Silver diamine fluoride: evidence update

ABSTRACTObjectiveThis study aims to analyze the burden of untreated caries in deciduous and permanent teeth in China from 1990 to 2019 and projects its future trends through 2039.Materials and MethodsData on the burden of caries in primary and permanent teeth in China between 1990 and 2019 were extracted from the Global Burden of Disease 2019 study to assess the current burden of untreated caries. The average annual percentage change (AAPC) was estimated using a joinpoint regression model to evaluate temporal trends in the burden of untreated caries. A Bayesian age–period–cohort model was applied to project the burden of untreated caries between 2019 and 2039.ResultsFrom 1990 to 2019, the age‐standardized incidence rate (ASIR) of untreated caries in deciduous teeth in China increased by 6.8%, with an AAPC of 0.22 (95% confidence interval [95% CI]: 0.15–0.22, p < 0.05). The ASIR of caries in permanent teeth decreased by 1.3%, with an AAPC of −0.05 (95% CI: −0.04 to −0.05, p < 0.05). The highest incidence of caries in primary teeth was observed in the 0–4 age group, whereas the highest ASIR of caries in permanent teeth was observed in the 20–24 age group. No significant sex differences were found in the incidence rates of caries in either dentition. Projections from 2020 to 2039 indicate an upward trend in the ASIR of caries in both deciduous and permanent teeth.ConclusionsOver the past 30 years, the burden of dental caries in China has increased significantly. Projections indicate that the ASIR of dental caries will continue to increase. Therefore, appropriate prevention and control strategies are required to reduce the burden of caries in the Chinese population.

Several cross-sectional studies report that caries in primary teeth is correlated with caries in permanent teeth. This eight-year cohort study sought to determine if caries in the primary dentition can predict caries in the permanent dentition of the same individuals and, if so, with what degree of prediction accuracy. A total of 362 Chinese children, from 3 to 5 years old at the time of the 1992 baseline study, were re-examined in 2000. The study found statistically significant associations between caries prevalence in primary and permanent dentitions (p < 0.01). Children having caries in their primary teeth were three times more likely to develop caries in their permanent teeth (relative ratio = 2.6, 95% CI = 1.4-4.7; p < 0.001). Caries on primary molars had the highest predictive value (85.4%). This study demonstrates that caries status in the primary teeth can be used as a risk indicator for predicting caries in the permanent teeth.

A Commentary onZheng F M, Yan I G, Duangthip D, Lo E C M, Gao S S, Chu C H.Randomized clinical trial on caries prevention of silver diamine fluoride. J Dent Res 2025; 10.1177/00220345251363837.DesignThis randomised controlled trial sought to compare the effectiveness of silver diamine fluoride (SDF) to sodium fluoride varnish (NaF) for the prevention of caries in anterior primary teeth for young children. The inclusion criteria were children aged 3–4 years of age. Children were excluded if they had co-operative challenges or were on long-term medications. Children with active caries were included, lesions were considered active if they were soft on probing. The setting was kindergartens in Hong Kong. The children received either 38% SDF or 5% NaF applied to their six upper anterior primary teeth at six-monthly intervals. The primary outcome measure was the mean number of new carious surfaces per child at 30 months follow-up. Intention-to-treat analysis was used with the Mann-Whitney U test applied for the analysis of the primary outcome.ResultsOverall, 730 children were randomised, 621 (85%) were followed up and analysed at the 30 months end point for the presence of new carious surfaces (dmfs). Not all children seen at baseline were analysed, however of those that were their caries experience was similar with a mean dmfs of 0.47 ± 1.35 for the SDF group and 0.48 ± 1.53 for the NaF group. At 30 months, there were less new lesions for those in the SDF group (0.35 ± 1.09), than the NaF group (0.54 ± 1.50) (p = 0.048).ConclusionsThe authors concluded that SDF was more effective than NaF in preventing new carious surfaces at 30 months for anterior caries in primary teeth of young children.

