Cochrane · intervention · CD012718
Topical silver diamine fluoride (SDF) for preventing and managing dental caries in children and adults
Worthington, HV, Lewis, SR, Glenny, A-M, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
76
current version
GRADE rated
39
No studies
35
Included studies
29
as reported
No studies 35 · 46.1%Ungraded 2 · 2.6%Very low 34 · 44.7%Low 4 · 5.3%Moderate 1 · 1.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children, adolescents and adults with any type of carious lesions or without carious lesions, in anterior or posterior primary or permanent teeth (coronal and root) | Children (n=12,020); older adults (n=1016); total 13,036 participants |
| Intervention | Topical application of SDF at any frequency of application, concentration of solution, or duration of treatment, with or without caries excavation | SDF, concentrations 12%, 30%, 38%, at various frequencies, intervals and durations (n=29 studies) |
| Comparison | Placebo; no treatment; SDF at a different frequency, concentration or duration; any other intervention | Placebo or no treatment (n=14); different SDF approaches (n=5); fluoride varnish (n=8); chlorhexidine varnish (n=1); silver nitrate plus fluoride varnish (n=1); sealants or resin infiltration (n=2); ART with GIC or glass ionomer material (n=4); GIC plus fluoride varnish (n=1); sealants plus fluoride varnish (n=1); restoration (n=1) |
| Outcomes | Primary caries prevention; Caries arrest; Secondary prevention of caries; Adverse effects; Dental pain or sensitivity; Aesthetics | Primary caries prevention; Caries arrest; Secondary prevention of caries; Adverse effects; Dental pain or sensitivity; Aesthetics |
| Study designs | RCT (parallel-group or split-mouth); cluster-RCT (>1 cluster per group); quasi-randomised trials excluded | RCT (n=29; 28 parallel-group, 1 split-mouth not usable) |
| Timing | End of study follow-up (any length of follow-up eligible) | 48 hours to 36 months |
Search date: 2023-06. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; ClinicalTrials.gov; WHO International Clinical Trials Registry Platform (ICTRP)
Questions and results
Silver diamine fluoride (SDF) vs Placebo or no treatment
Population: Children and adults (with or without carious lesions)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrest 36 months · Permanent dentition (coronal) | MD 0.20 [0.00, 0.40] 0.20 [0.00, 0.40] surfaces | 1 study · 373 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Secondary prevention of caries 24 months · Permanent dentition (coronal) | Peto OR 44.22 [33.12, 59.04] 62 per 1000 teeth vs 750 per 1000 | 1 study · 663 participants | Very low Downgraded: risk of bias, imprecision |
Caries arrest 24 months · Permanent dentition (root) | MD 0.24 [0.12, 0.36] 0.24 [0.12, 0.36] surfaces | 1 study · 158 participants | Very low Downgraded: risk of bias, imprecision |
Secondary prevention of caries Permanent dentition (root) | No studies measured this outcome for root surfaces | 0 studies | No studies |
Primary caries prevention 24 to 36 months · Permanent dentition (root) | MD -0.79 [-1.40, -0.17] -0.79 [-1.40, -0.17] surfaces | 3 studies · 439 participants | Moderate Downgraded: risk of bias |
Caries arrest 24 to 36 months · Primary dentition | MD 0.86 [0.39, 1.33] 0.86 [0.39, 1.33] surfaces | 2 studies · 841 participants | Low Downgraded: risk of bias, indirectness |
Primary caries prevention 36 months · Primary dentition | MD -1.14 [-1.58, -0.70] -1.14 [-1.58, -0.70] surfaces | 1 study · 373 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse effects 12 to 30 months · Adults | 1 study reported no adverse effects. 1 study reported a white discolouration of the gingiva adjacent to surfaces treated with SDF (116 surfaces) as well as redness (4 surfaces), and mild ulceration (2 surfaces). In… | 2 studies · 316 participants | Very low Downgraded: risk of bias, imprecision |
Aesthetics 30 months · Adults | 1 study reported that "only 19 (7%) [older adult participants] raised a complaint about the interventions at the 30-mo [month] examination, and half of them complained of black stain on the treated root surfaces." No… | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision |
Dental pain or sensitivity | No studies measured this outcome | 0 studies | No studies |
Adverse effects 48 hours to 30 months · Children | 1 study reported 3 adverse effects in the first 48 hours. Of these, 1 effect in SDF group was possibly related to treatment (spot on corner of lip that looked like a burn), and 2 effects in placebo group were possibly… | 3 studies · 983 participants | Very low Downgraded: risk of bias, imprecision |
Primary caries prevention 36 months · Permanent dentition (coronal) | MD -0.69 [-0.97, -0.41] -0.69 [-0.97, -0.41] surfaces | 1 study · 373 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Secondary prevention of caries 18 months · Primary dentition | OR 1.08 [0.52, 2.23] | 1 study · 128 participants | Very low Downgraded: risk of bias, imprecision |
SDF (given at a particular frequency, concentration, or duration) vs SDF (given at a different frequency, concentration, or duration)
Population: Children and adults (with or without carious lesions)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Aesthetics 24 months · Children | 1 study (119 children) reported that 45% parents were satisfied with child's dental appearance (data not reported by study group) | 1 study · 119 participants | Very low Downgraded: risk of bias, imprecision |
