Abstract
BACKGROUND Dental caries is the world’s most prevalent disease. Un treated caries can cause pain OBJECTIVES and negatively impact psycho social health, functioning, and nutrition. It is important to iden tify cost-effective, easy-to-use agents, which can prevent or arrest caries. This review eval uates Silver Diamine Fluoride (SDF). aprile/2025 DENTAL CADMOS To assess the effects of Silver Di amine Fluoride for preventing and managing caries in primary REVISIONE 267 REVISIONE 268 COCHRANE and permanent teeth (coronal and root caries) compared to any other intervention including pla cebo or no treatment. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, Cochrane Oral Health’s Trial Register and two clinical trials registers in June 2023. SELECTION CRITERIA We included Randomised Con trolled Trials (RCTs), with paral lel-group or split-mouth design, in children and adults (with or without carious lesions) that compared SDF with placebo or no treatment; different frequencies, concentra tions or duration of SDF; or any other intervention. DATA COLLECTION AND ANALYSIS We used standard methodologi cal procedures expected by Co chrane, and GRADE to assess the certainty of the evidence. We col lected data for primary caries prevention (change in caries in crement), arrest of carious le sions, secondary prevention of caries (lesions do not progress from initial classification), ad verse effects, dental pain or sen sitivity, and aesthetics at the end of study follow-up. MAIN RESULTS We included 29 RCTs (13,036 par ticipants; 12,020 children, 1016 older adults). We summarise outcome data for the five most clinically relevant comparisons. All studies included high risks of bias, and some find ings were imprecise (e.g. because of small sample sizes).-SDF versus placebo or no treat ment (14 studies; 2695 children, 905 older adults) Compared to placebo or no treat ment, SDF may help prevent new caries in the primary dentition, or on the coronal surfaces of perma nent dentition but the evidence is very uncertain. SDF likely prevents new root caries. SDF may help ar rest caries in the primary dentition and the permanent dentition, but the evidence is very uncertain. The evidence is very uncertain for sec ondary prevention of caries, for ad verse effects, and aesthetics.-Different approaches to SDF appli cation (5 studies, 1808 children) Studies compared different frequen cies or intervals of application, differ ent concentrations of SDF, and differ ent durations of treatment. Some studies included multiple compari sons of different approaches. Be cause of the different approaches, we could not combine findings from these studies. Due to very low-cer tainty evidence, we were unsure whether any approach to SDF appli cation was better than another for caries arrest; secondary prevention of caries or led to differences in ad verse effects or aesthetics.-SDF versus fluoride varnish (8 studies, 2868 children, 223 older adults) Compared to fluoride varnish, SDF may result in little or no difference to the prevention of new caries in the primary dentition. The evi dence is very uncertain for this outcome measure in the perma nent dentition. Due to very low-certainty evidence, we were unsure whether or not there were any differences between fluoride varnish (applied weekly for three applications) and SDF for caries arrest and secondary prevention of caries in the primary dentition. Similarly, we were unsure of ad verse effects, dental pain or sensi tivity, or aesthetics.-SDF versus sealants and resin in filtration (2 studies, 343 children) Very low-certainty evidence in this comparison meant we were un sure if either treatment was better than the other for primary preven tion of caries in permanent denti tion, or adverse effects.-SDF versus atraumatic restor ative treatment (ART) with glass ionomer cement (GIC) or GI mate rial (4 studies, 610 children) Very low-certainty evidence in this comparison meant we were un sure if either treatment was better than the other at arresting caries in the primary dentition. We were also unsure whether there were any differences between treat ments in adverse effects, dental pain or sensitivity, or aesthetics. AUTHORS’ CONCLUSIONS In the primary dentition, evidence remains uncertain whether SDF prevents new caries or progres sion of existing caries compared to placebo or no treatment, but it may offer benefit over placebo or no treatment in caries arrest. Compared to placebo or no treat ment, SDF probably also helps prevent new root caries. However, the evidence is uncertain for other caries outcome measures in this dentition and in all caries out comes for coronal surfaces of permanent dentition. Compared to fluoride varnish, SDF may offer little or no benefit in pre venting new caries in the primary dentition, but the evidence is very uncertain for other caries out come measures in the primary dentition and for preventing new caries in the permanent dentition. We were unable to establish whether one SDF treatment ap proach was better than another, or how SDF compared to other treat ments, because of very low-cer tainty evidence. The impact of SDF staining of teeth was poorly reported and the evi dence for adverse effects is very un certain. Additional well-conducted studies are needed. These should measure the impact of staining and be analysed to take account of clus tering issues within participants.
| Translated title of the contribution | Topical Silver Diamine Fluoride (SDF) for preventing and managing dental caries in children and adults: a Cochrane review |
|---|---|
| Original language | Italian |
| Pages (from-to) | 266-277 |
| Number of pages | 12 |
| Journal | Dental Cadmos |
| Volume | 93 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 2025 |
Keywords
- Carious lesions
- Fluorine
- Primary prevention
- Secondary prevention
- Silver Diamine Fluoride
ASJC Scopus subject areas
- Orthodontics
- Oral Surgery