Untreated dental caries remains a significant global public health challenge, disproportionately affecting vulnerable populations and highlighting inequalities in health systems worldwide. Examining its distribution across diverse contexts is essential for guiding targeted interventions, informing public policies, and allocating resources more effectively. This study aims to provide a comprehensive global assessment of the distribution of untreated dental caries in 204 countries and territories, spanning the years 2000, 2010, and 2019, by dimensions of structural determinants of health. This study employs an ecological design. This analysis describes the incidence, prevalence and years lived with disability (YLDs) due to untreated dental caries in permanent and deciduous teeth by structural determinants of health (dimensions of governance, macroeconomic policy, social policy, public policies and culture/societal values), for 204 countries and territories. Estimates of untreated caries in deciduous teeth by structural determinants were reported for children under 5 years of age, whereas estimates in permanent teeth were described for adolescents and adults aged between 15 and 49 years. Estimates were retrieved from the Global Health Data Exchange. There was a gradient of inequality between countries in terms of prevalence, YLDs, and the incidence of overt untreated caries. Countries that had better structural indicators had lower mean prevalence of untreated caries in primary teeth. In the permanent dentition, between-countries inequalities were not identified. Additionally, the mean prevalence was stable from 2010 to 2019. This study revealed possible cross-country inequalities in the burden of untreated caries in deciduous teeth that persisted over one decade. More developed countries experienced less disease burden. These findings show the need for targeted interventions to address the uneven burden of untreated dental caries worldwide. This study underscores the need for targeted global health policies to reduce untreated dental caries, especially in countries with lower structural health determinants, highlighting cross-country inequalities in disease burden and the importance of addressing these disparities in both primary and permanent dentition.

AimThe aim of the study is to find out the prevalence of periapical abscesses within carious primary teeth. Tooth abscesses in preschool children are a source of extra attention and worry for parents. Untreated carious primary teeth have a high chance of developing into a periapical abscess.Study designThe study design adopted was an analytical observational study.Materials and methodsChildren (n = 300) of which 56.7% males, and 43.3% females were evaluated for prevalence of abscesses associated with carious primary teeth. Teeth were examined by the WHO criteria of caries detection1 and abscesses associated with carious teeth were observed based on clinical signs and symptoms. Statistical analysis of data was done by Z-test with the help of SPSS 16 version.ResultsPrevalence of abscesses in anterior and posterior carious primary teeth was highest at the age of 3–5 years, respectively. No significant difference was observed between the prevalence of abscesses and genders. A significant difference (Z = 2.15, p < 0.05), (Z = 4.17, p < 0.001) was observed in prevalence of abscesses of anterior and posterior carious primary teeth among urban and rural populations respectively. If parents are graduates, the development of tooth abscesses in carious primary anterior and posterior teeth was significantly reduced. The social class of parents also significantly affects the development of tooth abscesses in carious primary anterior and posterior teeth.ConclusionIn the study, 30% abscess prevalence within carious primary teeth of preschool children was observed. Carious primary posterior teeth are two times more prone to develop abscesses as compared to carious primary anterior teeth. Social class and the education status of parents also affect the prevalence of abscesses.Clinical significanceData on abscesses prevalence in primary teeth helps Government to plan preventive, interceptive, restorative, and preventive educational programs at the school level.How to cite this articleSrivastava VK. Prevalence of Abscesses Associated with Carious Primary Teeth in Preschool Children and its Association with Age, Gender, Location, and Parent's Education and Social Class: An Observational Study. Int J Clin Pediatr Dent 2022;15(3):287-292.

