Knowledge, attitudes, and practices of silver diamine fluoride among general dental practitioners: a multinational cross-sectional study

Silver diamine fluoride (SDF) is an evidence-based minimally invasive material for arresting carious lesions; however, its clinical adoption in routine dental practice remains variable. This study assessed the knowledge, attitudes, and practices (KAP) of general dental practitioners (GDPs) regarding SDF across nine countries and identified factors associated with its clinical use. A multinational web-based cross-sectional survey was conducted among GDPs across nine countries between July and December 2025. Participants were recruited using non-probability convenience sampling through academic institutions, professional networks, and online platforms. A structured questionnaire assessed demographic characteristics, awareness, knowledge, attitudes, practices, barriers, and learning preferences regarding SDF. Respondents aware of SDF were included in the KAP analyses. Group comparisons were performed using nonparametric tests, and multivariable linear and logistic regression analyses were used to identify factors associated with KAP scores and current SDF use. A total of 1,084 GDPs participated, of whom 77.3% ( n = 838) were aware of SDF. Among SDF-aware participants, the mean knowledge and attitude scores were 22.80 ± 4.10 and 28.66 ± 5.28, respectively, while 31.1% ( n = 261) reported current SDF use. The main barriers were esthetic concerns related to black staining (64.7%) and parental refusal (48.8%). Multivariable regression showed that higher attitude scores (B = 0.048; p = 0.017) and 5–10 years of clinical experience were associated with higher practice scores (B = 0.488; p = 0.022), while advanced training was significantly associated with current SDF use (OR = 3.76; p < 0.001). Knowledge was not independently associated with current SDF use. Significant between-country differences were observed in knowledge, attitude, and practice scores ( p ≤ 0.001). Although awareness of SDF was relatively high, its routine clinical use remained limited among GDPs. Advanced training and positive practitioner attitudes were associated with SDF adoption, whereas knowledge alone was not. Expanding continuing education and improving access to training may facilitate broader evidence-based implementation of SDF in general dental practice.