{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T17:16:51Z","timestamp":1779383811641,"version":"3.53.1"},"reference-count":24,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Severe early childhood caries (SECC) in preschool children is a progressive, multifactorial disease with far-reaching consequences for child health, family functioning, and health systems. Minimally invasive dentistry (MID), particularly 38% silver diamine fluoride (SDF), is increasingly used to arrest lesions and \u201cbuy time\u201d when definitive restorative care is delayed. This narrative review synthesizes current evidence-based guidelines and real-world utilization data to clarify the appropriate role and limits of SDF in SECC management. Professional guidance supports SDF for lesion arrest within an ongoing caries management plan, but does not endorse it as a universal long-term substitute for durable restorative care. Observational studies show that many SDF-treated primary teeth receive additional intervention within approximately 2 years, and any delay in sedation\/general anesthesia is typically measured in weeks to months. A large recent private practice study found that 35% of children with caries progressed to higher-intensity treatment (restoration or extraction) over a median of 547 days, reinforcing the time-limited nature of interim stabilization. We propose a \u201cpreservation-to-precision\u201d framework that prioritizes child-centered outcomes\u2014freedom from pain and infection, durable function, and acceptable psychosocial impact\u2014through risk-based, tooth- and child-specific planning, realistic follow-up assessment, and clear exit criteria for transition to definitive care. In high-income settings, the ethical value of \u201cbuying time\u201d depends on whether systems use that time to advance children toward timely, definitive care rather than normalizing prolonged temporization as routine practice.<\/jats:p>","DOI":"10.3390\/ijerph23050656","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:46:18Z","timestamp":1779381978000},"page":"656","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preservation-to-Precision in Severe Early Childhood Caries: A Narrative Review of Silver Diamine Fluoride\u2014When \u201cBuying Time\u201d Must Not Become \u201cSelling Time\u201d"],"prefix":"10.3390","volume":"23","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, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB R3B 0L8, Canada"},{"name":"Division of Pediatric Dentistry, Department of Preventive Dental Sciences, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB R3E 0W2, Canada"},{"name":"TopSmiles Pediatric Dentistry and Orthodontics, Winnipeg, MB R2M 3A4, Canada"},{"name":"Butterfly Dental Group, Winnipeg, MB R3Y 1P5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","unstructured":"American Academy of Pediatric Dentistry (2025). Policy on Early Childhood Caries (ECC): Consequences and Preventive Strategies. The Reference Manual of Pediatric Dentistry, American Academy of Pediatric Dentistry."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/j.adaj.2018.07.002","article-title":"Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association","volume":"149","author":"Slayton","year":"2018","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_3","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_4","unstructured":"American Academy of Pediatric Dentistry (2025). Policy on the Use of Silver Diamine Fluoride for Pediatric Dental Patients. The Reference Manual of Pediatric Dentistry, American Academy of Pediatric Dentistry."},{"key":"ref_5","unstructured":"American Academy of Pediatric Dentistry (2025). Policy on Minimally Invasive Dentistry. The Reference Manual of Pediatric Dentistry, American Academy of Pediatric Dentistry."},{"key":"ref_6","unstructured":"American Academy of Pediatric Dentistry (2025). Policy on the Dental Home. The Reference Manual of Pediatric Dentistry, American Academy of Pediatric Dentistry."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ismail, A.I., Pitts, N.B., and Tellez, M. (2015). Authors of the International Caries Classification and Management System (ICCMS). The International Caries Classification and Management System (ICCMS\u2122): An example of a caries management pathway. BMC Oral Health, 15.","DOI":"10.1186\/1472-6831-15-S1-S9"},{"key":"ref_8","first-page":"CD012718","article-title":"Topical silver diamine fluoride for preventing and arresting dental caries","volume":"11","author":"Worthington","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Seifo, N., Cassie, H., Radford, J.R., and Innes, N.P.T. (2019). Silver diamine fluoride for managing carious lesions: An umbrella review. BMC Oral Health, 19.","DOI":"10.1186\/s12903-019-0830-5"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1159\/000478668","article-title":"Silver diamine fluoride has efficacy in controlling caries progression in primary teeth: A systematic review and meta-analysis","volume":"51","author":"Chibinski","year":"2017","journal-title":"Caries Res."},{"key":"ref_11","first-page":"201","article-title":"Clinical trials of silver diamine fluoride in arresting caries among children: A systematic review","volume":"1","author":"Gao","year":"2016","journal-title":"JDR Clin. Transl. Res."},{"key":"ref_12","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: A report from the American Dental Association","volume":"154","author":"Dhar","year":"2023","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_13","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_14","doi-asserted-by":"crossref","first-page":"400","DOI":"10.17796\/1053-4625-44.6.2","article-title":"Comparing Dental Treatment between Children Receiving and not Receiving Silver Diamine Fluoride","volume":"44","author":"Davis","year":"2020","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_15","first-page":"186","article-title":"Longitudinal Follow-up Comparing Future Care of Primary Teeth Treated with Silver Diammine Fluoride: A Private Dental Claims Review","volume":"46","author":"Schlotz","year":"2024","journal-title":"Pediatr. Dent."},{"key":"ref_16","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_17","doi-asserted-by":"crossref","unstructured":"Raskin, S.E., Tranby, E.P., Ludwig, S., Okunev, I., Frantsve-Hawley, J., and Boynes, S. (2021). Survival of silver diamine fluoride among patients treated in community dental clinics: A naturalistic study. BMC Oral Health, 21.","DOI":"10.1186\/s12903-020-01379-x"},{"key":"ref_18","unstructured":"Office of the United Nations High Commissioner for Human Rights (OHCHR) (2026, January 28). Convention on the Rights of the Child. Available online: https:\/\/www.ohchr.org\/en\/instruments-mechanisms\/instruments\/convention-rights-child."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/1477-7525-5-6","article-title":"Parental perceptions of children\u2019s oral health: The Early Childhood Oral Health Impact Scale (ECOHIS)","volume":"5","author":"Pahel","year":"2007","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/00005650-199902000-00003","article-title":"The PedsQL\u2122: Measurement model for the pediatric quality of life inventory","volume":"37","author":"Varni","year":"1999","journal-title":"Med. Care"},{"key":"ref_21","unstructured":"American Academy of Pediatric Dentistry, and Pediatric Oral Health Research and Policy Center (2021). Denial of Access to Operating Room Time in Hospitals for Pediatric Dental Care. Policy Brief, American Academy of Pediatric Dentistry."},{"key":"ref_22","first-page":"33","article-title":"Denial of Operating Room Access for Pediatric Dental Treatment: A National Survey","volume":"43","author":"Vo","year":"2021","journal-title":"Pediatr. Dent."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Baghdadi, Z.D. (2026). When \u201cAdvances\u201d Become Substitutes for Access: A Systems Critique of Children\u2019s Dentistry in NHS England and the Normalisation of Extraction, Containment, and Planned Tooth Loss. Children, 13.","DOI":"10.20944\/preprints202601.1356.v1"},{"key":"ref_24","unstructured":"Australian Institute of Health and Welfare (2026, April 10). Oral Health and Dental Care in Australia, Available online: https:\/\/www.aihw.gov.au\/reports\/dental-oral-health\/oral-health-and-dental-care-in-australia\/contents\/about."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/5\/656\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:48:20Z","timestamp":1779382100000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/5\/656"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":24,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["ijerph23050656"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23050656","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}