboriginal children experience dental decay at more than twice the rate of non-Aboriginal children. The Select Committee into the Provision of and Access to Dental Services in Australia noted that the rate of potentially preventable hospitalizations was the highest among children aged between 5 and 9 years and was higher among Indigenous Australians and those living in remote locations. The application of a silver fluoride (AgF) solution to decayed surfaces has been shown to be effective in stopping the decay process and reducing the occurrence of new decay but has been tested to a limited extent in the Australian context. Objective: This study aims to evaluate the feasibility of using the skills of an Aboriginal health practitioner to undertake the application of AgF to carious primary molars to arrest the caries progression and prevent the occurrence of new caries among young Aboriginal children in remote communities. Methods: This study is a cluster-randomized controlled trial with communities randomized and stratified based on caries level and water fluoridation status. The trial will recruit 640 children (aged between 6 months and 7 years) from 30 communities. Informed consent will be obtained. At baseline, each child in the intervention group will be examined by a calibrated examiner and subsequently by an oral health practitioner who will prescribe to an Aboriginal health practitioner the teeth to be treated with AgF. A formulation with 38% AgF will be applied for 1 minute (0.004 mL per tooth). The control group will be provided with standard minimally invasive care. Participants will be followed annually for 2 years to assess caries arrest and prevention by blinded calibrated examiners. Child oral health–related quality of life and dental anxiety will be elicited through validated questionnaires. Tests of proportions will be used to evaluate the proportion of lesions arrested and the proportion of surfaces at risk that decayed over the follow-up. Multiple logistic regression with appropriate control for clustering of teeth and communities will be used to evaluate caries arrest, controlling for potential confounding factors. Results: Community engagement has commenced, and data collection protocols have been prepared. Staff specific to the study (eg, Aboriginal health practitioners or workers) are in the process of recruitment. Participant recruitment will commence in March 2026 and conclude in December 2026. Study outcomes will be reported at 12- and 24-month follow-ups. Conclusions: This study will test the effectiveness and feasibility of a non-oral health professional applying AgF to achieve caries arrest and prevention and validate clinical findings against digital imagery acquired on site. This pragmatic study will inform the development of suitable and accessible models of care for dental service provision in rural and remote communities in Australia. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12624000457549p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=387518&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/72227
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© Peter Arrow, Susan Piggott, Lorraine Anderson, Dawn Bessarab, Lisa Jamieson, David Atkinson, Hien Ngo, Sanjeewa Kularatna, Utsana Tonmukayakul, Soniya Nanda, Jilen Patel, Lorraine Powell, Mohamed Estai. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 07.Oct.2025. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.