Silver Diamine Fluoride can arrest caries in children

Early childhood caries (ECC) is a significant global health problem. Silver diamine fluoride (SDF) has been shown to reduce caries and SDF at 38% has been used to arrest ECC in Argentina, Australia, Brazil, China, Japan, and recently the United States.

The aim of this review was to investigate the clinical effectiveness of silver diamine fluoride (SDF) in arresting dental caries among children.

Methods

Searches were conducted in the PubMed, Embase, Scopus, China National Knowledge Infrastructure (CNKI), Ichushi-web, Biblioteca Virtual en Salud Espana (BVSE) and Biblioteca Virtual em Saude (BVS) databases. Prospective clinical studies investigating the caries-arresting effect of SDF treatment in children with or without control groups were considered

Two reviewers selected studies with a third reviewer arbitrating disagreements. Two reviewers independently abstracted data and risk of bias was assessed. Random effects meta-analysis was carried out on studies were caries arresting rates were presented or could be calculated.

Results

19 studies were included (16 in primary dentition, 3 in permanent)
14 studies used 38% SDF
Meta-analysis was conducted on 8 studies, which used 38% SDF to arrest dentine caries in primary teeth. The overall caries arresting rate was 81% (95% CI; 68% to 89%).

	Caries arresting rate	95% Confidence interval	Probability P
6 months	86%	47% to 98%	= 0.06
12 months	81%	59% to 93%	= 0.01
18 months	78%	70% to 85%	< 0.001
24 months	65%	35% to 86%	= 0.32
> 30 months	71%	56% to 83%	= 0.01
Overall	81%	68% to 89%	< 0.001

Conclusions

The authors concluded: –

SDF was commonly used at a high concentration (38%; 44,800 ppm fluoride) and is effective in arresting caries among children. There is no consensus on its number and frequency of application to arrest caries. Further studies are necessary to develop evidence-based guidelines on its use in children.

Comments

The reviews have conducted a broad ranging search for papers on this question and included studies published in a number of languages. This is helpful, as SDF in nor commonly sued in most developed western countries. While an assessment of study quality has been carried out clear descriptions if the study designs of the included studies is not provided. Although from the risk of bias table one could assume that 8 included studies are RCTs but it is important to note that none of the included studies could be considered to be at low risk of bias. Consequently the quality of the overall evidence available for this review is low.

A broader review by the same group published earlier this year (Dental Elf – Mar 21^st 2016) included 5 RCTs studies using 38% SDF found the overall proportion of arrested dentine caries after SDF solution treatment was 65.9 % (95 % CI; 41.2 % – 90.7 %; p< 0.001). A might be anticipated the figure for caries reduction is lower than the 81% reported here as it is restricted to RCTs.

Overall all included studies do demonstrate an ability to arrest caries and SDF does offer a lower cost alternative to other topical fluorides for caries prevention. However, it does have one important limitation in that SDF treatment will stain carious lesions black, which may not be acceptable for some children and their parents. As the authors suggest further high quality RCTs are necessary to clarify the size of the caries reduction effect and to determine the optimum number of frequency of application to arrest decay. This would also understand the cost-effectiveness of SDF treatment.