Caries arrest 12 to 30 months · Primary dentition | In 1 study (45 children), 4 applications of 38% SDF at 1-monthly intervals resulted in fewer surfaces with active caries compared with 2 applications at 6-monthly intervals (MD 1.04 surfaces, 95% CI 0.23 to 1.85), and… | 4 studies · 1360 participants | Very low Downgraded: risk of bias, inconsistency |
Secondary prevention of caries 30 months · Primary dentition | MD -0.10 [-0.61, 0.41] -0.10 [-0.61, 0.41] lesions | 1 study · 203 participants | Very low Downgraded: risk of bias, imprecision |
Primary caries prevention | No studies reported data for this outcome | 0 studies | No studies |
Dental pain or sensitivity | No studies reported data for this outcome | 0 studies | No studies |
Adverse effects 24 to 30 months · Children | 1 study (203 children) reported that black or brown staining on treated lesions was commonly found in both groups, with little or no difference according to whether SDF treatment was given in 3 applications at… | 3 studies · 1121 participants | Very low Downgraded: risk of bias, imprecision |
Silver diamine fluoride (SDF) vs Fluoride varnish
Population: Children and adults (with or without carious lesions)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental pain or sensitivity 12 months · Children | OR 0.36 [0.10, 1.34] 290 per 1000 vs 128 per 1000 | 1 study · 62 participants | Very low Downgraded: risk of bias, imprecision |
Aesthetics 12 months · Children | OR 0.68 [0.41, 1.11] 770 per 1000 vs 578 per 1000 | 1 study · 263 participants | Very low Downgraded: risk of bias, imprecision |
Secondary prevention of caries Permanent dentition (root) | No studies reported data in this dentition type | 0 studies | No studies |
Primary caries prevention 36 months · Permanent dentition (root) | MD -0.20 [-0.91, 0.51] -0.20 [-0.91, 0.51] surfaces | 1 study · 100 participants | Very low Downgraded: risk of bias, imprecision |
Secondary prevention of caries 30 months · Primary dentition | MD 0.04 [-0.30, 0.38] 0.04 [-0.30, 0.38] surfaces | 1 study · 309 participants | Very low Downgraded: risk of bias, imprecision |
Caries arrest Permanent dentition (root) | No studies reported data in this dentition type | 0 studies | No studies |
Caries arrest Permanent dentition (coronal) | No studies reported data in this dentition type | 0 studies | No studies |
Adverse effects 24 hours to 30 months · Children | In 1 study, black or brown staining on treated lesions was more common after SDF (OR 3.19, 95% CI 1.95 to 5.23), with no other adverse effects. 1 study reported complaints of a transient bitter taste with SDF use (with… | 3 studies · 980 participants | Very low Downgraded: risk of bias, imprecision |
Primary caries prevention 24 months · Permanent dentition (coronal) | OR 0.95 [0.44, 2.05] 129 per 1000 vs 124 per 1000 | 1 study · 237 participants | Very low Downgraded: risk of bias, imprecision |
Primary caries prevention 12 months · Primary dentition | MD 0.00 [-0.26, 0.26] 0.00 [-0.26, 0.26] surfaces | 1 study · 434 participants | Low Downgraded: risk of bias, imprecision |
Secondary prevention of caries Permanent dentition (coronal) | No studies reported data in this dentition type | 0 studies | No studies |
Caries arrest 30 months · Primary dentition | MD -0.13 [-0.87, 0.61] -0.13 [-0.87, 0.61] surfaces | 1 study · 309 participants | Very low Downgraded: risk of bias, imprecision |
Silver diamine fluoride (SDF) vs Chlorhexidine varnish
Population: Children and adults (with or without carious lesions)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Secondary prevention of caries | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Caries arrest | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Primary caries prevention 36 months · Permanent dentition (root) | MD -0.40 [-0.95, 0.15] -0.40 [-0.95, 0.15] surfaces | 1 study · 99 participants | Very low Downgraded: risk of bias, imprecision |
Dental pain or sensitivity | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Aesthetics | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Adverse effects | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Silver diamine fluoride (SDF) vs Silver nitrate plus fluoride varnish
Population: Children and adults (with or without carious lesions)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects 18 months · Children | Gao 2019 noted that "arrested lesions were stained black" (reported with no associated data). No other adverse effects observed, and no reports from parents of systemic disease. | 1 study · 1070 participants | Very low Downgraded: risk of bias, imprecision |
Secondary prevention of caries | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Primary caries prevention | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Dental pain or sensitivity | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Caries arrest 18 months · Primary dentition (coronal) | MD -0.10 [-0.51, 0.31] -0.10 [-0.51, 0.31] surfaces | 1 study · 1070 participants | Low Downgraded: risk of bias, imprecision |
Aesthetics | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Silver diamine fluoride (SDF) vs Sealants or resin infiltration
Population: Children and adults (with or without carious lesions)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary caries prevention Permanent dentition (root) | No studies reported data in this dentition type | 0 studies | No studies |
Caries arrest Primary and permanent dentition | No studies reported data in either dentition type | 0 studies | No studies |
Aesthetics | No studies reported data for this outcome | 0 studies | No studies |
