The Effect of Silver Diamine Fluoride in Preventing Caries in the Primary Dentition: A Systematic Review and Meta-Analysis

Abstract

Objectives: To investigate whether silver diamine fluoride (SDF) is effective in preventing new caries lesions in primary teeth when compared to placebo or active treatments. Methods: Systematic review (CRD42016036963) of controlled clinical trials. Searches were performed in 9 electronic databases, 5 registers of ongoing trials, and reference lists of identified review articles. Two researchers carried out data extraction and quality appraisal independently. The primary outcome was the difference in caries increment (decayed, missing, and filled surfaces or teeth – dmfs or dmft) between SDF and control groups. These differences were pooled as weighted mean differences (WMD) and prevented fractions (PF). Results: Searches yielded 2,366 unique records; 6 reports of 4 trials that randomized 1,118 and analyzed 915 participants were included. Two trials compared SDF to no treatment, 1 compared SDF to placebo and sodium fluoride varnish (FV), and 1 compared SDF to high-viscosity glass ionomer cement (GIC). All studies had at least 1 domain with unclear or high risk of bias. After 24 months of follow-up, in comparison to placebo, no treatment, and FV, SDF applications significantly reduced the development of new dentin caries lesions (placebo or no treatment: WMD = –1.15, PF = 77.5%; FV: WMD = –0.43, PF = 54.0%). GIC was more effective than SDF after 12 months of follow-up but the difference between them was not statistically significant (WMD, dmft: 0.34, PF: –6.09%). Conclusion: When applied to caries lesions in primary teeth, SDF compared to no treatment, placebo or FV appears to effectively prevent dental caries in the entire dentition. However, trials specifically designed to assess this outcome are needed.

Evidence-Based Dentistry Update on Silver Diamine Fluoride

“…In their recent systematic review and metaanalysis, Oliveira and colleagues 49 evaluated caries prevention for primary teeth and concluded that, when compared with placebo at 24 months or more, SDF decreased the development of dentin caries lesions in treated and untreated primary teeth with a preventive fraction of 77.5%. Comparisons between SDF and FV concluded that SDF performed significantly better than FV at 18 and 30 months, and comparison between SDF and glass ionomer cements (GIC) showed that GIC was better than SDF at 12 months (not statistically significant).…”

Silver Diamine Fluoride in Pediatric Dentistry

“…Oliveira et al 11 in a systematic review and meta-analysis evaluated the effectiveness of SDF in preventing caries in primary dentition compared to placebo, fluoride varnish, or no treatment. They concluded that SDF appears to prevent caries effectively in the complete primary dentition.…”

“…13,22,26 However, for a cumulative effect of silver uptake and risk of silver poisoning to occur, a total lifetime silver exposure of 1 g, corresponding to nearly 400 SDF applications is needed as per the U.S. Environmental Protection Agency. 49 Another concern is the black discoloration 10,11,34,40 in the arrested lesions disclosed after SDF application (Figs 2B and 3B). Parents and children should be informed that SDF application causes black or dark brown stain, as the soft infected dentin turns harder and development of a sclerotic black surface in the tooth.…”

“…9 Though not new, silver diamine fluoride (SDF) most recently had demonstrated amplified attention by clinicians globally due to its effectiveness in arresting the progression of carious lesions. 10,11 More than four decades witnessed the successful usage of silver fluoride (AgF) as a preventive material in both clinical and in vitro studies. 12 The U.S. Food and Drug Administration (FDA) gave clearance in August 2014 to the first SDF preparation for dental use in the United States and is available for use since April 2015.…”

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

“…The third systematic review looked at SDF use for prevention of caries in primary teeth. 227 This review included 2 trials comparing SDF with no treatment, one comparing SDF with a placebo and NaF varnish and the other comparing SDF with glass ionomer cement. The conclusions were that SDF appears to effectively prevent new caries development when compared with no treatment, placebo, or fluoride varnish.…”