Using sequential applications of a novel silver diamine fluoride gel and sodium fluoride varnish to arrest severe early childhood caries lesions: A clinical trial with single group assignment

BACKGROUND

Silver diamine fluoride (SDF) gel was developed to overcome the clinical limitations of liquids with children. The authors conducted a clinical trial to determine caries lesion arrest in primary teeth at 1-year follow-up when 38% SDF gel and 2.5% sodium fluoride varnish were applied sequentially at the same appointment. Parent satisfaction was assessed.

METHODS

The study design was an open-label prospective, clinical trial with single group assignment. Participants were 237 children aged 3 through 4 years at enrollment and from 5 centros educativos iniciales (preschools). Eligible children had 1 or more d3 (cavitation into dentin) active caries lesions. Teeth with active caries lesions (cavitation confined to enamel [d2] or d3) were treated by applying 1 or 2 drops of viscous 38% SDF gel (Advantage Silver Dental Arrest Gel, Elevate Oral Care, LLC) dabbing the excess with cotton. Treated teeth were covered with 2.5% sodium fluoride varnish (Fluorimax, Elevate Oral Care, LLC) to mask the taste. Treatment was repeated at 5 months postexamination. The primary outcome was caries lesion (d2-d3) arrest at 1 year.

RESULTS

Two hundred nineteen children were available at the 1-year follow-up. There was a median of 21 (interquartile range [IQR], 13-34) active carious surfaces (d2-d3) at baseline. Median arrested carious surfaces was 92.6% (IQR, 81.1%-100.0%; 95% CI, 86.8% to 95.2%). When parents were asked whether they were bothered by the color change of teeth, the median response on a 10-point scale in which 1 equaled not bothered at all and 10 equaled very bothered was 1.0 (IQR, 1.0-2.0).

CONCLUSIONS

Two applications of 38% SDF gel and 2.5% sodium fluoride varnish arrested greater than 90% of carious surfaces at 1 year and with high levels of parental satisfaction.

PRACTICAL IMPLICATIONS

Combined treatment was highly efficacious in a population with many caries lesions. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT05395065.

Silver Diamine Fluoride in Pediatric Dentistry: Effectiveness in Preventing and Arresting Dental Caries-A Systematic Review

BACKGROUND

Tooth decay is considered a global scourge by the World Health Organization (WHO) starting at an early age. In recent years, silver diamine fluoride (SDF) has regained interest, particularly in pediatric dentistry, used to prevent the development of carious lesions or arrest their progression.

OBJECTIVE

The aim of this study was to assess, through a systematic review of the literature, the effectiveness of SDF, used in pedodontics, in temporary teeth, in preventing or arresting dental caries.

MATERIAL AND METHODS

An electronic search was conducted on PubMed, Web of Science and Scopus. The effect of SDF on both temporary and permanent teeth has been considered.

RESULTS

The inclusion criteria identified 16 randomized controlled trials involving patients aged 18 months to 13 years and followed over a period of 12-30 months.

CONCLUSIONS

SDF is a practical, accessible and effective non-invasive way to prevent and arrest caries in temporary and permanent teeth. Its application requires regular monitoring. The resulting black spot is diminished by immediate application of potassium iodide but this may affect its effectiveness.

Assessing the Effects and Acceptance of Silver Diamine Fluoride Treatment in Early Childhood Caries

BACKGROUND

 Early childhood caries (ECC) is a widespread dental problem that impacts children below the age of six years. Traditional restorative treatments like fillings are often challenging and invasive for young children. Silver diamine fluoride (SDF) offers a minimally invasive and cost-effective alternative for managing ECC. However, the effects, acceptance, and understanding of this treatment by parents remain crucial for its successful implementation.

AIM

To evaluate the impact and level of acceptance of SDF treatment in ECC.

MATERIALS AND METHODS

Thirty-two children from an Anganwadi center aged between two to five years suffering from ECC were selected. A 38% SDF was applied for 3 minutes on the identified carious lesion, and the arrest percentage was checked after a recall period of three weeks and three months. The Likert scale was used for the questionnaire regarding parental feedback about the ease of application procedure, tooth discoloration, possible pain associated with the procedure, and the taste of SDF.

RESULTS

In the present study, a total of 75 surfaces were subjected to the application of SDF. After a period of three weeks, it was observed that 64 of these surfaces had successfully undergone the process of caries arrest. This finding was deemed to be statistically significant, with a P value of 0.021. Furthermore, the remaining surfaces that had not achieved caries arrest were subsequently treated at three months. The results of this subsequent treatment were also found to be statistically significant, with a P value of 0.027. These findings highlight the efficacy of both caries treatment and caries arrest in relation to the utilization of SDF.

CONCLUSION

SDF was found to be minimally invasive, easy to administer, inexpensive, highly efficient, and effective treatment in arresting caries in the primary dentition of young children, particularly in patients lacking cooperation.

Silver release from dentine treated with combinations of silver diamine fluoride, potassium iodide and etching

For individuals with very high to extremely high caries activity and poor control of daily oral hygiene, a simple treatment for arresting their caries activity is necessary. Silver Diamine Fluoride (SDF) has become increasingly common for this purpose due to its efficacy and ease of application. To avoid or reduce tooth discoloration after SDF treatment potassium iodide (KI) may be applied. However, the release of silver from SDF-treated tooth surfaces may be of concern. Thus, the aim of the present study was to quantify the amount of silver leached in both a short- and long-term perspective. In this in vitro experiment we measured the cumulative release of silver from SDF-treated dentin surfaces with and without imminent application of KI, and with and without phosphoric acid etching as pre-treatment, after 24 h and weekly for four weeks. The release of silver was highest after 24 h for all treatment groups, with a significant drop after this point. When etching was not used, the use of KI did not affect the release of silver. However, when etching was used, there was a significantly lower silver release when KI was also used compared to when KI was not used. This effect was largest for the first two weeks, after which the difference was smaller as all groups released low amounts of silver.