Background: Dental caries is a prevalent dental problem affecting primary and permanent teeth. Early demineralization of enamel lesions can be reversed through remineralization. Many studies have focused on caries prevention and disease progression arrest using silver diamine fluoride (SDF). No in vitro studies have compared the remineralization effects of different 38% SDF solutions on artificially demineralized enamel lesions. This study aimed to compare the remineralization potential of three commercial 38% silver diamine fluoride formulations on artificial enamel lesions in primary teeth using a pH cycling model. The hypothesis was as follows: different commercial SDF formulations would exhibit varying remineralization effects, as measured by surface microhardness, due to potential differences in their compositions. Materials and Methods: In this study, 75 primary molars were randomized into five groups (N = 15): I: baseline, II: SDF Riva Star Aqua® 38%, III: Riva Star® 38%, IV: SDF Advantage Arrest® 38%, and V: control. Artificial caries were created by submerging teeth in 10 mL of demineralization solution (pH 4.5) for three days in a light-resistant container, ensuring distinct visual changes in the enamel as per the International Caries Detection and Assessment System (ICDAS level 2). After pH cycling, all samples underwent a standardized Vickers microhardness test (VMHT) with a 50 g load for 15 s. Data were analyzed using one-way ANOVA and Tukey’s post hoc test, with a significance level set at p ≤ 0.05. Results: The one-way ANOVA test indicated a significant difference in microhardness among the groups (SDF Riva Star Aqua, SDF Riva Star, and SDF Advantage Arrest), with an F-value of 167.73 and p < 0.001. The post hoc Scheffé test showed that SDF Riva Star Aqua and SDF Riva Star were not significantly different (p = 0.388). However, SDF Advantage Arrest had a significantly higher mean microhardness compared to both groups (p < 0.001). Overall, these results show that SDF Advantage Arrest leads to greater microhardness than SDF Riva Star Aqua or SDF Riva Star. Conclusions: SDF Advantage Arrest showed superior performance among the SDF-treated groups, significantly increasing microhardness compared to SDF Riva Star Aqua and SDF Riva Star. This suggests that SDF Advantage Arrest offers enhanced remineralization and structural strengthening, making it the most effective option for managing demineralized primary teeth. Future research should investigate the long-term performance and mechanisms of these treatments to optimize clinical protocols for preserving primary tooth integrity.

Paradigm shift in the effective treatment of caries in schoolchildren at risk

The use of silver diamine fluoride (SDF) as a nonsurgical caries management product is growing. Evidence suggests that SDF is very successful in arresting caries. However, a common concern with SDF treatment is the unaesthetic black staining. The purpose of this qualitative study was to determine parents' views following their children's treatment with SDF to manage severe early childhood caries (ECC). Parents were interviewed as part of a mixed-method study of SDF to arrest severe ECC. Children with caries lesions in primary teeth were treated with 2 applications of 38% SDF, followed by fluoride varnish. Semistructured in-person and phone interviews were conducted with 19 parents of children in the study. Data were transcribed verbatim and manually coded and uploaded to NVivo 12 for further coding analysis. None of the parents had previously heard about SDF, and they learned about it from the study dentist. Although parents trusted the dentist's information on SDF, they welcomed additional evidence, especially relating to product safety and effectiveness. Some parents were minimally concerned with the black staining caused by SDF treatment. It was more important that SDF arrested caries progression, minimized pain and sensitivity, and prevented dental infection. However, some parents expressed concerns related to the unaesthetic black staining. Interestingly, many parents indicated that their children were not overly concerned with the black staining. A majority of parents said that they would recommend the treatment to others. This is the first qualitative study involving parents of children who were treated with SDF. Most parents were accepting of SDF as a nonsurgical treatment to arrest caries and minimize dentinal sensitivity secondary to caries, although some expressed concern about the black staining in anterior teeth. It is important to adequately inform parents of the negative aesthetic consequences and obtain informed consent before treatment. This qualitative study revealed that many parents of children with severe ECC are accepting of SDF as a nonrestorative caries management option, despite the black staining of caries lesions. Dental professionals need to be aware of these parental concerns and obtain written informed consent prior to treatment. Parents also requested more information and resources on SDF on its benefits, effectiveness, and any associated risks.

Evidence-Based Dentistry Update on Silver Diamine Fluoride

AimSilver diamine fluoride (SDF) is taken into account as one among the effective measures for caries arrest and prevention in youngsters, due to the fact it proffers marginally invasive but cost-effective alternative to time-commemorated restorative caries control. The study was carried out to appraise the effectiveness of SDF (38%) in arresting active carious lesions and to gauge parental perception toward the treatment of cavities with SDF in the primary teeth.Materials and methodsA total of 36 children in the age range 2–10 years, having active caries lésions, based on ICDAS criteria, in primary teeth were selected following the baseline examination. After four dropouts and refusal by two patients, 30 patients were treated with 1–2 topical applications of SDF (38%). Lesions were reassessed at 1 week and 3 months taking into account to assess the color and amend inconsistency (soft/hard). Parents have been mentioned regarding features of pain or infection and have been surveyed with regard to subjective feelings regarding SDF.ResultsQuantitative variables have been subjected to the Chi-square test. All the 30 participants within the present study at baseline were reported to possess active caries lesion. About 80% of carious lesions were found to be arrested at first recall and 93.3% after 3 months. No occurrence of pain or infection was documented. Parental perception for simple application, taste, and esthetics became statistically significant. Conclusion: Study outcomes endorse SDF to be effective in preventing active carious lesions in deciduous dentition in youngsters, and treatment outcomes were affirmative by the parents.Clinical significanceSDF has been a possible management option for a noninvasive remedy to inhibit active carious lesions in deciduous dentition without causing any psychological trauma to children.How to cite this articleShrivastava U, Barjatya K, AK BB, et al. Effectiveness and Parental Perception of Silver Diamine Fluoride toward Treatment of Dental Caries in Primary Teeth. Int J Clin Pediatr Dent 2021;14(6):790–794.

