ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Silver Diamine Fluoride Is Effective at Arresting Early Dentin Caries in Children Compared to No Treatment
Clinical Question In children, is silver diamine fluoride as effective at arresting early dentin caries compared to no treatment?
Clinical Bottom Line Silver diamine fluoride is effective at arresting dentin caries in children; however, there is a definite need for more thorough clinical research, especially with adult populations.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26831727Gao/201617 randomized controlled trials Systematic review of randomized trials
Key resultsThis systematic review included 17 randomized control trials out of 2,177 papers initially located. Ten studies investigated the re-mineralizing effect on early enamel caries using silicon tetrafluoride, fluoride gel, silver diamine fluoride or sodium fluoride. Seven of these studies reported an arresting effect on dentin caries after application of silver diamine fluoride or nano-silver fluoride. Five studies evaluated the use of 38% silver diamine fluoride to arrest dentin caries in children. In the reviewed studies, dental professionals were satisfied with clinical results showing the overall proportion of arrested dentin caries. The meta-analysis performed on the five papers reporting on 38% silver diamine fluoride treatment to arrest dentin caries showed the overall proportion of arrested dentine caries to be 65.9% (95% CI: 41.2% - 90.7%; p < 0.001). Each of the studies was relatively similar in their findings.
Evidence Search silver diamine fluoride AND caries
Comments on
The Evidence
The clinical studies used were found by two researchers working separately in four databases. To eliminate bias the two researchers discussed their results with a third researcher. The studies were only used if the clinical trials were found to show remineralization or arresting effects on caries in children. The studies were further categorized into remineralizing of early enamel caries and arresting of dentin caries. They used the initial active dentin caries surfaces at baseline compared to the total number of arrested dental caries after treatment to calculate the rate of caries arrest. Caries were considered active if soft by “gentle probing” and arrested if hard to probe. In the end, out of the initial 2,177 articles from the four databases only 100 publications were reviewed and only 17 studies were fully assessed. Of these studies, five used silver diamine fluoride (SDF) at 38% in order to arrest dentin caries and were included in the meta-analysis. Three studies reported annual application of SDF with mean proportions ranging from 65.2% to 79.2% in arresting dentin caries. One study used 38% SDF every 6 months with a mean proportion of dentin caries arrest at 84.8%. The last study used 38% SDF as a one-time application at the baseline and had a mean proportion of 31.2% in dentin caries arrest. The five different studies had relatively close mean proportions in arresting dentin caries with an overall mean proportion of dentin caries arrest using 38% SDF of 65.9% (95% CI: 41.2% - 90.7%; p < 0.001). The individual studies did not exhibit evidence of bias with the exception of allocation concealment, which for all studies was rated as "unclear." There was a high degree of heterogeneity among the studies chosen to represent SDF in the meta-analysis as represented by an I-squared statistic of 96%. Gao states, “The five publications selected had different duration, dentition, starting age, mode of delivery, concentration and frequency of SDF treatment.” This simply shows there is still a need for further clinical research on silver diamine fluoride.
Applicability Silver diamine fluoride is suitable for arresting dental caries in children but it can also be used to prevent secondary caries in any patient that has already had a primary lesion treated. Patients with a high caries risk index that have had primary lesions treated will benefit greatly from this newly available option. Patients suffering from xerostomia, patients with too many carious lesions to treat all at once, patients unable to physically and/or mentally handle treatment or patients that don’t have access to dental care will benefit as well. Due to esthetic concerns SDF would primarily be used on posterior teeth. This is mostly due to the patient’s preference. SDF is also a relatively low-cost treatment and has minimal side effects.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry)
Keywords Prevention, arrest, secondary caries, cavitated lesion, silver diamine fluoride, antibacterial agents
ID# 3245
Date of submission: 04/26/2017spacer
E-mail brost@livemail.uthscsa.edu
Author Angela Brost
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Carol Nguyen, RDH, MS
Faculty mentor/Co-author e-mail nguyenc@uthscsa.edu
Basic Science Rationale
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