Randomized Clinical Trial of 12% and 38% Silver Diamine Fluoride Treatment

Abstract

This 30-mo randomized clinical trial compared the effectiveness of 2 concentrations (12% or 38%) of silver diamine fluoride (SDF) and 2 periodicity of application (once or twice a year) in arresting cavitated dentin caries in primary teeth. Children aged 3 to 4 y who had at least 1 active cavitated caries lesion were enrolled and randomly allocated into 4 groups for intervention. Group 1 had 12% SDF applied annually (every 12 mo), group 2 had 12% SDF applied semiannually (every 6 mo), group 3 had 38% SDF applied annually, and group 4 had 38% SDF applied semiannually. Clinical examinations were performed semiannually in kindergarten by a single examiner to investigate whether the SDF-treated caries became arrested. A total of 888 children with 4,220 decayed tooth surfaces received SDF application at baseline, and 799 (90.0%) children with 3,790 surfaces (89.8%) were evaluated at the 30-mo examination. The caries arrest rates were 55.2%, 58.6%, 66.9%, and 75.7% for groups 1, 2, 3, and 4, respectively ( P < 0.001). Caries treated with 38% SDF had a higher chance of becoming arrested than those treated with 12% SDF (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.51-2.60, P < 0.001). The interaction between frequency of SDF application and visible plaque index (VPI) score was significant ( P = 0.017). Among those children who received annual SDF application, children with a higher VPI score had a lower chance to have their caries become arrested (OR, 0.59, 95% CI, 0.49-0.72). In conclusion, SDF at a concentration of 38% is more effective than that of 12% in arresting active caries in primary teeth. For children with poor oral hygiene, caries arrest rate of SDF treatment can be increased by increasing the frequency of application from annually to semiannually ( ClinicalTrials.gov NCT02385474).

Comparison of two caries prevention programs among Thai kindergarten: a randomized controlled trial

“…The active caries treated with SDF usually turns into arrested caries, which is normally brown or black, hard, glossy, and non-progressive. SDF inhibits tooth demineralization and promotes remineralization [21,22]. However, this study did not alter the child eating habit which might affect the caries development.…”

Evidence-Based Dentistry Update on Silver Diamine Fluoride

“…Several trials have stressed that in their results, anterior teeth have much higher rates of arrest than posterior teeth 41–45 As an example, one of the trials not included in the reviews, because it just published its 30-month results, 42 reports caries arrest by type of primary tooth using SDF 38% semiannually (Box 2). …”

“…The difference in arrest rates in children receiving applications twice per year versus once per year was small between 24 and 30 months in all teeth, but among children who received annual application, those with visible plaque had a lesser likelihood of having their lesions arrested. Fung and colleagues 42 conclude that, for children with poor oral hygiene, caries arrest rate can be increased by increasing the frequency of application from annually to semiannually.…”

“…Large lesions, occlusal lesions and those with visible plaque have less chances of arrest 41,42,44 (Figs. 6 and 7);…”

Silver Diamine Fluoride in Pediatric Dentistry

“…10 Eight studies 5,21,34-39 reported caries arrest with SDF application in children based on published literature in English for the last two decades ( Table 2). Five studies reported the use of 38% SDF for caries arrest 5,21,34,35,39 while three studies [36][37][38] reported 30% SDF. The researchers found that 38% of SDF application is most effective compared to a no treatment (negative control) or a placebo in the primary teeth for arresting dentine caries.…”