{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T22:19:40Z","timestamp":1782512380662,"version":"3.54.5"},"reference-count":17,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Silver diamine fluoride (SDF) is a key preservation-based intervention in pediatric dentistry. It can arrest many cavitated lesions, reduce treatment burden, and expand access for children who cannot receive conventional restorative care. This viewpoint article offers a reasoned, heuristic framework for calibrating SDF guidance to the strength of the underlying evidence. It does not present a systematic review or formal policy standards. Foundational trials support the clinical usefulness of 38% SDF. The 2017 AAPD guidelines provided conditional recommendations based on low-quality evidence. The current challenge is no longer whether to endorse SDF but how to calibrate guidance on its implementation. Later studies addressing intervals and implementation often have open-label designs, small samples, single centers, or overlapping data sources. Mechanistic and microbiome studies support biological plausibility, but policy should not treat them as definitive evidence. We propose a hypothesis-generating framework that separates claims about the existence of an effect (for which there is stronger directional support) from claims about its optimal conditions (which remain more uncertain), highlights dataset overlap, and matches recommendation strength to study quality. The framework supplements GRADE and provides illustrative upgrade pathways. The goal is to preserve SDF access while making guidelines more transparent, credible, and precise.<\/jats:p>","DOI":"10.3390\/children13050629","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T10:15:27Z","timestamp":1777630527000},"page":"629","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["From Preservation to Precision in Pediatric Dentistry: Evidence-Calibrated Viewpoint and Heuristic Framework for Silver Diamine Fluoride Guidance"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0071-9141","authenticated-orcid":false,"given":"Ziad D.","family":"Baghdadi","sequence":"first","affiliation":[{"name":"Centre for Community Oral Health, College of Dentistry, University of Manitoba, Winnipeg, MB R3B 0L8, Canada"},{"name":"Department of Preventive Dental Sciences Division of Pediatric Dentistry, College of Dentistry, University of Manitoba, Winnipeg, MB R3E 0W2, Canada"},{"name":"Topsmiles Pediatric Dentistry & Orthodontics, Winnipeg, MB R2M 3A5, Canada"},{"name":"Butterfly Dental Group, Winnipeg, MB R3Y 1P5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","first-page":"E135","article-title":"Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs","volume":"39","author":"Crystal","year":"2017","journal-title":"Pediatr. 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The Reference Manual of Pediatric Dentistry, American Academy of Pediatric Dentistry."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1177\/154405910508400807","article-title":"Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial","volume":"84","author":"Llodra","year":"2005","journal-title":"J. Dent. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1177\/0022034509338671","article-title":"Efficacy of silver diamine fluoride for arresting caries treatment","volume":"88","author":"Yee","year":"2009","journal-title":"J. Dent. 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BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04791-9"},{"key":"ref_16","first-page":"69","article-title":"The effectiveness of silver diamine fluoride and fluoride varnish in arresting caries in young children and associated oral health-related quality of life","volume":"86","author":"Sihra","year":"2020","journal-title":"J. Can. Dent. Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Manerkar, M., Cruz de Jesus, V., Mittermuller, B.A., Lee, V.H.K., Singh, S., Bertone, M., Chelikani, P., and Schroth, R.J. (2025). Effects of silver diamine fluoride on oral bacterione and mycobiome: A randomized clinical trial. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-06986-0"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/5\/629\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T04:15:34Z","timestamp":1778818534000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/5\/629"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":17,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["children13050629"],"URL":"https:\/\/doi.org\/10.3390\/children13050629","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]}}}