Is Silver Diamine Fluoride Effective in Arresting Enamel Caries? A Randomized Clinical Trial

Abstract

Background: There is limited information on the effectiveness of 38% silver diamine fluoride (SDF) in managing enamel caries. Objective: This study aimed to compare effectiveness of 38% SDF and 5% Sodium fluoride (NaF) varnish in arresting enamel caries in young children when applied semiannually over 18 months. Methods: A randomized controlled trial was conducted on children aged 1–3 years who had at least one active carious surface. They were allocated into two groups: Group 1 (38% SDF) and Group 2 (5% NaF varnish). Visual-tactile examination was used to assess extent of carious lesions. Enamel caries that did not progress to dentin were classified as having caries arrest. Intention-to-treat analysis was performed. Results: At baseline, 290 children with 1974 tooth surfaces with enamel caries were recruited. Caries arrest rates at the tooth surface level in Group 1 and Group 2 were 59.1% and 58.8%, respectively (p = 0.873), at 18 months. The multilevel logistic regression analysis revealed that tooth position, tooth surface, extent of enamel caries at baseline, caries experience, and brushing with fluoride toothpaste influenced caries arrest (p < 0.05). Conclusion: The semiannual application of 38% SDF and 5% NaF varnish had comparable effectiveness in arresting enamel caries in primary teeth.

Effectiveness of silver diamine fluoride versus sodium fluoride varnish combined with mother’s motivational interviewing for arresting early childhood caries: a randomized clinical trial

“…This agrees with Duangthip et al [11] who reported a small and non-significant difference between 30% SDF and 5% NaF in arresting ICDAS 3 or 4 lesions. Our findings disagree with Phonghanyudh et al [12] who reported that 38% SDF had significantly higher arrest rate of ICDAS 3 enamel lesions than NaF after 6 months. However, Phonghanyudh et al applied NaF varnish on affected lesions only unlike the present study where NaF varnish was applied to all teeth with greater area available to act as fluoride reservoir and continuously release fluoride than when applied on affected lesions only [46].…”

“…It seems that the caregivers’ main concern was to stop caries progression regardless of the esthetics. These findings agree with previous studies [ 12 , 15 , 21 ].…”

“…It is important to interpret the findings within the context of the study setting. Children in previous studies assessing the effect of SDF and NaF varnish on arresting caries had higher tooth brushing frequency [ 12 , 21 ]. In the present study, however, the children had high levels of plaque accumulation and low tooth brushing frequency which highlight the need for behavior change interventions to promote good oral hygiene and control ECC.…”

“…Sodium Fluoride (NaF) varnish is a common fluoride product for caries prevention [ 9 , 10 ]. Previous studies have shown positive results in arresting enamel caries when 5% NaF varnish was used [ 11 , 12 ]. However, 5% NaF varnish has low efficacy in arresting dentin caries [ 13 ].…”

Comparative evaluation of prevention of demineralization of artificial enamel caries treated with two fluoride varnishes and 38% SDF in primary teeth: an in vitro study

“…In early enamel lesions, both fluoride varnish and SDF have been suggested as treatment strategies, especially in young children, due to their ease of application and safety [ 3 , 12 , 16 , 17 ]. The effect of SDF compared to NaF varnish on enamel remineralization was previously investigated [ 12 , 18 ]. Yet, up to our knowledge, our study is the first to compare the effect of SDF and fluoride varnishes containing calcium-phosphate on WSLs in primary teeth.…”