Topical silver diamine fluoride for managing dental caries in children and adults

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of silver diamine fluoride in arresting and preventing caries in deciduous and permanent teeth (coronal and root caries) compared to any other intervention including placebo or no treatment.</p

The efficacy of silver diamine fluoride in arresting caries in children

Data sourcesPubMed, Scopus, Web of Science, the Latin American and Caribbean Health Sciences Literature database (LILACS), the Brazilian Library in Dentistry (BBO), Cochrane Library and grey literature.Study selectionTwo reviewers selected randomised clinical trials (RCTs) that compared the efficacy of SDF application with other active treatments or placebo in arresting carious lesions.Data extraction and synthesisThree authors extracted data using customised extraction forms, and risk of bias was assessed by two independent reviewers. Meta-analyses were performed on studies classified at 'low' or 'unclear' risk of bias, where similar outcomes were recorded in primary teeth, and that compared SDF to active treatments.ResultsEleven studies were included; five studies were at 'low', two at 'unclear' and four studies at 'high' risk of bias. Eight were conducted with primary teeth, two with permanent first molars and one conducted on both. Six studies used 38% SDF, two 30% SDF, one 12% SDF, one compared 38% SDF to 12% SDF and one used Nano Silver Fluoride (NSF).ConclusionsSDF is more effective than active treatments or placebo for carious lesion arrest in primary teeth. The body of evidence was of high quality for primary teeth. However, there was not enough high quality evidence to draw conclusions about carious lesion arrest in first permanent molars

"It's really no more difficult than putting on fluoride varnish":a qualitative exploration of dental professionals' views of silver diamine fluoride for the management of carious lesions in children

Background Despite evidence that Silver Diamine Fluoride (SDF) can be effective in managing carious lesions in primary teeth, the use of SDF in the UK remains limited. This study explored dental professionals’ views and experiences of using SDF for managing carious lesions in children. In addition, it explored what they perceived to be the advantages, disadvantages, barriers and enablers to the use of SDF in practice. Methods Fifteen semi-structured face-to-face or over-the-phone interviews were conducted with 14 dental professionals from NHS Tayside and NHS Grampian in Scotland. Interviews were transcribed verbatim, coded and analysed using a thematic approach. Results Thirteen of 14 dental professionals interviewed were familiar with, or had some existing knowledge of, SDF. Four had used it to treat patients. The majority of participants thought that the main advantage of SDF was that it required minimal patient cooperation. SDF was also perceived as a simple, pain-free and non-invasive treatment approach that could help acclimatise children to the dental environment. However, SDF-induced black staining of arrested carious lesions was most commonly reported as the main disadvantage and greatest barrier to using it in practice. Participants believed that this discolouration would concern some parents who may fear that the black appearance may instigate bullying at school and that others may judge parents as neglecting their child’s oral health. Participants thought that education of clinicians about SDF use and information sheets for parents would enhance the uptake of SDF in dental practice. Participants believed that younger children might not be as bothered by the discolouration as older ones and they anticipated greater acceptance of SDF for posterior primary teeth by both parents and children. Conclusion Dental professionals were aware that SDF can be used for arresting carious lesions. They pointed out that the staining effect of carious lesions is a major disadvantage that could be a barrier for many parents. Participants considered the application process to be simple and non-invasive and requires a minimum level of child cooperation. Participants appreciated the potential of SDF in paediatric dentistry and suggested actions that could help overcome the barriers they highlighted

Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial

Objectives: This multicentre, assessor‐blinded, two‐arm cluster randomized trial evaluated the clinical and cost‐effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in UK secondary schools. Methods: Pupils aged 11–13 years with their own mobile telephone attending secondary schools with above average free school meals eligibility were randomized (at year‐group level) to receive a lesson and twice‐daily text messages or to usual care. Year‐groups (n = 84) from 42 schools including 4680 pupils (intervention, n = 2262; control, n = 2418) were randomized. Results: In 2383 participants with valid data at baseline and 2.5 years, the primary outcome of presence of at least one treated or untreated carious lesion (D4‐6 MFT [Decayed, Missing and Filled Teeth] in permanent teeth using International Caries Detection and Assessment System) was 44.6% in the intervention group and 43.0% in control (odds ratio [OR] 1.04, 95% CI 0.85–1.26, p = .72). There were no statistically significant differences in secondary outcomes of presence of at least one treated or untreated carious lesion (D1‐6 MFT), number of D4‐6 MFT and D1‐6 MFT, plaque and bleeding scores or health‐related‐ (Child Health Utility 9D) or oral health‐related‐ quality of life (CARIES‐QC). However, twice‐daily toothbrushing, reported by 77.6% of pupils at baseline, increased at 6 months (intervention, 86.9%; control, 83.0%; OR 1.30, 95% CI 1.03–1.63, p = .03), but returned to no difference at 2.5 years (intervention, 81.0%; control, 79.9%; OR 1.05, 95% CI 0.84–1.30, p = .69). Estimated incremental costs and quality‐adjusted life‐years (QALYs) of the intervention, relative to control, were £1.02 (95% CI −1.29 to 3.23) and −0.003 (95% CI −0.009 to 0.002), respectively, with a 7% chance of being cost‐effective (£20 000/QALY gained threshold). Conclusion: There was no evidence of statistically significant difference for caries prevalence at 2.5‐years. The intervention's positive 6‐month toothbrushing behaviour change did not translate into caries reduction. (ISRCTN 12139369). COVID‐19 pandemic adversly affected follow‐up

When Less is More:Minimally Invasive, Evidence-Based Treatments for Dentine Caries in Primary Teeth - The Hall Technique and Silver Diamine Fluoride

Evidence supports minimally invasive dentistry, and we have a better understanding of dental caries as a biofilm-mediated disease. These factors, together with the current need to reduce aerosol generation, make treatment approaches such as the Hall Technique and the use of silver diamine fluoride (SDF) more relevant than ever. Successful treatment planning depends on carious lesions being detected, their status accurately assessed, and a correct diagnosis made. Choosing the most appropriate treatment options for the tooth and child relies on marrying this with a precise history and an understanding of indications and contraindications for treatments. This article outlines the optimal use of the Hall Technique and SDF, allowing dental practitioners and therapists to use these modalities as less invasive approaches to provide the highest quality treatment for children with dental caries; less is more

The use of silver diamine fluoride (SDF) in dental practice

Silver diamine fluoride (SDF) is a clear, odourless liquid indicated for desensitisation of non-carious tooth lesions and molar incisor hypomineralisation. It is also useful for arresting carious lesions in adults and children who are high caries-risk and/or have difficult-to-control, progressing carious lesions, those who are unable to tolerate invasive treatment, elderly populations, and those who are medically compromised or have additional care and support needs. SDF may be used to manage lesions that are too extensive to restore but not associated with pain and/or infection. This can be important particularly where extractions might be contra-indicated for medical or behavioural reasons. This paper summarises the global evidence for the effectiveness and safety of SDF, describes what it is, its mechanisms of action and presents recommendations on how to use it. There are details on indications/contra-indications and risks/benefits to be considered in the use of SDF also discussion of how to approach SDF's side effect of black staining of carious tooth tissue. We give an example of an information sheet (Appendix S1, see online supplementary information) that may be used when discussing SDF with patients, particularly for primary teeth in children, but adaptable for the permanent dentition and for adults.</p