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

Abstract

A systematic review was performed to evaluate the efficacy of silver diamine fluoride (SDF) in controlling caries progression in children when compared with active treatments or placebos. A search for randomized clinical trials that evaluate the effectiveness of SDF for caries control in children compared to active treatments or placebos with follow-ups longer than 6 months was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and grey literature. The risk of bias tool from the Cochrane Collaboration was used for quality assessment of the studies. The quality of the evidence was evaluated using the GRADE approach. Meta-analysis was performed on studies considered at low risk of bias. A total of 5,980 articles were identified. Eleven remained in the qualitative synthesis. Five studies were at “low,” 2 at “unclear,” and 4 studies at “high” risk of bias in the key domains. The studies from which the information could be extracted were included for meta-analysis. The arrestment of caries at 12 months promoted by SDF was 66% higher (95% CI 41-91%; p < 0.00001) than by other active material, but it was 154% higher (95% CI 67-85%; p < 0.00001) than by placebos. Overall, the caries arrestment was 89% higher (95% CI 49-138%; p < 0.00001) than using active materials/placebo. No heterogeneity was detected. The evidence was graded as high quality. The use of SDF is 89% more effective in controlling/arresting caries than other treatments or placebos. The quality of the evidence was graded as high.

Evidence-Based Dentistry Update on Silver Diamine Fluoride

“…These 4 studies of permanent teeth have not been combined in a metaanalysis because they reported outcomes using different measures (number of teeth with new caries lesions or active lesions, in all surfaces vs only pit and fissure, and provide the data in different units of measurement [means and standard deviation vs number of events]). 51 No solid conclusions can be reached with such a small number of studies on permanent teeth in children.…”

“…Based on the Gao 2016 metaanalysis, 18 the proportion of caries arrest on primary teeth treated with different application protocols (1 application, annual, and biannual), and followed from 6 to 30 months, was 81% (95% confidence interval, 68%–89% p <.001). Chibinski and colleagues (2017) 51 reported that the caries arrest at 12 months promoted by SDF was 66% higher (41%–91%) than by other active material, but it was 154% higher (67%–85%) than by no treatment. Chibinski and associated 51 also reported a risk ratio of 1.66 (95% confidence interval, 1.41–1.96) when comparing SDF with active treatments, and a risk ratio of 2.54 (95% confidence interval, 1.67–3.85) when comparing SDF with no treatment.…”

“…Chibinski and colleagues (2017) 51 reported that the caries arrest at 12 months promoted by SDF was 66% higher (41%–91%) than by other active material, but it was 154% higher (67%–85%) than by no treatment. Chibinski and associated 51 also reported a risk ratio of 1.66 (95% confidence interval, 1.41–1.96) when comparing SDF with active treatments, and a risk ratio of 2.54 (95% confidence interval, 1.67–3.85) when comparing SDF with no treatment.…”

“…And finally, there is a clear need for the continued evolution of well-designed, randomized, clinical trials to produce studies with a low risk of bias during the planning, execution, and reporting of results. Standardization in the presentation of data between studies, 18,51 whether they focus on arrest or prevention, is imperative to be able to combine and translate the data into strong clinical guidelines. As indicated, clinicians need to know how to manage arrested lesions for longer periods, which is important for very young children and imperative for permanent teeth.…”

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

“…The use of SDF has recently gained interest due to its easy application and is a promising strategy that can be widely used in several populations, including those for whom restorative treatment is not possible. 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 …”