{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T10:50:36Z","timestamp":1782471036131,"version":"3.54.5"},"reference-count":11,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"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>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\u20132025), 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 (&lt;6 months, 6\u201312 months, &gt;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.<\/jats:p>","DOI":"10.3390\/children13060834","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T08:43:57Z","timestamp":1782463437000},"page":"834","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"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":"TopSmiles Pediatric Dentistry & Orthodontics, 246 St. Anne\u2019s Road, Winnipeg, MB R2M 3A4, Canada"},{"name":"Butterfly Dental Group, Winnipeg, MB R3Y 1P5, Canada"},{"name":"Children\u2019s Dental Centre, 1630 Ness Ave, Winnipeg, MB R3J 3X1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,20]]},"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. Dent."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Baghdadi, Z.D. (2026). From Preservation to Precision in Pediatric Dentistry: Evidence-Calibrated Viewpoint and Heuristic Framework for Silver Diamine Fluoride Guidance. Children, 13.","DOI":"10.3390\/children13050629"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Baghdadi, Z.D. (2026). Equity or Two-Tier Care? Guardrails for Silver Diamine Fluoride and Delegated Early Childhood Caries Pathways. Children, 13.","DOI":"10.3390\/children13030386"},{"key":"ref_4","first-page":"CD012718","article-title":"Topical silver diamine fluoride for preventing and managing dental caries in children and adults","volume":"11","author":"Worthington","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_5","first-page":"186","article-title":"Longitudinal follow-up comparing future care of primary teeth treated with silver diamine fluoride","volume":"46","author":"Schlotz","year":"2024","journal-title":"Pediatr. Dent."},{"key":"ref_6","first-page":"59","article-title":"Dentists\u2019 Adoption of Silver Diamine Fluoride among 1- to 5-Year-Old Children in North Carolina","volume":"6","author":"Meyer","year":"2021","journal-title":"JDR Clin. Transl. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.adaj.2022.12.008","article-title":"Silver diamine fluoride-associated delays in procedural sedation in young children: A retrospective cohort study","volume":"154","author":"Meyer","year":"2023","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Whitlatch, K., Richardson, C., Cocke, S., Norris, J., and Meyer, B. (2026). Implementing a disease management standard operating procedure in a contemporary private pediatric dental practice. Front. Dent. Med., 7.","DOI":"10.3389\/fdmed.2026.1781479"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.adaj.2023.04.011","article-title":"Evidence-based clinical practice guideline on restorative treatments for caries lesions","volume":"154","author":"Dhar","year":"2023","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_10","unstructured":"The American Dental Association (2026, May 04). Silver Diamine Fluoride. Available online: https:\/\/www.ada.org\/resources\/ada-library\/oral-health-topics\/silver-diamine-fluoride."},{"key":"ref_11","unstructured":"American Academy of Pediatric Dentistry (2024). Policy on the use of silver diamine fluoride for pediatric dental patients. The Reference Manual of Pediatric Dentistry, American Academy of Pediatric Dentistry. Available online: https:\/\/www.aapd.org\/media\/Policies_Guidelines\/P_SilverDiamine.pdf."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/6\/834\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T10:22:48Z","timestamp":1782469368000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/6\/834"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,20]]},"references-count":11,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["children13060834"],"URL":"https:\/\/doi.org\/10.3390\/children13060834","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,20]]}}}