UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride : Rationale , Indications and Consent
Prevented caries
Time ( years )
308 3-5 year olds | Control : 1.6 new lesions ( only applied to lesions ) Chu et al ., 2002
100 % SDF q1year
50 % exc SDF q1year exe NaF q3mon
0 % NaF q3mon
0.5 1 1.5 2 2.5 3 Time ( years )
Prevented caries
Time ( years )
227 60-89 years olds | Control : 1.3 new lesions
Zhang et al ., 2013
100 %
50 %
0 % 0.5 1 1.5 2 2.5 3 Time ( years )
SDF q1year + OHI q6mon
|
Prevented caries
100 %
50 %
0 %
|
203 79 year olds | Control : 2.5 new lesions Tan et al ., 2010
0.5 1 1.5 2 2.5 3
|
SDF q1year NaF q3mon Chlorhex q3mon |
Prevented caries
100 %
50 %
0 %
|
708 6-8 year olds | Control : 0.44 new lesions Monse et al ., 2012
0.5 1 1.5 2 2.5 3
|
SDF once GIC sealant once |
|
Time ( years ) |
|
|
Time ( years ) |
|
Tea extract was used in one group to activate color change for improved follow-up diagnosis ; no differences in arrest were seen . 32 Indeed , when stannous fluoride was used to activate color change , a break in the black color within a lesion at six months was highly sensitive and specific for active caries . 37
Silver diamine fluoride greatly outperformed fluoride varnish for caries arrest 29 and was equivalent or better than glass ionomer cement ( GIC ) ( FIGURE 1 ). 31 , 33 The addition of semiannual intensive oral health education with the application of silver diamine fluoride in the elderly increased the arrest of root caries ( FIGURE 1 ). 38
Caries Prevention When silver diamine fluoride was applied only to carious lesions , impressive prevention
29 , 35
was seen for other tooth surfaces . Fluoride-releasing GIC can have this effect but it is limited to surfaces adjacent to the treated surface and of short duration . Direct application to healthy surfaces in children also helps prevent caries ( FIGURE 2 ). 29 , 35 , 39 Two studies show great difference in the level of prevention in the elderly ; 38 , 40 the difference is hard to reconcile . As seen for arrest , prevention is less after one year without repeat application . 41
Annual application of silver diamine fluoride prevented many more carious lesions than four times per year fluoride varnish in both children 29 and the elderly . 40
Prevention was roughly equivalent to twice per year varnish in one study ( FIGURE 2 ). 39 The addition of semiannual intensive oral health education in a study of the elderly increased prevention . 38 Although many fell out , GIC or resin sealants outperformed silver diamine fluoride in preventing caries in the first molars of children , 39 , 41 though the cost was ~ 20 times more .
Ongoing Trials Unpublished reports of clinical studies unanimously confirm better caries arrest and / or prevention by silver diamine fluoride over control or other materials .
JANUARY / FEBRUARY 2017 | PENNSYLVANIA DENTAL JOURNAL 19