Comparison of the effectiveness of 38% silver diamine fluoride and atraumatic restorative treatment for treating dental caries in a school setting: A randomized clinical trial

Abstract

Background. Dental caries is an infectious microbial disease of the teeth, affecting mostly young children. It is caused by the interplay of numerous factors that are more common in susceptible and lower-income groups. Therefore, there is a dire need for a simple yet effective method of treating dental caries.Objectives. The aim of the study was to compare the effectiveness of 38% silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) in the treatment of dental caries in a school setting. Material and methods.A randomized clinical trial (RCT) using a parallel-group design was conducted among schoolchildren aged 6-12 years. Oral hygiene practices and sugar exposure were recorded at baseline. In the schoolchildren, 190 dental caries lesions were restored using 38% SDF (group 1) or ART (group 2). The χ 2 test and the Kaplan-Meier survival analysis were done to assess the 2 treatment modalities. The RCT was carried out and reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) checklist. Results.A total of 190 children fulfilled the inclusion criteria and the mean age of the study population was 9.3 ±1.3 years. The majority of the participants brushed their teeth once daily, using a toothbrush, rinsed their mouth after meals and had optimal sugar exposure. In measuring the outcome of the interventions after 9 months, 58.9% of the participants from group 1 had their restorations intact as compared to 47.8% in group 2, and this was found to be statistically significant (p = 0.004). The survival analysis using the log rank test showed 38% SDF to be better in comparison with ART.Conclusions. This study indicated that SDF was better at arresting caries, and hence it can be considered a viable treatment option in areas with limited access to oral healthcare.

A systematic review on the effect of silver diamine fluoride for management of dental caries in permanent teeth

“…Satyarup et al ( 2022 ) investigated the effectiveness of 38% SDF and atraumatic restorative treatment (ART) for treating dental caries of permanent molars in children for a period of 9 months. The SDF treatment group presented with 5.6% carious teeth and partly lost restorations, while the control group had 16.7% carious teeth with partly lost restorations and 8.9% carious teeth with completely lost restorations ( p = .004).…”

“…Li et al ( 2017 ) and Zhang et al ( 2013 ) included community‐dwelling elders, while, in Tan et al ( 2010 ) study, the older people in residential homes and in Satyarup et al ( 2022 ) trial, disabled individuals were only recruited. This should be taken into account when comparing the data sets of the four studies since the differences in results between Tan et al ( 2010 ), Satyarup et al ( 2022 ) and the other two studies (Satyarup et al, 2022 ; Zhang et al, 2013 ) might be related to the variations in their selection criteria. Having studies that only include older participants/disabled individuals would limit this systematic review by not allowing for speculation towards adults of other age/background groups.…”

“…Having studies that only include older participants/disabled individuals would limit this systematic review by not allowing for speculation towards adults of other age/background groups. The three studies only assessed the effect of SDF on root caries while Satyarup et al ( 2022 ) reported the effect of SDF use on enamel carious lesions. This was another limitation, as the SDF application was not explored in other types of dental caries.…”

“…Different durations for 11 studies were also noticed. Satyarup et al ( 2022 ) conducted the clinical study for a period of six months while Baraka et al ( 2022 ) had nine months only. Mauro et al ( 2004 ) and Zhang et al ( 2013 ) only reported results for the end of the study.…”

“…The study provided details of dropout reasons, including changes in (2022) and the other two studies (Satyarup et al, 2022;Zhang et al, 2013) might be related to the variations in their selection criteria.…”