Topical Silver Diamine Fluoride(SDF) for Dental Caries: a Systematic Review

Objectives: This Cochrane review aimed to assess the effects of SDF for preventing and arresting caries in primary and permanent teeth compared to other interventions.
Methods: We searched for randomised controlled trials in CENTRAL, MEDLINE, Embase, and trials registers in June 2023. We used Cochrane’s risk of bias tool to assess study bias and GRADE to assess certainty of evidence.
Results: We report a subset of results for three clinically relevant comparisons:
0 Compared with placebo or no treatment, SDF
- probably reduces new caries (moderate-certainty evidence) in primary dentition (MD -1.14 surfaces, 95% CI -1.58 to -0.70; 1 study, n=373), coronal surfaces of permanent dentition (MD -0.69 95% CI -0.97 to -0.41; 1 study, n=373) and root surfaces (MD -0.79 95% CI -1.40 to -0.17; 3 studies, n=439)
- probably increases caries arrest (moderate-certainty evidence) in primary dentition (MD 0.86 surfaces, 95% CI 0.39 to 1.34, 2 studies, n=840) and coronal surfaces permanent dentition (MD 0.20 surfaces, 95% CI 0.00 to 0.40; 1 study, n=373)
- may increase caries arrest (low-certainty evidence) on root surfaces (MD 0.24 95% CI 0.12 to 0.36; 1 study, n=158)
0 We were unsure whether any approach to SDF application was better than another for arresting caries (4 studies, n=1447; very low-certainty evidence).
0 There may be little or no difference (low-certainty evidence) between SDF and FV in:
- primary caries prevention in primary dentition (MD 0.00 surfaces, 95% CI -0.26 to 0.26; 1 study, n=434), coronal surfaces permanent dentition (OR 0.95, 95% CI 0.44 to 2.05; 1 study, n=237) and root surfaces (MD -0.20 95% CI -0.91 to 0.51; 1 study, n=100).
- caries arrest (MD -0.13 95% CI -0.87 to 0.61; 1 study, n=309)
Conclusions: Given the certainty of the evidence for SDF compared with no treatment, additional studies for this comparison may not be warranted.