Patient Comfort and Acceptance of Different Isolation Techniques for Silver Diamine Fluoride Application: A Randomized Clinical Trial.

BACKGROUND: Efficient isolation is critical for effective silver diamine fluoride (SDF) application in pediatric dentistry. However, conventional methods like cotton roll isolation may be uncomfortable and compromise cooperation. This study compares patient comfort and acceptance of cotton roll, OpalDam, and OptraDam during SDF application. AIM: To evaluate and compare patient discomfort and satisfaction associated with cotton roll, OpalDam, and OptraDam isolation techniques during SDF application in primary mandibular molars of children. MATERIALS AND METHODS: Thirty-nine children aged 5-9 years were randomly allocated to cotton roll, OpalDam, or OptraDam isolation (n = 13 per group). A calibrated operator applied 38% SDF under the assigned isolation. Postprocedure pain was recorded with the Wong-Baker FACES Pain Rating Scale (WBFPS); a six-item 0-10 numerical questionnaire captured annoyance, gag reflex, fluid leakage, oral stretching, tongue pressure, and overall comfort. Intergroup differences were analyzed with one-way analysis of variance (ANOVA) and Tukey post hoc tests (α = 0.05). RESULTS: Mean WBFPS scores differed significantly (F = 7.708, p = 0.002). OpalDam showed the lowest pain (1.38 ± 1.50) vs OptraDam (2.54 ± 2.11) and cotton rolls (4.00 ± 1.41). The difference in pain experienced by patients treated under cotton roll and OpalDam exhibited a statistically significant difference (p = 0.001). Across all questionnaire domains, OpalDam achieved the most favorable ratings, followed by OptraDam, with cotton rolls consistently demonstrating higher discomfort (p < 0.05 for all comparisons). CONCLUSION: OpalDam and OptraDam provide superior patient comfort and acceptance compared to cotton roll isolation. OpalDam may be the preferred method for noninvasive pediatric procedures such as SDF application.