Caries management using silver diamine fluoride and providing domiciliary dental care for dependent older adults: a qualitative study of Swiss dentists

Objectives: Maintaining the oral health of dependent older adults is challenging, with limited access to dental care and limited focus on preventive oral health programs. This study aimed to evaluate the attitudes of General Dental Practitioners (GDPs) working in Switzerland to caring for dependent older adults focused on the use of silver diamine fluoride (SDF) as a caries preventive agent and more widely on the provision of domiciliary dental care (DDC). Methods: Seventeen GDPs working in Switzerland were interviewed. Each interview was semi-structured by a topic guide, digitally recorded, and transcribed. The transcribed data were analysed using a thematic analysis. Results: Three major themes to the widespread use of SDF in this population were identified: lack of basic knowledge including indications for use; aesthetic concerns and product availability. The GDPs identified three major barriers related to DDC provision: lack of infrastructure; poor financial rewards and safety concerns. Conclusions: The GDPs interviewed as part of this study identified a number of reasons for the low levels of uptake of SDF as a caries preventative agent for dependent older adults. They also identified a number of barriers to further utilisation of DDC as a modality for addressing oral health provision in this population.