Skip to main content

Advertisement

SpringerLink
Log in

Caries arrest effectiveness of silver diamine fluoride compared to alternative restorative technique: randomized clinical trial

  • Original Scientific Article
  • Published:
European Archives of Paediatric Dentistry Aims and scope Submit manuscript

Abstract

Objective

This RCT study assessed and compared the effect of a biannual application of 38% silver diamine fluoride (SDF) with alternative restorative technique (ART) on arresting caries in primary dentition.

Methods

The RCT was conducted over a period of 12 months and included 79 healthy children (237 primary teeth), aged 3–8 years, selected from the University Pediatric Dentistry outpatient clinics, with at least one primary asymptomatic tooth with active dentinal occlusal/labial lesions. Children were randomly assigned to SDF application or ART treatment. Visual and tactile examinations were used after 6 and 12 months to assess the activity of the carious lesions using the ICDAS II.

Results

At 6- and 12-month-evaluation periods, no statistically significant differences in lesions arrest were found between SDF and ART groups (P = 1.000). Considering the frequency of arrested caries between the test groups at 6 and 12 months, no significant differences were observed between anterior and posterior lesions, as well as between the maxillary and mandibular lesions. When comparing the working time for the two treatments, the median time for those treated with SDF was 3.3 min, compared to 14.4 min for ART and was statistically significant (P < 0.0001).

Conclusion

Both SDF and ART are, indeed, effective for arresting caries. However, the chair-time management required for SDF is significantly shorter compared to ART. Taking into consideration the present evidence, the best decision regarding disease management and application of SDF or ART is to be made by the dentist and the patient/parent, recognizing individuals’ differences and preferences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Al-Meedani LA, Al-Dlaigan YH. Prevalence of dental caries and associated social risk factors among preschool children in Riyadh, Saudi Arabia. Pak J Med Sci. 2016;32(2):452.

    PubMed  PubMed Central  Google Scholar 

  • Al Ayyan W, Al Halabi M, Hussein I, Khamis A, Kowash M. A systematic review and meta-analysis of primary teeth caries studies in Gulf Cooperation Council States. Saudi Dent J. 2018;30(3):175–82.

    Article  PubMed  PubMed Central  Google Scholar 

  • Alhabdan YA, Albeshr AG, Yenugadhati N, Jradi H. Prevalence of dental caries and associated factors among primary school children: a population-based cross-sectional study in Riyadh, Saudi Arabia. Environ Health Prev Med. 2018;23(1):60.

    Article  PubMed  PubMed Central  Google Scholar 

  • American Academy of Pediatric Dentistry. Fluoride therapy. Pediatr Dent. 2018;40(6):250–3.

    Google Scholar 

  • Bedi R, Sardo-Infirri J. Oral health care in disadvantaged communities. London: FDI World; 1999.

    Google Scholar 

  • Beltrán-Aguilar ED. Silver diamine fluoride (SDF) may be better than fluoride varnish and no treatment in arresting and preventing cavitated carious lesions. J Evid Based Dent Pract. 2010;10(2):122–4.

    Article  PubMed  Google Scholar 

  • Chen KJ, Gao SS, Duangthip D, Lo ECM, Chu CH. Prevalence of early childhood caries among 5-year-old children: A systematic review. J Investig Clin Dent. 2019;10(1):e12376.

    Article  PubMed  Google Scholar 

  • Chibinski AC, Wambier LM, Feltrin J, Loguercio AD, Wambier DS, Reis A. Silver diamine fluoride has efficacy in controlling caries progression in primary teeth: a systematic review and meta-analysis. Caries Res. 2017;51(5):527–41.

    Article  PubMed  Google Scholar 

  • Chu CH, Lo EC, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. J Dent Res. 2002;81(11):767–70.

    Article  PubMed  Google Scholar 

  • Clemens J, Gold J, Chaffin J. Effect and acceptance of silver diamine fluoride treatment on dental caries in primary teeth. J Public Health Dent. 2018;78(1):63–8.

