When does silver diamine fluoride outperform fluoride varnish for caries arrest?

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.

Is Silver Diamine Fluoride Effective in Arresting Enamel Caries? A Randomized Clinical Trial. © 2022 by the authors. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Abstract

BACKGROUND: Dental caries is a global public health concern, with interproximal caries presenting a particular challenge due to their limited accessibility. Fluoride has long been employed in the prevention and management of early-stage carious lesions. AIM: To evaluate and compare the effectiveness of 38% silver diamine fluoride (SDF) and 5% sodium fluoride varnish (NaF) in arresting interproximal caries in primary molars. SETTINGS AND DESIGN: A split-mouth randomized clinical trial was conducted following the CONSORT guidelines. METHODS: Children aged 5-9 years with at least two noncavitated interproximal carious lesions (ICCMS stages RA1-RB4) were included. Teeth were randomly assigned to receive either 38% SDF (Group 1) or 5% NaF varnish (Group 2), applied biannually. Caries arrest was assessed radiographically as primary outcome at 6, 9, and 12 months. STATISTICAL ANALYSIS: Descriptive statistics summarized the data. Normality was confirmed through the Shapiro-Wilk test, permitting parametric analysis. Paired and unpaired t-tests assessed intra- and inter-group differences, respectively, and Chi-square tests analyzed the categorical variables. A two-tailed &#x3b1; =0.05 and power of 80% were applied. RESULTS: At the 12-month follow-up, the caries arrest rate was 76.31% in Group 1 and 47.3% in Group 2, showing a statistically significant difference (P < 0.05). The arrest rates for 38% SDF at RA1, RA2, RA3, and RB4 were 90.9%, 88%, 80%, and 37.5%, respectively, compared to 80%, 60%, 22.2%, and 0% for 5% NaF varnish. CONCLUSION: SDF demonstrated greater effectiveness than NaF varnish in arresting interproximal caries in primary molars, particularly in lesions involving dentin.

Abstract

The present randomized clinical trial&#xa0;with a split-mouth design investigated the effectiveness of 30% silver diamine fluoride (SDF) compared to 5% sodium flouride varnish (NaD)&#xa0;in arresting proximal caries in the primary molars of preschool-aged children. Forty-three&#xa0;children with contralateral initial proximal carious lesions on primary molars were included. Caries status at the baseline was recorded using clinical and radiographic indices. Lesions restricted to the enamel or the exterior third of dentin were included. A sufficient space was created between the contacts using elastic separators. Then, 5% NaF varnish and 30% SDF were randomly applied to either side of the mouth. Six months later, bitewing radiographs were obtained, and the post-intervention caries scores were compared with the baseline radiographs. Children's oral hygiene was recorded via a questionnaire. The&#xa0;findings indicated that the baseline and post-intervention caries status were comparable between the groups.&#xa0;The success rate of the SDF treatment (74.4%) and the NaF varnish (67.5%) was comparable. Baseline radiographic caries status was significantly related to the treatment result in the NaF group (p&#x2009;=&#x2009;0.047). Dental flossing was significantly associated with the treatment result when SDF was used (p&#x2009;=&#x2009;0.027). In conclusion, both fluoride-containing materials exhibited comparable efficacy in arresting early proximal caries lesions in primary molars. SDF 30% showed a higher but insignificant success rate in arresting initial proximal lesions of the primary molar compared to NaF 5% varnish.Trial registration: IRCT, IRCT20220425054647N1. Registered on 24 September 2022, https://en.irct.ir/trial/63168 .