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Evidence found and GRADE certainty

65 questions · 91 findings · 10 reviews · Dental caries

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No studies found 5 · 5.5%GRADE not reported 32 · 35.2%Very low 15 · 16.5%Low 6 · 6.6%Moderate 15 · 16.5%High 18 · 19.8%

38% SDF (every 6 months) vs no treatment

Inactive (arrested) carious lesions on permanent first molars · Children with dental caries in permanent (first) molars

Six-monthly SDF produced significantly more inactive (arrested) lesions than no treatment in children's permanent molars (0.3 vs 0.1; p<0.05; ungraded).

1 finding from 1 review

10% silver diamine fluoride (SDF) vs Glass ionomer restoration and tooth-brushing

Remineralisation of early enamel caries · Children with early enamel caries in erupting permanent first molars

One pilot study found 10% silver diamine fluoride worked about as well as glass ionomer restoration and tooth-brushing for remineralising early enamel caries; ungraded.

1 finding from 1 review

38% silver diamine fluoride vs No treatment / other preventive agents (GIC, 5% NaF varnish)

Caries arrest · Children with dentine carious lesions (ICDAS 4-5) in primary teeth

A second meta-analysis reported odds ratios of 2.44 to 3.63 favouring 38% SDF over fluoride varnish/water for caries arrest (ungraded).

2 findings from 1 review

38% SDF solution (applied biannually) vs 12% SDF solution (applied biannually)

Arrest of advanced cavitated carious lesions on any coronal surface · Primary teeth with advanced cavitated carious lesions on any coronal surface

38% SDF solution biannually compared with 12% SDF solution biannually: RR 1.29 (95% CI 1.21 to 1.38); High certainty.

1 finding from 1 review

30% SDF solution (applied annually) vs 30% SDF solution (once weekly for 3 weeks)

Arrest of advanced cavitated carious lesions on any coronal surface · Preschool children with advanced cavitated carious lesions on any coronal surface (primary teeth)

30% SDF solution (applied annually) probably did not differ from 30% SDF solution (once weekly for 3 weeks) for arrest or reversal of cavitated coronal carious lesions (RR 1.13, 95% CI 0.95 to 1.34; moderate certainty).

3 findings from 1 review

38% silver diamine fluoride vs 12% SDF solution (applied annually)

Arrest of advanced cavitated carious lesions on any coronal surface · Preschool children with advanced cavitated carious lesions on any coronal surface (primary teeth)

38% SDF solution (applied annually) was more effective than 12% SDF solution (applied annually) for arrest or reversal of cavitated coronal carious lesions (RR 1.27, 95% CI 1.16 to 1.4; high certainty).

4 findings from 1 review
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12% SDF solution (applied annually) vs 12% SDF solution (applied biannually)

Arrest of advanced cavitated carious lesions on any coronal surface · Preschool children with advanced cavitated carious lesions on any coronal surface (primary teeth)

12% SDF solution (applied annually) did not differ from 12% SDF solution (applied biannually) for arrest or reversal of cavitated coronal carious lesions (RR 0.94, 95% CI 0.87 to 1.02; high certainty).

4 findings from 1 review
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38% silver diamine fluoride vs 38% SDF + potassium iodide solution (applied annually)

Arrest or reversal of noncavitated and cavitated root carious lesions · Adults (including institutionalized/older adults) with noncavitated and cavitated carious lesions on root surfaces (permanent teeth)

38% SDF solution (applied annually) may not differ from 38% SDF + potassium iodide solution (applied annually) for arrest or reversal of root carious lesions (RR 0.8, 95% CI 0.25 to 2.61; low certainty).

1 finding from 1 review

38% SDF solution (applied biannually) vs 12% SDF solution (applied biannually)

Arrest of advanced cavitated carious lesions on any coronal surface · Preschool children with advanced cavitated carious lesions on any coronal surface (primary teeth)

38% SDF solution (applied biannually) was more effective than 12% SDF solution (applied biannually) for arrest or reversal of cavitated coronal carious lesions (RR 1.3, 95% CI 1.21 to 1.41; high certainty).