A total of 1,974 primary molar teeth from the skeletal remains of 373 children from Prehistoric times to the 18th century were examined for caries prevalence and site characteristics. Results showed that caries in primary teeth was initiated more often at the cemento-enamel junction than the contact point in most time periods and that caries prevalence values recorded were comparable to those in other reports based upon much smaller sample sizes. Caries prevalence and site characteristics for primary molar teeth were found to be similar to those of permanent dentitions of corresponding periods, a finding that contradicts many previous studies. This study showed a higher caries prevalence in primary molars during the Romano-British period than recorded previously.

Background: The Global Burden of Disease (GBD) studies highlight oral health as a significant global concern, particularly in regions such as Iran, the Middle East and North Africa (MENA). This study synthesizes GBD data on the incidence, prevalence, and disability-adjusted life years (DALYs) associated with dental caries and oral disorders to inform targeted interventions aimed at alleviating their burden and improving outcomes in these regions. Methods: This study employs estimation techniques to comprehensively assess the occurrence and impact of dental caries in deciduous and permanent teeth, along with oral disorders across Iran, MENA, and globally. Data were drawn from the GBD site. We analyzed incidence, prevalence, and DALYs, utilizing disability weights with joinpoint regression models to inform public health interventions.Results: From 1990 to 2021, global and regional trends in dental caries and oral disorders were examined. Descriptive statistics illustrate significant regional disparities in incidence, prevalence, and DALYs. Globally, the incidence rate of caries in deciduous teeth decreased at an average annual percent change (AAPC) of -0.25% (95% CI: -0.30 to -0.20), while the MENA region and Iran showed AAPCs of -0.57% (-0.65 to -0.49) and -0.08% (-0.15 to -0.01), respectively. These trends highlight both progress and persistent disparities. The models reveal temporal changes in disease burden, with notable declines and fluctuations over time. These findings underscore persistent challenges in oral health, particularly in regions such as Iran and MENA, where socioeconomic conditions and healthcare access vary significantly.Conclusion: This study underscores considerable regional variation in dental caries and oral disorders, emphasizing ongoing public health challenges. Demographic shifts and reduced sugar intake, influenced by sociopolitical factors like war, have significantly decreased the global burden of oral conditions since 1990. The findings underscore the urgency of integrating oral health into primary care systems, expanding subsidized fluoride programs in rural areas, and addressing socioeconomic barriers to dental access in MENA. Community-driven initiatives, such as school-based screenings and mobile dental clinics, should be prioritized in underserved regions.