Effectiveness of 38% Silver Diamine Fluoride Application along with Atraumatic Restorative Treatment for Arresting Caries in Permanent Teeth When Compared to Atraumatic Restorative Treatment in Adults-Study Protocol for a Randomized Controlled Trial

INTRODUCTION

Dental caries in the adult population that require preventive and therapeutic treatment are generally neglected in rural communities. The determination of the effectiveness of the application of 38% silver diamine fluoride (SDF) in arresting caries lesions when combined with atraumatic restorative treatment (ART) is very important, as it serves as a preventive and restorative procedure to regain the function of the permanent dentition. The assessment of optimal SDF application with ART, in comparison with ART alone, in managing cavitated carious lesions in a pragmatic setting, is the need of the hour to recommend optimal dental care, especially in rural settings which have minimal access to comprehensive dental care.

METHODS AND ANALYSIS

The clinical trial will enrol 220 adults (18-65 years) with cavitated carious lesions attending the Amrita School of Dentistry in the Ernakulam district, India. This study is a randomized, controlled trial with a 1:1 allocation ratio in two parallel groups. Study arm 1 will receive 38% SDF application and ART, and study arm 2 will receive ART only. A digital radiograph will be taken immediately after restoration (baseline) as well as at the end of the 6th month for evaluation of caries arrest. The assessment of the survival of the restoration will be done on the 7th day, 30th day, and at the end of the 6th month. The final analysis would include both the tooth and person levels.

ETHICS AND DISSEMINATION

This trial adheres to the principles of the Declaration of Helsinki and the guidelines of the Indian Council of Medical Research (ICMR). This study protocol has been approved by the Institutional Review Board. This trial has been registered prospectively with the Clinical Trial Registry of India (Registration No: CTRI/2021/12/038816).

Teaching and utilization of silver diamine fluoride and Hall-style crowns in US pediatric dentistry residency programs

BACKGROUND

Nonsurgical caries management, particularly silver diamine fluoride (SDF) and Hall-style crowns, present alternative options for populations that have barriers to traditional treatment. The authors aimed to assess changes in the teaching and utilization of these modalities in pediatric dental residency programs.

METHODS

The authors e-mailed a 29-question electronic survey regarding the utilization and teaching of nonsurgical caries management agents to US pediatric dentistry residency program directors. Data were compared with results from a similar survey conducted in 2015 to analyze trends, report protocols, barriers for utilization, and possible reasons for changes.

RESULTS

Respondents from 82 programs completed the surveys (89% response rate). Although only 26% of respondents reported using SDF in 2015, 100% reported its utilization in 2020 (P < .001). The Hall-style crown technique is taught didactically in 90% of programs, and 69.5% of respondents use it at least sporadically in their clinics. Long wait times for the operating room (4 weeks-14 months) and sedation (1 week-12 months) motivate increased utilization of SDF, interim therapeutic restorations, and Hall-style crowns. Guidelines supporting off-label utilization of SDF have also resulted in its increased utilization.

CONCLUSIONS

US pediatric residency programs have universally adopted SDF for caries arrest in the primary dentition, and this trend seems to extend to other nonsurgical caries management agents. These changes are likely driven by diverse barriers to delivery of traditional restorative care.

PRACTICAL IMPLICATIONS

The rapid increases in teaching and utilization of minimal intervention techniques provide clinicians with more options for caries management in patients with barriers to traditional treatment.

Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials-a report of the American Dental Association and the American Academy of Pediatric Dentistry

BACKGROUND

National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly one-fourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons.

TYPE OF STUDIES REVIEWED

The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.

Arrest of Root Carious Lesions via Sodium Fluoride, Chlorhexidine and Silver Diamine Fluoride In Vitro

OBJECTIVE

To compare the root carious lesion arrest of chlorhexidine (CHX) and silver diamine fluoride (SDF) varnishes and/or sodium fluoride rinses (NaF) in vitro.

BACKGROUND

Effective and easily applicable interventions for treating root carious lesions are needed, as these lesions are highly prevalent amongst elderly individuals.

METHODS

In 100 bovine dentin samples, artificial root carious lesions were induced using acetic acid and a continuous-culture Lactobacillus rhamnosus biofilm model. One quarter of each induced lesion was excavated and baseline dentinal bacterial counts assessed as Colony-Forming-Units (CFU) per mg. Samples were allocated to one of four treatments (n = 25/group): (1) untreated control; (2) 38% SDF or (3) 35% CHX varnish, each applied once, plus 500 ppm daily NaF rinse in the subsequent lesion progression phase; and (4) daily NaF rinses only. Samples were re-transferred to the biofilm model and submitted to a cariogenic challenge. After six days, another quarter of each lesion was used to assess bacterial counts and the remaining sample was used to assess integrated mineral loss (ΔZ) using microradiography.

RESULTS

ΔZ did not differ significantly between control (median (25th/75th percentiles): 9082 (7859/9782) vol % × µm), NaF (6704 (4507/9574) and SDF 7206 (5389/8082)) (p < 0.05/Kruskal-Wallis test). CHX significantly reduced ΔZ (3385 (2447/4496)) compared with all other groups (p < 0.05). Bacterial numbers did not differ significantly between control (1451 (875/2644) CFU/µg) and NaF (750 (260/1401)) (p > 0.05). SDF reduced bacterial counts (360 (136/1166)) significantly compared with control (p < 0.05). CHX reduced bacterial counts (190 (73/517)) significantly compared with NaF and control (p < 0.05).

CONCLUSION

CHX varnish plus regular NaF rinses arrested root carious lesions most successfully.