Dental caries has been around for time immemorial. It is a microbial infectious disease and probably the most significant chronic childhood disease prevalent globally. It can lead to a high level of morbidity and affect the quality of life in many ways. It is a secular infectious disease cutting across all sections of society in both developed and developing nations. Some of the consequences of untreated lesions are pain, swelling, fever, inability to eat, malnutrition, difficulty in speech and tooth loss.

A lot has changed in the recent past in understanding the science of dental caries, its prevention and treatment but data from across the world shows that dental caries remains a serious disease globally.

The level of awareness in caregivers (parents and non dental healthcare providers) regarding the symptoms, treatment (especially of untreated lesions) and prevention of dental caries remains low. This leads to a huge burden of care on the society.

Special health care needs children are at a much higher risk of developing dental caries because of their inherent challenges of carrying our even simple acts like tooth brushing. Added to this is also the fact that most of the parents of special children may be focused on seeking and providing seemingly more important medical care to their child/children which leads to a neglect of dental care. Medical care in special children may also involve administering medications in a sweetened syrup form which are mostly sugar based. Lack of awareness regarding caries prevention amongst parents leads to dental caries in such children. Special children are often on pureed diets which are more cariogenic and need special preventive protocols often found missing. Added to these is the fact that special children need a different approach for their dental treatment and hence not all dentists are able to competently treat special children. More often than not this also entails higher treatment costs which become a constraint for many parents leading to a neglect of dental caries. This may become a vicious cycle and end in serious morbidity and tooth loss.

Over time numerous preventive strategies and protocols have been tried and tested by the dental fraternity of researchers and clinicians. Literature is replete with many examples and two stand out in recent times. These are topical application of fluoride varnish (FV) and silver diamine fluoride (SDF). Many studies have been conducted on both the protocols and there are meta analysis and systematic reviews too, explaining the evidence on their efficacy. Both protocols work.

Traditionally fluoride varnish has been extensively used in the prevention of dental caries. SDF has proven itself to be a effective measure in arresting decay, hence the interest in its use in special children. Very few relevant studies exist in the literature where in SDF has been studied in special children, either alone or with fluoride varnish.

This trial will try and bridge this gap.