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