4 findings from 1 review
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38% SDF solution (applied biannually) vs 38% SDF solution (applied annually)

Arrest of advanced cavitated carious lesions on any coronal surface · Preschool children with advanced cavitated carious lesions on any coronal surface (primary teeth)

38% SDF solution (applied biannually) was more effective than 38% SDF solution (applied annually) for arrest or reversal of cavitated coronal carious lesions (RR 1.21, 95% CI 1.12 to 1.3; high certainty).

4 findings from 1 review
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38% SDF + potassium iodide solution (applied annually) vs CPP-ACP

Remineralization/arrest of early enamel carious lesions · Patients with early enamel carious lesions on permanent molars

For early enamel lesions, annual SDF+KI was significantly less effective than twice-daily CPP-ACP (54.8% vs 100% arrested; p<0.001; ungraded).

1 finding from 1 review

38% SDF + potassium iodide solution (applied annually) vs Tricalcium silicate (TCS) paste (applied twice daily)

Remineralization/arrest of early enamel carious lesions · Patients with early enamel carious lesions on permanent molars

For early enamel lesions, annual SDF+KI was significantly LESS effective than twice-daily tricalcium silicate paste (54.8% vs 100% arrested; p<0.001; ungraded).

1 finding from 1 review

30% silver diamine fluoride vs Atraumatic restorative treatment (ART)

Patient discomfort during treatment (anxiety scale) · Children (age 1-10 years) with active cavitated dentin caries lesions in primary molars

One study found no significant difference in patient discomfort between SDF and ART (p = 0.15; ungraded).

1 finding from 1 review

Silver diamine fluoride (SDF) vs Other methods (pooled: ART/glass ionomer cement, nano-silver fluoride, sodium fluoride varnish, placebo)

Adverse effects (tooth staining and other side effects) · Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)

SDF commonly causes black staining of arrested lesions; only mild, transient adverse events were reported, with no major adverse events (ungraded).

1 finding from 1 review

38% silver diamine fluoride vs Fluoride varnish

Arrest or reversal of noncavitated and cavitated root carious lesions · Adults (including institutionalized/older adults) with noncavitated and cavitated carious lesions on root surfaces (permanent teeth)

38% SDF solution (applied annually) may not differ from 5% NaF varnish for arrest or reversal of root carious lesions (RR 0.64, 95% CI 0.04 to 9.66; very low certainty).

1 finding from 1 review

38% silver diamine fluoride vs no treatment

Arrest or reversal of noncavitated and cavitated root carious lesions · Adults (including institutionalized/older adults) with noncavitated and cavitated carious lesions on root surfaces (permanent teeth)

38% SDF solution (applied annually) may not differ from no treatment for arrest or reversal of root carious lesions (RR 1.92, 95% CI 0.52 to 6.87; very low certainty).

1 finding from 1 review

30% SDF solution (applied annually) vs Fluoride varnish

Arrest of advanced cavitated carious lesions on any coronal surface · Preschool children with advanced cavitated carious lesions on any coronal surface (primary teeth)

30% SDF solution (applied annually) was more effective than 5% NaF varnish (once weekly for 3 weeks) for arrest or reversal of cavitated coronal carious lesions (RR 1.41, 95% CI 1.2 to 1.66; high certainty).

3 findings from 1 review

38% silver diamine fluoride vs 5,000-ppm F (1.1% NaF) toothpaste or gel

Arrest or reversal of noncavitated and cavitated root carious lesions · Adults (including institutionalized/older adults) with noncavitated and cavitated carious lesions on root surfaces (permanent teeth)

38% SDF solution (applied annually) may not differ from 5,000-ppm F (1.1% NaF) toothpaste or gel for arrest or reversal of root carious lesions (RR 0.72, 95% CI 0.18 to 2.95; very low certainty).

1 finding from 1 review

30% SDF solution (once weekly for 3 weeks) vs Fluoride varnish

Arrest of advanced cavitated carious lesions on any coronal surface · Preschool children with advanced cavitated carious lesions on any coronal surface (primary teeth)

30% SDF solution (once weekly for 3 weeks) probably did not differ from 5% NaF varnish (once weekly for 3 weeks) for arrest or reversal of cavitated coronal carious lesions (RR 0.97, 95% CI 0.8 to 1.18; moderate certainty).

3 findings from 1 review