Available online 1 September 2017
https://doi.org/10.1016/j.jdent.2017.08.015Get rights and content
Abstract
Objectives
The Stopping Cavities Trial investigated effectiveness and safety of 38% silver diamine fluoride in arresting caries lesions.
Materials and Methods
The
study was a double-blind randomized placebo-controlled superiority
trial with 2 parallel groups. The sites were Oregon preschools.
Sixty-six preschool children with ≥1 lesion were enrolled. Silver
diamine fluoride (38%) or placebo (blue-tinted water), applied topically
to the lesion. The primary endpoint was caries arrest (lesion
inactivity, Nyvad criteria) 14–21 days post intervention. Dental plaque
was collected from all children, and microbial composition was assessed
by RNA sequencing from 2 lesions and 1 unaffected surface before
treatment and at follow-up for 3 children from each group.
Results and Conclusion
Average
proportion of arrested caries lesions in the silver diamine fluoride
group was higher (0.72; 95% CI; 0.55, 0.84) than in the placebo group
(0.05; 95% CI; 0.00, 0.16). Confirmatory analysis using generalized
estimating equation log-linear regression, based on the number of
arrested lesions and accounting for the number of treated surfaces and
length of follow-up, indicates the risk of arrested caries was
significantly higher in the treatment group (relative risk, 17.3; 95%
CI: 4.3 to 69.4). No harms were observed. RNA sequencing analysis
identified no consistent changes in relative abundance of
caries-associated microbes, nor emergence of antibiotic or metal
resistance gene expression. Topical 38% silver diamine fluoride is
effective and safe in arresting cavities in preschool children. The
treatment is applicable to primary care practice and may reduce the
burden of untreated tooth decay in the population.
Comments