Is silver diamine fluoride effective for root caries in older adults?

Abstract

BACKGROUND/AIMS: Root caries among elderly communities is of growing public health concern globally. This controlled clinical trial investigated the effectiveness of silver diamine fluoride and oral health education in preventing and arresting root caries. METHODS: Two hundred sixty-six elderly subjects who had at least 5 teeth with exposed root surfaces and did not have serious life-threatening medical diseases were allocated to 3 groups according to a computer-generated random list: group 1 (the control group) received oral hygiene instructions (OHI) annually; group 2 received OHI and silver diamine fluoride (SDF) application annually, and group 3 was given OHI and SDF application annually, plus an oral health education (OHE) programme every 6 months. RESULTS: Two hundred twenty-seven elderly subjects were followed for 24 months. The mean numbers of new root caries surfaces in groups 1, 2 and 3 were 1.33, 1.00 and 0.70, respectively (ANOVA, p < 0.05). Group 3 had fewer root surfaces with new caries than group 1 (Scheff&#xe9; multiple-comparison test, p < 0.05). The mean numbers of arrested root caries surfaces in groups 1, 2 and 3 were 0.04, 0.28 and 0.33, respectively (ANOVA, p < 0.01). Group 3 and group 2 had a greater number of active root caries surfaces which became arrested than group 1 (Scheff&#xe9; multiple-comparison test, p < 0.05). CONCLUSION: Annual application of SDF together with biannual OHE was effective in preventing new root caries and arresting root caries among community-dwelling elderly subjects.

Abstract

BACKGROUND: Silver diamine fluoride (SDF) is widely recognized for managing early childhood caries, but its efficacy and applications in older adults remain understudied. OBJECTIVES: This scoping review synthesizes current clinical evidence on SDF's effectiveness in improving oral health outcomes among adults aged 65 years or older. DATA/SOURCES: Two independent researchers systematically searched Embase, PubMed, Scopus, and Web of Science for English-language clinical studies (through June 30, 2025) assessing SDF's effects on oral health in older adults. STUDY SELECTION/RESULTS: Nine clinical studies were included, evaluating SDF's impact on dental caries, gingival inflammation, and dentine hypersensitivity. Seven studies focused on caries management. Two controlled trials demonstrated SDF's effectiveness in arresting root caries, while three trials explored prevention, with two reporting significant efficacy. A single-arm trial reported an 86 % root caries arrest rate, and a retrospective study found 45 % of SDF-treated lesions remained arrested after 24 months. One controlled trial reported 59 % reduction in plaque accumulation and 67 % reduction in gingival inflammation with SDF. Another controlled trial demonstrated SDF outperformed potassium nitrate in alleviating hypersensitivity by 10 %. CONCLUSIONS: SDF demonstrates potential for improving oral health in older adults, particularly in arresting and preventing caries, reducing plaque, and managing hypersensitivity. However, the evidence base remains limited, highlighting the need for rigorous clinical trials to establish long-term outcomes, safety profiles, and optimized protocols for this population. CLINICAL SIGNIFICANCE: This review underscores SDF's promise in geriatric dental care and identifies critical research priorities, including long-term efficacy, adverse effects, and age-specific treatment protocols.