Secondary prevention of caries 24 months · Primary dentition (coronal) | OR 2.76 [0.67, 11.43] | 1 study · 75 participants | Ungraded |
Primary caries prevention 18 months · Permanent dentition (coronal) | OR 1.76 [0.74, 4.20] 74 per 1000 vs 124 per 1000 | 1 study · 242 participants | Very low Downgraded: risk of bias, imprecision |
Primary caries prevention Primary dentition | No studies reported data in this dentition type | 0 studies | No studies |
Adverse effects 24 months · Children | In 1 study, people complained about a transient bitter taste associated with SDF (with no associated data), with no other adverse effects. In another study, there were no adverse effects. No studies reported this… | 2 studies · 336 participants | Very low Downgraded: risk of bias, imprecision |
Dental pain or sensitivity | No studies reported data for this outcome | 0 studies | No studies |
Silver diamine fluoride (SDF) vs Atraumatic restorative treatment (ART) with glass ionomer cement (GIC) or glass ionomer material
Population: Children and adults (with or without carious lesions)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary caries prevention Primary and permanent dentition | No studies reported this outcome | 0 studies | No studies |
Dental pain or sensitivity 3 months · Children | OR 0.16 [0.02, 1.32] 52 per 1000 vs 9 per 1000 | 1 study · 234 participants | Very low Downgraded: risk of bias, imprecision |
Secondary prevention of caries Primary and permanent dentition | No studies reported this outcome | 0 studies | No studies |
Adverse effects 48 hours to 24 months · Children | In 1 study, 115 of 118 children had black stains on teeth treated with SDF; there were no other adverse effects or allergic reactions. In 1 study, the rate of adverse effects reported by caregiver and person who… | 3 studies · 482 participants | Very low Downgraded: risk of bias, imprecision |
Caries arrest Permanent dentition | No studies reported this outcome in this dentition type | 0 studies | No studies |
Caries arrest 24 months · Primary dentition | OR 1.13 [0.52, 2.45] | 1 study · 143 participants | Very low Downgraded: risk of bias, imprecision |
Aesthetics 24 months · Children | 1 study reported that 45% of parents were satisfied with appearance of their child's teeth; data not reported by study group. 1 study reported that 1 of 34 caregivers in SDF group were "annoyed with teeth appearance",… | 2 studies · 248 participants | Very low Downgraded: risk of bias, imprecision |
Silver diamine fluoride (SDF) vs Glass ionomer cement (GIC) plus fluoride varnish
Population: Children and adults (with or without carious lesions)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects 6 months | Parents were asked if any harm was noticed due to the use of SDF, but the results were not reported in the study report; we could not determine whether there were any associated harms with either treatment (Mendiratta… | 1 study | Ungraded |
Primary caries prevention | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Secondary prevention of caries | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Dental pain or sensitivity | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Aesthetics | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Caries arrest 6 months · Primary dentition (coronal) | OR 1.89 [0.61, 5.87] | 1 study · 69 participants | Very low Downgraded: risk of bias, imprecision |
Silver diamine fluoride (SDF) plus fluoride varnish vs Sealants plus fluoride varnish (with or without restorations)
Population: Children and adults (with or without carious lesions)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrest 24 months · Mixed dentition (coronal) | MD 0.11 [-0.01, 0.22] 0.11 [-0.01, 0.22] proportion | 1 study · 413 participants | Low Downgraded: risk of bias, imprecision |
Adverse effects Study period (24 months) · Children | Ruff 2022 reported that there were no adverse events during the study period; adverse events were not defined by the study authors. Assumed data available for 1398 participants. | 1 study · 1398 participants | Very low Downgraded: risk of bias, imprecision |
Aesthetics | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Dental pain or sensitivity | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Primary caries prevention | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Secondary prevention of caries | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Silver diamine fluoride (SDF) vs Restoration (restorative treatment)
Population: Children and adults (with or without carious lesions)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrest 12 months · Primary dentition (coronal) | OR 0.03 [0.01, 0.10] | 1 study · 98 participants | Very low Downgraded: risk of bias, imprecision |
Dental pain or sensitivity 12 months · Children | OR 9.14 [0.49, 172.21] | 1 study · 69 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects 12 months · Children | Cleary 2022 reported that there were no unanticipated adverse events; adverse events were not defined. | 1 study | Very low Downgraded: risk of bias, imprecision |
Aesthetics 6 to 12 months · Children | Cleary 2022 reported no significant differences (P > 0.05) in parental acceptability, satisfaction, and preference between treatments at 6 and 12 months; at 12 months children in the restoration arm felt happier with… | 1 study | Very low Downgraded: risk of bias, imprecision |
Secondary prevention of caries | No studies reported data for this outcome in this comparison | 0 studies | No studies |
Primary caries prevention | No studies reported data for this outcome in this comparison | 0 studies | No studies |