Survival of Silver Diamine Fluoride Among Patients Treated in Community Dental Clinics: A Naturalistic Study

Abstract

Objectives: To describe survival outcomes of silver diamine fluoride (SDF) among a population-based sample receiving care in community settings.Methods: 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. Survival rates of SDF alone, SDF applied with a sedative filling, and SDF with a same-day restoration were compared. Failure was defined as a restoration or extraction of the tooth 7 to 365 days after initial application, while survival was defined a patient that returned 180 or more days after application and the 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 the intent of treatment. 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 demonstrably prevented and arrested early stage dental caries among patients in one “real world” community dentistry setting. Professional organizations, policy makers, providers, and payors should consider broadening the option to use SDF by informing clinical guidelines, reimbursement policies, and treatment decisions, especially amidst COVID-19 pandemic driven guidelines to minimize risk of exposure to airborne pathogens. Future research should address clinical, social, health service delivery, workforce, and economic outcomes including costs and invasive procedures deferred, using diverse population-based samples, and the mechanisms underlying the success of a single application and the potential for SDF to prevent caries found in this study.Trial registration: N/A