    Article  PubMed  Google Scholar 

  • Colak H, Dulgergil CT, Dalli M, Hamidi MM. Early childhood caries update: a review of causes, diagnoses, and treatments. J Natl Sci Biol Med. 2013;4(1):29–38.

    Article  Google Scholar 

  • Contreras V, Toro MJ, Elías-Boneta AR, Encarnación-Burgos MA. Effectiveness of silver diamine fluoride in caries prevention and arrest: a systematic literature review. Gen Dent. 2017;65(3):22.

    PubMed  PubMed Central  Google Scholar 

  • Crystal YO, Kreider B, Raveis VH. Parental expressed concerns about silver diamine fluoride (SDF) treatment. J Clin Pediatr Dent. 2019;43(3):155–60.

    Article  PubMed  Google Scholar 

  • Crystal YO, Niederman R. Silver diamine fluoride treatment considerations in children’s caries management. Pediatr Dent. 2016;38(7):466–71.

    PubMed  PubMed Central  Google Scholar 

  • Deery C. Silver lining for caries cloud? Evid Based Dent. 2009;10(3):68.

    Article  PubMed  Google Scholar 

  • dos Santos Jr VE, De Vasconcelos FM, Ribeiro AG, Rosenblatt A. Paradigm shift in the effective treatment of caries in schoolchildren at risk. Int Dent J. 2012;62(1):47–51.

    Article  Google Scholar 

  • Duangthip D, Chu CH, Lo EC. A randomized clinical trial on arresting dentine caries in preschool children by topical fluorides–18 month results. J Dent. 2016;44:57–63.

    Article  PubMed  Google Scholar 

  • Duangthip D, Wong M, Chu C, Lo E. Caries arrest by topical fluorides in preschool children: 30-month results. J Dent. 2018;70:74–9.

    Article  PubMed  Google Scholar 

  • Ekstrand KR, Martignon S, Ricketts DJN, Qvist V. Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper Dent. 2007;32(3):225–35.

    Article  PubMed  Google Scholar 

  • Enzo B. Carious lesions and first restorative treatment: adopted by the General Assembly: September 2019, San Francisco, United States of America. Int Dent J. 2020;70(1):5–6.

    Article  Google Scholar 

  • Frankl S. Should the parent remain with the child in the dental operatory? J Dent Child. 1962;29:150–63.

    Google Scholar 

  • Frencken J, Van Amerogen E, Phantumvanit P, Songpaisan Y, Pilot T. Manual for the atraumatic restaurative treatment approach to control dental caries. 1997. Dent Health Int Ned. ISBN90-803296-1-4.

  • Frencken JE. Atraumatic restorative treatment and minimal intervention dentistry. Br Dent J. 2017;223(3):183–9.

    Article  PubMed  Google Scholar 

  • Fung M, Duangthip D, Wong M, Lo E, Chu C. Randomized clinical trial of 12% and 38% silver diamine fluoride treatment. J Dent Res. 2018;97(2):171–8.

    Article  PubMed  Google Scholar 

  • Gao SS, Zhang S, Mei ML, Lo EC, Chu CH. Caries remineralisation and arresting effect in children by professionally applied fluoride treatment: a systematic review. BMC Oral Health. 2016;16:12.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gotjamanos T. Silver fluoride use. Aust Dent J. 1997;42(2):138.

    Article  PubMed  Google Scholar 

  • Guedes R, Piovesan C, Ardenghi T, Emmanuelli B, Braga M, Ekstrand K, et al. Validation of visual caries activity assessment: a 2-yr cohort study. J Dent Res. 2014;93(7):101S-S107.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hansen R, Shirtcliff RM, Ludwig S, Dysert J, Allen G, Milgrom P. Changes in silver diamine fluoride use and dental care costs: a longitudinal study. Pediatr Dent. 2019;41(1):35–44.

