Efficacy of Silver Diamine Fluoride for Arresting Caries Treatment

Methods: 976 kindergarten and primary schoolchildren in Kathmandu, Nepal (545 males (56%) and 431 females (44%)), age 3-9 years and a mean age of 5.2 (SD=1.2) years at the time of enrollment, were randomly assigned to one of the protocols:

Group 1: One application of 38% SDF for 2 minutes without a reducing agent.

Group 2: One application of 38% SDF for 2 minutes, using of tea as a reducing agent.

Group 3: One application of 12% SDF for 2 minutes without a reducing agent.

Group 4: No treatment for carious teeth. This was the control group.

Primary health care workers were trained to carry out the treatment without caries removal. A dentist and a dental therapist performed the baseline examinations prior to treatment while follow up examinations were carried out at 6, 12 and 24 months by the dental therapist, blind to the subjects' treatment group assignment. Both examiners were calibrated in the diagnostic criteria and 10% of the children were re-examined. The data were entered into a computer and analyzed with SAS 9.1 software.

Results: Only the single application of 38% SDF with or without tannic acid was effective in arresting caries after 6 months (4.5 and 4.2 mean number of arrested surfaces; p<0.001), after 1 year (4.1 and 3.4; p<0.001) and after 2 years (2.2 and 2.1; p<0.01). Tannic acid conferred no additional benefit.

Conclusion: ACT using 38% SDF provides an alternative when restorative treatment for primary teeth is not an option.