Survival of silver diamine fluoride among patients treated in community dental clinics: A naturalistic study

Abstract

Background: Silver diamine fluoride (SDF) is a minimally-invasive preventive services used in the U.S. to avert and arrest caries since 2014. Survival outcomes based in real world delivery settings have not been documented. We analyzed 12-month survival outcomes of SDF applied independently or concurrently with other restorative procedures among a population receiving community dental careMethods: We analyzed data on SDF applications from de-identified dental claims on Oregon Health Plan patients served by Advantage Dental in 2016, who had been seen in 2015 (patient n=2,269; teeth n=7,787). We compared survival rates of SDF alone, SDF applied with a sedative filling, and SDF with a same-day restoration. Failure was defined as a restoration or extraction of the tooth 7 to 365 days after initial application. Survival was defined as a patient returning 180 or more days after application whose tooth did not have restoration or extraction. Differences were assessed through Wilcoxon equality of survivor function tests and log-rank equality of survivor tests to compare failure rates, Cox Proportional Hazards models to assess factors associated with survival of SDF, and Kaplan-Meier survival estimate to calculate the probability of survival over time.Results: SDF alone had an overall survival rate of 76%. SDF placed with sedative filling and with a same-day restoration had survival rates of 50% and 84% respectively, likely reflecting treatment intent. SDF alone survived exceptionally well on primary cuspids, permanent molars, and permanent bicuspids and among patients aged 10 to 20 years, with modest variation across caries risk assessment categories. A single annual application of SDF was successful in 68% of cases. Among SDF failures on permanent dentition, more than two-thirds of teeth received a minor restoration.Conclusions: SDF is a minimally invasive non-aerosolizing option that prevented and arrested early stage dental caries among patients in one community dentistry setting. Professional organizations, policy makers, providers, and payors should broaden optional SDF use by informing clinical guidelines, reimbursement policies, and treatment decisions. Future research should address clinical, social, service delivery, workforce, and economic outcomes using diverse population-based samples, and the mechanisms underlying single application success and caries prevention potential. Trial registration: N/A

SDF, SAP P11-4, and GI Sealants for Managing Initial Caries Lesions Produce Clinic and Payor Savings in Financial Impact Model

“…In the short time since it has been used in the US for caries arrest, SDF has already been impactful, for example by lowering the use of general anesthesia in young children by 70% in a large Medicaidfocused network of community clinics. 27 SDF is the focus of the ADA evidence-based guideline on NonRestorative Caries Treatment. 3 The WHO acknowledged SDF's potential to equitably decrease suffering from caries by adding it to its Lists of Essential Medicines (for both children and adults).…”

“…The copyright holder for this preprint this version posted January 31, 2023. ; https://doi.org/10.1101/2023.01. 27.23285118 doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.…”

“…The copyright holder for this preprint this version posted January 31, 2023. ; https://doi.org/10.1101/2023.01. 27.23285118 doi: medRxiv preprint was added to the US Food and Drug Administration's National Drug Codes Directory under the Over the Counter Anticaries Drug Monograph (NDC: 72247-101).…”

Silver Diamine Fluoride Applications in Dentistry: Review Article

“…Gottlieb found that there is a mutual factor concerning the mechanism of desensitizing hypersensitive dentin and arresting DC (49) , also it might possible to measure the SDF caries arresting action in relation to the desensitizing action since the SDF can occlude the dentinal tubules and gives promising results in treating patients with dentin hypersensitivity (12) .…”

Manejo de la caries dental en tiempos de covid- 19: Revisión de literatura.

“…27,34 Esta terapia está contraindicada en pacientes que reportan alergia a la Plata, 35 los pacientes deben ser monitoreados de cerca para verificar la detención de todas las lesiones de forma periódica en función de los factores de riesgo; esto, es especialmente importante cuando se aplica a los dientes permanentes. 36,37 El seguimiento idealmente debería incluir un examen radiográfico y el plan de manejo de caries debe incluir control de placa, asesoramiento dietético, 27,38 la combinación de otras modalidades de Flúor para la prevención de caries como barniz F, geles de Flúor, enjuagues de Flúor y pasta de dientes con Flúor; además, de ser posible sellantes según la edad y la situación individual del paciente. 25,39 El seguimiento de grandes lesiones o lesiones en áreas difíciles de limpiar se puede combinar con el uso de restauraciones de ionómero de vidrio o tratamiento restaurador tradicional, según las circunstancias del paciente.…”