Title Silver Diamine Fluoride is More Effective in Arresting and Preventing Root Caries in the Elderly Population than Sodium Fluoride Varnish
Clinical Question Is silver diamine fluoride (SDF) more effective in arresting and preventing root caries in the elderly population than sodium fluoride varnish?
Clinical Bottom Line Silver diamine fluoride was shown to provide better prevention of root caries when compared with sodium fluoride varnish. SDF caused greater than 70% reduction in development of root caries as opposed to sodium fluoride varnish with reduction in the range of 40-65%.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
20671206 Tan/2015306 healthy elders with at least 5 exposed root surfaces Randomized Controlled Trial
Key resultsPrevented Fraction after the 3 year study for sodium fluoride varnish was 64% and SDF was 71% . (PF = [(control mean – intervention mean)/control mean] x 100%) Relative risk of developing new root caries after study was 0.26 in sodium fluoride varnish and 0.19 in SDF with a 95% confidence interval. Highest development of root caries after 3 years was seen in those subjects that received oral hygiene instructions only, followed by chlorohexidine varnish, then sodium fluoride varnish, and lastly SDF (p < 0.001).
Evidence Search Silver Diamine Fluoride for root caries
Comments on
The Evidence
Validity: The research utilized groups that are similar in sample size and age at the start and resulted in at least an 80% completion rate. All groups were treated the same and there was adequate follow-up within 5 years of treatment. There were no competing interests revealed from the research. Based on these facts the articles should be considered valid. Perspective: Although the study was conducted on institutionalized dependent elderly population, it is expected that the results would still be the same if it is performed on functionally independent elderly populations considering that the two materials are professionally applied.
Applicability Due to improvement in dental awareness, many people now retain their to older age but gingival recession exposes the root. Thus prevalence of root caries is high in the elderly population, therefore preventing and arresting caries is of high significance in dental practice. Although SDF has a higher percentage of root caries prevention than sodium fluoride varnish, SDF causes black-staining of the carious lesion when used to arrest caries lesions, and this may limit its acceptability by patients. However, SDF is less costly in terms of treatment and labor; SDF only required one application per year as opposed to sodium fluoride varnish that required application 4 times per year to have a preventive effect.
Specialty (Public Health) (General Dentistry) (Restorative Dentistry) (Interprofessional CATs)
Keywords elderly care Arresting caries root caries sodium fluoride varnish silver diamine fluoride solution •prevention •minimally invasive •oral health
ID# 3173
Date of submission 04/18/2017
E-mail REECETA@livemail.uthscsa.edu
Author Taylor Reece
Co-author(s) Kylie Barroso
Co-author(s) e-mail Kybarr52@yahoo.com
Faculty mentor Bennett T. Amaechi, BDS, MSc, PhD
Faculty mentor e-mail amaechi@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
by Kylie S. Barroso (Austin, Texas) on 07/07/2017
Silver diamine fluoride (SDF) is a topical medication used to arrest dental caries by reducing and inhibiting the demineralization process and slowing collagen destruction. Sodium fluoride is also used to arrest dental caries via a similar mechanism. However, the silver in the SDF also inhibits reproduction of microbes by breaking their cell wall, disrupting the microbe’s respiration, and attaching to its DNA, which stops its replication. This helps to prevent the formation of future caries. Therefore, the SDF is more effective in prevention of dental caries compared to sodium fluoride.
Comments and Evidence-Based Updates on the CAT
None available