    PubMed  Google Scholar 

  • Hobdell M, Petersen PE, Clarkson J, Johnson N. Global goals for oral health 2020. Int Dent J. 2003;53(5):285–8.

    Article  PubMed  Google Scholar 

  • Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, et al. The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Commun Dent Oral Epidemiol. 2007;35(3):170–8.

    Article  Google Scholar 

  • Jiang M, Wong MCM, Chu CH, Dai L, Lo ECM. Effects of restoring SDF-treated and untreated dentine caries lesions on parental satisfaction and oral health related quality of life of preschool children. J Dent. 2019;88:103171.

    Article  PubMed  Google Scholar 

  • Jiang M, Wong MCM, Chu CH, Dai L, Lo ECM. A 24-month randomized controlled trial on the success rates of restoring untreated and SDF-treated dentine caries lesions in primary teeth with the ART approach. J Dent. 2020;100:103435.

    Article  PubMed  Google Scholar 

  • Kidd EA. Clinical threshold for carious tissue removal. Dent Clin. 2010;54(3):541–9.

    Google Scholar 

  • Kowash M, Alkhabuli J, Dafaalla S, Shah A, Khamis A. Early childhood caries and associated risk factors among preschool children in Ras Al-Khaimah, United Arab Emirates. Eur Arch Paediatr Dent. 2017;18(2):97–103.

    Article  PubMed  Google Scholar 

  • Llodra JC, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res. 2005;84(8):721–4.

    Article  PubMed  Google Scholar 

  • Lo EC, Chu CH, Lin HC. A community-based caries control program for pre-school children using topical fluorides: 18-month results. J Dent Res. 2001;80(12):2071–4.

    Article  PubMed  Google Scholar 

  • Mabangkhru S, Duangthip D, Hung CC, Phonghanyudh A, Jirarattanasopha V. A randomized clinical trial to arrest dentin caries in young children using silver diamine fluoride. J Dent. 2020;99:103375.

    Article  PubMed  Google Scholar 

  • Mattos-Silveira J, Floriano I, Ferreira FR, Viganó MEF, Mendes FM, Braga MM. Children’s discomfort may vary among different treatments for initial approximal caries lesions: preliminary findings of a randomized controlled clinical trial. Int J Pediatr Dent. 2015;25(4):300–4.

    Article  Google Scholar 

  • Mei M, Lo E, Chu C. Arresting dentine caries with silver diamine fluoride: what’s behind it? J Dent Res. 2018;97(7):751–8.

    Article  PubMed  Google Scholar 

  • Milgrom P, Horst JA, Ludwig S, Rothen M, Chaffee BW, Lyalina S, et al. Topical silver diamine fluoride for dental caries arrest in preschool children: a randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. J Dent. 2018;68:72–8.

    Article  PubMed  Google Scholar 

  • Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869.

    Article  PubMed  PubMed Central  Google Scholar 

  • Muñoz-Sandoval C, Gambetta-Tessini K, Giacaman RA. Microcavitated (ICDAS 3) carious lesion arrest with resin or glass ionomer sealants in first permanent molars: a randomized controlled trial. J Dent. 2019;88:103163.

    Article  PubMed  Google Scholar 

  • Rajab LD, Hamdan M. Early childhood caries and risk factors in Jordan. Comm Dent Health. 2002;19(4):224–9.

    Google Scholar 

  • Shalan HMABR. Oral health status of preschool children in Egypt. ASDS. 2018;2(5):67–72.

    Google Scholar 

  • Shoaib L, Deery C, Ricketts D, Nugent Z. Validity and reproducibility of ICDAS II in primary teeth. Caries Res. 2009;43(6):442–8.

    Article  PubMed  Google Scholar 

  • Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: a report from the American Dental Association. J Am Dent Assoc. 2018;149(10):837–49.

    Article  PubMed  Google Scholar 

  • Tirupathi S, Nirmala S, Rajasekhar S, Nuvvula S. Comparative cariostatic efficacy of a novel Nano-silver fluoride varnish with 38% silver diamine fluoride varnish a double-blind randomized clinical trial. J Clin Exp Dent. 2019;11(2):e105.

