Silver Diamine Fluoride may prevent and arrest root caries in older adults

Journal of Evidence Based Dental Practice

Available online 6 May 2019

Summary

Subjects or Study Selection

In this systematic review (SR) and meta-analysis, the participants were adults of any age with exposed root surfaces. Two reviewers independently searched for randomized controlled clinical trials with at least 12 months of follow-up, without language or date of publication restraints, in 8 electronic databases, 5 registries of ongoing trials, and reference lists of narrative reviews.

Key Study Factor

This review investigated the effects of a silver diamine fluoride (SDF) solution in any concentration or frequency and applied by any health care worker in any setting compared to no intervention, placebo, or any cariostatic agent or dental restorative material.

Main Outcome Measure

The main outcomes were the development of new carious lesions and the arrest of

existing carious lesions in exposed root surfaces of permanent teeth within at least 12 months

after SDF application.

Main Results

This SR included 4 articles from 3 trials with 895 randomly assigned older adults with the mean age of 72.1 to 78.8 years, at 12, 24, and 30 or more months of follow-up. A meta-analysis of the 3 trials with 24 months of follow-up and comparison of SDF with placebo showed that SDF applications significantly decreased the number of new root carious lesions (-0.56; 95% confidence interval [CI], -0.77 to -0.36). The Prevented Fraction (PF) for root caries prevention ranged from 50.30% to 68.35%. In a study with comparisons between SDF and fluoride varnich (FV) or chlorhexidine (CHX) varnish, CHX had significantly higher preventive effect than did SDF at 12 months of follow-up, but there were no significant differences between SDF and FV at any of the follow-up periods or between SDF and CHX varnish at 24 months or longer.

For the caries arrest, 1 study showed significantly higher numbers of arrested lesions in the SDF group than in the placebo after 24 months. In the other study, SDF group had significantly higher percentages of carious lesions arrested than did the placebo group at each follow-up period.

Conclusions

The authors concluded that annual applications of 38% SDF in older adults decreased the incidence of new carious lesions in exposed root surfaces by at least 50%; in addition, the longer the duration of the intervention, the greater was the effect. The preventive effect of SDF for root caries is similar to that of 5% FV and 1% CHX varnish. Further research is needed to replicate these findings and to determine the best frequency and interval of SDF applications.