SDF for Caries Prevention in Primary Teeth: A Systematic Review

Objectives: To assess the effects of silver diammine fluoride application (SDF) on caries prevention in primary teeth.
Methods: We carried out a search of nine electronic databases, four registers of ongoing trials, and the reference lists of identified review articles. The search yielded 2155 unique records. Examining titles and abstracts for randomized or quasi-randomized trials addressing SDF for caries prevention in primary teeth, with 12 months of follow-up or more, identified 49 publications. Full-texts were independently read by two reviewers. The same reviewers independently extracted data and assessed for potential bias trials that met the inclusion criteria. A third reviewer resolved disagreements. Differences in caries increment (decayed, missing and filled surfaces or teeth - dmfs or dmft) between SDF and no treatment, placebo or active treatment groups were pooled as weighted mean difference (WMD) using fixed effect meta-analyses in Stata 14 when data from more than one study was available.
Results: Four trials met the inclusion criteria. Two trials compared SDF to placebo, one compared SDF to both placebo and sodium fluoride varnish (FV) and one compared SDF to high viscosity glass-ionomer cement (GIC). All studies had at least one domain with unclear or high risk of bias. At 12 months of follow-up, GIC was more effective than SDF but the difference between them was not statistically significant (WMD, dmft: 0.19; 95% CI -1.14 to 1.52). At 24 months of follow-up SDF was more effective than placebo (WMD, dmfs: -1.16; 95% CI -1.48 to -0.83) and FV (WMD, dmfs: -0.43; 95% CI -0.70 to -0.16).
Conclusions: SDF is an efficacious agent for caries prevention when compared to placebo or fluoride varnish.