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 service used in the U.S. to avert and arrest caries since 2014. No studies document survival outcomes based in real world delivery. We analyzed 12-month survival outcomes of SDF applied independently or concurrently with other restorative procedures among a population receiving community dental care. 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 (patient n = 2269; teeth n = 7787). 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 a 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 75% of cases. Among SDF failures on permanent dentition, more than two-thirds of teeth received a minor restoration. Conclusion SDF is a minimally invasive non-aerosolizing option that prevented non-cavitated lesions and arrested early decay among community dentistry patients when applied independently or concurrently with restorative procedures. 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.

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

“…Our study found that caries arrest was better in group 1, which was reflected by 58.9% of the teeth recording score 1. Similar findings were also reported in studies conducted by Zhi et al, 1 Llodra et al, 10 Fung et al, 23 and Vollú et al 32 The analysis also showed that the survival of the SDF restorations was higher than in the case of ART, and this was similar to the findings of Raskin et al 33 This may be a consequence of the remineralizing effect of SDF without requiring a proper cavity form, technical skills and or the use of complex armamentarium. Due to the abovementioned advantages of SDF, it can be used with little or no training by primary healthcare workers in areas with the shortage of dental manpower.…”

Fluoride and silver ion concentrations and pH in silver diamine fluoride solutions from Argentina

“…There is undoubtedly renewed interest in the use of SDF solutions, especially since the COVID-19 pandemic triggered a search for procedures that generate the least amount of aerosols possible 18,19 . The advantages of using SDF solutions are that application time is fast, without the need for cavity preparation, and the product is effective in primary and permanent dentition, making it an important resource, especially for public dental healthcare [19][20][21] .…”

Minimally Invasive Therapies for the Management of Dental Caries—A Literature Review

“…The findings of this population-level, real-world study suggests that SDF application is effective in caries arrest. Since the data for the study was drawn from dental claims, the diagnosis for SDF application (e.g., hypersensitivity vs decay, cavitated vs non-cavitated lesions) could not be ascertained and therefore data only represents overall survival rates of SDF application and must be interpreted cautiously [ 63 ].…”