One review reported a 64% prevented fraction for 38% SDF versus placebo for preventing coronal caries in permanent first molars (one study; ungraded).
SDF showed no clear advantage for caries arrestment at the surface level.
SDF showed a higher caries-arrestment proportion at the individual level, but the reported difference was not statistically significant.
SDF showed a higher caries-free proportion at the tooth level, but the reported difference was not statistically significant.
No eligible studies assessed SDF for coronal caries in adults; this is an evidence gap identified by the review.
SDF did not significantly differ from placebo for oral health-related quality of life in children (MD 0.03, 95% CI -0.16 to 0.22; ungraded).
SDF did not significantly differ from atraumatic restorative treatment for oral health-related quality of life (MD 0.02, 95% CI -0.32 to 0.36; ungraded).
One study found no significant difference in patient discomfort between SDF and ART (p = 0.15; ungraded).
SDF was not significantly better than ART at arresting caries (pooled ES 0.05, 95% CI -0.42 to 0.51; ungraded).
Silver diamine fluoride was about 2.5 times more likely than sodium fluoride to arrest dentine caries surfaces at 18 months (pooled OR 2.51, 95% CI 1.25 to 5.10; 2 RCTs), although between-study heterogeneity was high (I2=90.3%); certainty of evidence was not formally graded.
Limited evidence from two trials suggests SDF may help prevent new caries, but preventive efficacy was not meta-analyzed and remains uncertain (ungraded).
SDF plus fluoride varnish did not significantly differ from ART plus fluoride varnish for oral health-related quality of life (MD 0.16, 95% CI -0.1 to 0.42; ungraded).
In one trial, SDF greatly increased individual-level caries arrestment versus ART/glass ionomer cement (OR 18.03); this subgroup was not separately GRADE-rated.
In one trial, SDF increased tooth-level caries arrestment versus 5% sodium fluoride varnish (OR 4.75; ungraded subgroup).
Pooling two highly heterogeneous trials, SDF showed no significant difference versus 5% sodium fluoride varnish in surface-level caries arrestment (OR 1.46; ungraded subgroup).
Pooling two trials, SDF markedly increased individual-level caries arrestment versus placebo (OR 18.10; ungraded subgroup).
Pooling two trials, SDF and ART/glass ionomer cement showed no clear difference in tooth-level caries arrestment (OR 1.22, wide CI; ungraded subgroup).
SDF had no significant effect on oral health-related quality of life versus pooled standard-of-care caries treatments (SMD -0.06, 95% CI -0.20 to 0.08; ungraded).
Prior SDF application significantly reduces the immediate bond strength of adhesives to dentin overall (MD 7.12 MPa favoring untreated dentin, 95% CI 1.38 to 12.85; ungraded), with very high heterogeneity (I2=98%).
Prior SDF application does not influence the immediate bond strength of glass-ionomer cement to dentin (MD -0.11 MPa, 95% CI -0.54 to 0.31; ungraded).