    Article  PubMed  PubMed Central  Google Scholar 

  • Trieu A, Mohamed A, Lynch E. Silver diamine fluoride versus sodium fluoride for arresting dentine caries in children: a systematic review and meta-analysis. Sci Rep. 2019;9(1):2115.

    Article  PubMed  PubMed Central  Google Scholar 

  • US Food and Drug Administration. Diamine Silver Fluoride Dental Hypersensitivity Varnish [510(k) premarket notification]. FDA Chicago. 2017. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K102973. Accessed 9 Feb 2020.

  • van’t Hof MA, Frencken JE, Helderman WHVP, Holmgren CJ. The atraumatic restorative treatment (ART) approach for managing dental caries: a meta-analysis. Int Dent J. 2006;56(6):345–51.

    Article  Google Scholar 

  • Vollú AL, Rodrigues GF, Teixeira RVR, Cruz LR, dos Santos MG, de Lima Moreira JP, et al. Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment on dentine caries arrestment in primary molars of preschool children: a 12-months parallel randomized controlled clinical trial. J Dent. 2019;88:103165.

    Article  PubMed  Google Scholar 

  • Waggoner WF, Nelson T. Restorative dentistry for the primary dentition. Pediatric dentistry. Amsterdam: Elsevier; 2019. p. 304–28.

    Google Scholar 

  • World Health Organization. Oral health surveys: basic methods. 5th ed. Geneva: World Health Organization Press; 2013.

    Google Scholar 

  • World Health Organization. Oral health, fact sheet. Geneva: WHO; 2018.

    Google Scholar 

  • World Health Organization. Ending childhood dental caries: WHO implementation manual. Geneva: WHO; 2019.

    Google Scholar 

  • Yamaga R. Arrestment of caries of deciduous teeth with diamine silver fluoride. Dent Outlook. 1969;33:1007–13.

    Google Scholar 

  • Yee R, Holmgren C, Mulder J, Lama D, Walker D, van Palenstein HW. Efficacy of silver diamine fluoride for arresting caries treatment. J Dent Res. 2009;88(7):644–7.

    Article  PubMed  Google Scholar 

  • Young DA, Nový BB, Zeller GG, Hale R, Hart TC, Truelove EL, et al. The American Dental Association caries classification system for clinical practice: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2015;146(2):79–86.

    Article  PubMed  Google Scholar 

  • Zhao IS, Gao SS, Hiraishi N, Burrow MF, Duangthip D, Mei ML, et al. Mechanisms of silver diamine fluoride on arresting caries: a literature review. Int Dent J. 2018;68(2):67–76.

    Article  PubMed  Google Scholar 

  • Zhi QH, Lo ECM, Lin HC. Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. J Dent. 2012;40(11):962–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the children and their caregivers who participated in this research and made it possible. This research was funded by the Deanship of Scientific Research at Princess Nourah bint Abdulrahman University through the Fast-track Research Funding Program.

Author information

Authors and Affiliations

  1. College of Dentistry, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

    H. M. Abdellatif, A. M. Ali & M. A. ElKateb

  2. College of Dentistry Texas A&M University, Dallas, USA

    H. M. Abdellatif

  3. Faculty of Dentistry, Alexandria University, Qism Bab Sharqi, Egypt

    A. M. Ali, S. I. Baghdady & M. A. ElKateb

Authors
  1. H. M. Abdellatif
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. M. Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. I. Baghdady
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. A. ElKateb
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. M. Ali.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdellatif, H.M., Ali, A.M., Baghdady, S.I. et al. Caries arrest effectiveness of silver diamine fluoride compared to alternative restorative technique: randomized clinical trial. Eur Arch Paediatr Dent 22, 575–585 (2021). https://doi.org/10.1007/s40368-020-00592-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40368-020-00592-0

Keywords

Search

Navigation