Clinical evaluation of a modified silver fluoride application technique designed to facilitate lesion assessment in outreach programs

Abstract

BackgroundAn advantage of using silver fluoride treatments for carious primary teeth in outreach programs especially where dental resources are limited is that the treatments can be carried out by dental auxiliaries. One limitation to date is that assessments of lesion status have been based on a tactile test where a sharp probe or explorer is drawn across the surface of a lesion to assess its hardness. This is a technique-sensitive step and has the potential for iatrogenic damage, especially when a lesion is deep. This study was undertaken to determine whether an alternative, non-invasive, visual assessment could be a reliable indicator of lesion status. The approach was based on the retention, or otherwise, of a black surface deliberately created at the time of initial treatment.MethodsA total of 88 lesions in the primary molars of 45 children, aged 5 to 10 years, were treated with a one-minute application of 40% silver fluoride. The surface of the lesions was then deliberately turned black by the application of 10% stannous fluoride as a reducing agent. All lesions were on an approximal or occlusal surface of a first or second primary molar. The presence or absence of a continuous black surface at 6 months and any changes in radiographic depth that had occurred in that period were determined from digitized photographs and bitewing radiographs.ResultsThe retention of an uninterrupted black surface was associated with minimal or no caries progression whereas lesions with an incomplete or lost black surface were 4.6 times more likely to have progressed. Use of the Datta and Satten Rank-Sum Test to account for any clustering effect showed that the difference was statistically significant (p < 0.0001). The sensitivity and specificity of the approach were 80% and 81% respectively.ConclusionThe retention of a continuous black surface after the application of silver fluoride followed by a reducing agent on carious lesions in primary molars can provide a useful visual indicator of lesion progression and so be relevant for use in dental outreach programs.

Silver Diamine Fluoride Has Efficacy in Controlling Caries Progression in Primary Teeth: A Systematic Review and Meta-Analysis

“…Thirty papers were excluded after abstract reading, resulting in 19 full-text articles for the assessment of eligibility. Eight papers were excluded due to: (1) follow-up period equal to or lower than 6 months [Craig et al, 2013;Nishino et al, 1969], (2) absence of control group [Almeida et al, 1994], (3) being an early report of another study already included [Lo et al, 2001;Nassar et al, 2010], (4) inadequate test group [McDonald and Sheiham, 1994;Vachirarojpisan et al, 2009] and (5) the method of evaluation was based on qualitative scores [Braga et al, 2009] ( Fig. 1 ).…”

An alternate technique of care using silver fluoride followed by stannous fluoride in the management of root caries in aged care

“…to carious deciduous teeth in rural NSW in a minimal intervention study. After 2 years, 74% of the carious approximal surfaces and 90% of the carious occlussal surfaces remained unchanged . Topical AgF+SnF 2 has been shown to be effective in preventing pit and fissure caries in permanent first molars …”

Aesthetic perception, acceptability and satisfaction in the treatment of caries lesions with silver diamine fluoride: A scoping review

“…Moreover, previous studies have proved the efficacy of this material in the prevention and control of coronary caries progression, both in primary and in permanent teeth, and root caries lesions in permanent teeth . Thus, SDF usage could potentially increase access to health care and improve oral health, ultimately reducing the need for urgent care …”

“…11,12 Thus, SDF usage could potentially increase access to health care and improve oral health, ultimately reducing the need for urgent care. 13 With regard to the mechanism of action, silver particles act on proteins, ensuring the antibacterial action of SDF. 14 Despite antimicrobial effectiveness, silver particles, however, are responsible for causing blackening of carious enamel and dentin.…”