This work is licensed under Creative Commons Attribution–NonCommercial International License
(CC BY-NC 4.0).
Caries in early childhood (ECC) is a condition that affects children who are on Medicaid at a disproportionate rate,
which contributes to more children not receiving care and preventive treatment. The minimally invasive and low-cost
intervention, silver diamine fluoride (SDF), has been established to halt the development of caries. Inconsistent
outcomes have also been caused by variability in its clinical use functionality, such as frequency, technique, and
Medicaid reimbursement. The current review summarizes available findings on the applications of SDF among the
pediatric population, including the detection of protocol differences, and the potential for uniformity in Medicaid
programs. PubMed, Scopus, and Google Scholar were used to conduct a narrative literature review based on the
studies concerning the efficacy, safety, and application of SDF to underserved pediatric populations. Results indicate
that SDF is always extremely efficient in caries arrest, but there exists considerable variation in the guidelines of
application. There are studies that prescribe applying it annually, whereas some studies prove to be twice-yearly in
order to achieve better results. Major challenges during the implementation process are staff training, workflow
integration, and Medicaid billing issues. Though SDF has proven to be an efficient and fair instrument regarding the
management of caries in children, it is not a mainstream practice due to the absence of a standardized procedure
unique to the Medicaid system. The review suggests a necessity to develop coherent, evidence-based instructions to
facilitate SDF delivery in a Medicaid environment that would eventually enhance patient outcomes and decrease
disparities in child oral health care.