The Effect of Silver Diamine Fluoride in Preventing Caries in the Primary Dentition: A Systematic Review and Meta-Analysis

Abstract

Objectives: To investigate whether silver diamine fluoride (SDF) is effective in preventing new caries lesions in primary teeth when compared to placebo or active treatments.

Methods: Systematic review (CRD42016036963) of controlled clinical trials. Searches were performed in 9 electronic databases, 5 registers of ongoing trials, and reference lists of identified review articles. Two researchers carried out data extraction and quality appraisal independently. The primary outcome was the difference in caries increment (decayed, missing, and filled surfaces or teeth - dmfs or dmft) between SDF and control groups. These differences were pooled as weighted mean differences (WMD) and prevented fractions (PF).

Results: Searches yielded 2,366 unique records; 6 reports of 4 trials that randomized 1,118 and analyzed 915 participants were included. Two trials compared SDF to no treatment, 1 compared SDF to placebo and sodium fluoride varnish (FV), and 1 compared SDF to high-viscosity glass ionomer cement (GIC). All studies had at least 1 domain with unclear or high risk of bias. After 24 months of follow-up, in comparison to placebo, no treatment, and FV, SDF applications significantly reduced the development of new dentin caries lesions (placebo or no treatment: WMD = -1.15, PF = 77.5%; FV: WMD = -0.43, PF = 54.0%). GIC was more effective than SDF after 12 months of follow-up but the difference between them was not statistically significant (WMD, dmft: 0.34, PF: -6.09%).

Conclusion: When applied to caries lesions in primary teeth, SDF compared to no treatment, placebo or FV appears to effectively prevent dental caries in the entire dentition. However, trials specifically designed to assess this outcome are needed.

Keywords: Cariostatic agents; Dental caries; Preventive dentistry; Silver diamine fluoride; Systematic review.

Conflict of interest statement

Declaration of Interest:

The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this paper.

© 2018 S. Karger AG, Basel.

Figures

Figure 1

Flow diagram showing the process of identifying, screening, assessing for eligibility, excluding and including studies.

Figure 2

Ascertainment of the risk of bias in the included studies (+ Low risk, − High risk,? Unclear risk).

Figure 3

Comparison between silver diamine fluoride and placebo (or no treatment), 5% sodium fluoride varnish (NaF varnish) and high viscosity glass ionomer cement (GIC) regarding the mean increment in the number of decayed, extracted and filled surfaces or teeth (dmfs/dmft) in the primary dentition, by duration of follow-up (24 months or more and less than 24 months). Only data on the comparison between SDF and GIC corresponds to dmft.

Figure 4

Comparison between silver diamine fluoride and placebo (or no treatment), 5% sodium fluoride varnish (NaF varnish) and high viscosity glass ionomer cement (GIC) regarding the prevented fraction in the primary dentition, by duration of follow-up (24 months or more and less than 24 months).