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

Purpose: To provide an evidence calibrated, time bound clinical framework for the use of 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 (2017–2025), 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 (< 6 months, 6–12 months, >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. Conclusion: 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. Equity explicit implementation prevents the framework from penalizing underserved children.