The aim of this study is to compare the effect of GSH (reduced glutathione) and KI (potassium iodide) on SDF (silver diamine fluoride) discolouration and dentine remineralisation. Sixteen primary molars were utilised, yielding 4 dentine specimens each. Three specimens per tooth were allocated: one as a control and the others to experimental groups. Initial microhardness measurements were taken from one remaining dentine specimen per tooth. Subsequently, all groups underwent exposure to a demineralisation solution. Colorimetry assessed specimen colour, and post-second microhardness measurements on demineralised specimens, treatments were administered as follows: group 1 (control, n = 16): 38% SDF, group 2 (n = 16): 38% SDF followed by KI, group 3 (n = 16): 38% SDF with 5% GSH added by weight. Following pH cycling across all groups, colorimetry reassessed 48 dentine specimens. Final microhardness measurements ensued, followed by statistical analysis. Normality was checked via Shapiro-Wilk, and homogeneity via Levene's test. Independent samples t test compared normally distributed groups; Mann-Whitney U compared non-normally distributed groups. ANOVA compared means of normally distributed groups, and Kruskal-Wallis for non-normally distributed ones. Repeated measures ANOVA compared dependent groups with normal distribution, and Friedman test for non-normal. Post hoc Bonferroni analyses identified significant differences. IBM SPSS 25 was used to conduct analyses. The mean ΔE* values for SDF and SDF + GSH groups were significantly higher than those of the SDF + KI group (p < 0.05). Significant differences in L* values during final colour measurement were noted between the SDF + KI group and both SDF and SDF + GSH groups (p < 0.05). Although mean remineralisation microhardness measurements were higher than mean demineralisation microhardness measurements in all groups, statistical significance was observed only in the SDF and SDF + KI groups (p < 0.05). The study found that the addition of 5% GSH by weight to SDF does not significantly affect discolouration. Moreover, the addition of 5% GSH to the SDF solution may have a minor impact on the remineralisation potential of SDF. The application of KI after SDF reduces discolouration and does not affect the expected remineralisation process.

ABSTRACTBackground:Silver diamine fluoride (SDF) has emerged as an effective, noninvasive treatment for arresting dental caries. While its use has been extensively studied in pediatric populations, there is limited evidence regarding its effectiveness in adults.Materials and Methods:This prospective study was conducted on 100 adult patients aged 25–60 years with active caries lesions in posterior teeth. Participants were randomly divided into two groups: the experimental group received a single application of 38% SDF, while the control group received standard fluoride varnish. Caries arrest was assessed using visual-tactile examination and scored using the International Caries Detection and Assessment System criteria at baseline, 1 month, and 6 months. Patient satisfaction and side effects were also documented. Statistical analysis was performed using paired t-tests and Chi-square tests, with a significance level set at P < 0.05.Results:After 6 months, 85% of caries lesions in the SDF group were arrested, compared to 45% in the fluoride varnish group (P < 0.001). Patient satisfaction scores were significantly higher in the SDF group, with a mean score of 4.7 compared to 3.5 in the control group. Minor side effects, such as temporary staining, were observed in 90% of SDF-treated teeth but were deemed acceptable by patients.Conclusion:The application of 38% SDF is highly effective in arresting caries in adult patients and provides a promising, minimally invasive treatment option. Although tooth staining remains a common side effect, its clinical benefits outweigh aesthetic concerns, making it a valuable tool in caries management.

BackgroundUsing silver diamine fluoride (SDF) for caries management has raised dentists’ interests in Southeast Asia (SEA). However, information about the teaching of SDF in dental schools in SEA is limited. Therefore, this survey aimed to describe the extent to which SDF had been introduced into the education of undergraduate students in the dental schools in SEA.MethodsAn online questionnaire survey was conducted on the duration, method, contents, and barriers regarding the teaching of SDF. Teachers in charge of undergraduate program in pediatric dentistry and those in community dentistry in all the 90 dental schools in SEA were approached and we required each department to reply once only. Descriptive statistics and Chi-square test were used to describe and assess the differences between the two departments in the teaching of SDF.ResultsA total of 81 responses from the departments of 49 schools were received, giving a school-level response rate of 54% (49/90). SDF was taught in the undergraduate program in 86% (42/49) of the respondent schools, and 50% (21/42) of these schools had included SDF in the teaching for five or more years. Almost all (98%) of the departments taught SDF through lectures. Furthermore, 55% of them adopted SDF in clinical practice. Regarding the teaching content, the use of SDF for arresting cavitated caries lesion was the most commonly covered (82–97%), followed by for arresting early noncavitated lesions (69–82%), for preventing new caries development (66–79%) and for treating dental hypersensitivity (77%). There were variations in the post-treatment instruction taught. For the departments not teaching SDF, the most common reason (10/19, 53%) was that SDF was not available.ConclusionSDF is covered in the undergraduate program in most of the dental schools in SEA. The use of SDF to arrest cavitated caries lesions in primary teeth is usually taught. However, other applications of SDF, such as for prevention of caries and treatment of dental hypersensitivity, are less commonly mentioned in the teaching.