Non-Cochrane · intervention · PM36232217
Silver Diamine Fluoride (SDF) Efficacy in Arresting Cavitated Caries Lesions in Primary Molars: A Systematic Review and Metanalysis.
Zaffarano Luciano, Salerno Claudia, Campus Guglielmo, et al. · International journal of environmental research and public health · 2022 · PubMed · doi:10.3390/ijerph191912917
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
7
current version
GRADE rated
0
No studies
0
Included studies
16
linked below
No studies 0 · 0%Ungraded 7 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%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 with active dentin cavitated caries lesions in primary molars (first and second molars) | 3168 children (age 1-10 years) with cavitated caries in primary molars across 9 RCTs (n=9) |
| Intervention | SDF applied to active dentin cavitated lesions in primary molars | 38% SDF (8 studies) or 30% SDF (1 study), applied once or repeated every 3/6/12 months (n=9) |
| Comparison | No treatment or any other non-invasive or minimally-invasive treatment | ART (3 studies); 5% NaF varnish (1); silver-based/nano-silver fluoride varnish (2); 12% SDF (1); no treatment (1); different SDF application protocols (1) |
| Outcomes | Primary: caries arrest rate, mean number of inactivated lesions, odds ratios; Secondary: patient discomfort during the treatment procedure | Caries arrest rate (all 9 studies; 5 meta-analyzed); patient discomfort/anxiety (1 study) |
| Study designs | Randomized (RCT) and non-randomized (NRSI) clinical studies | 9 randomized controlled trials; no NRSI met the inclusion criteria (n=9) |
| Timing | Follow-up longer than 6 months; no publication time restriction (last searched 10 Jan 2022) | Follow-up 6 to 36 months |
Search date: 10 January 2022 (databases searched from inception to 10 January 2022). Databases: PubMed, Embase, Scopus (plus OpenGrey grey literature and reference-list cross-referencing)
Questions and results
Silver diamine fluoride (SDF; 38% or 30%), applied at any frequency vs No treatment or another non-invasive/minimally-invasive treatment (ART, sodium fluoride or silver-based varnish, or 12% SDF)
Population: Children (age 1-10 years) with active cavitated dentin caries lesions in primary molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrest Pooled across follow-up evaluations (1-36 months) SDF is effective in arresting caries progression in cavitated primary molars overall (pooled ES 0.33, 95% CI 0.26-0.40; ungraded). Source: Abstract; Results 3.6 (Meta-Analysis); Figure 3a; Table S4 (not available) · same question in other reviews | ES 0.33 [0.26, 0.40] | 5 studies · 1386 participants | Ungraded |
Caries arrest rate (absolute proportion of lesions arrested) Follow-up >=12 months The pooled caries arrest rate with SDF (>=30%, applied annually/biannually) was 51.62% (622/1205 lesions arrested) at >=12 months follow-up. Source: Abstract; Results 3.6; Conclusions 5 · same question in other reviews | Proportion 0.5162 | 5 studies · 1205 participants | Ungraded |
SDF applied once (single application, no re-application) vs Other non/minimally-invasive treatment (ART or silver-fluoride varnish)
Population: Children (age 1-10 years) with active cavitated dentin caries lesions in primary molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrest Follow-up up to 12 months (single application) · SDF application frequency: single (one-time) application A single (one-time) SDF application did not significantly arrest caries (pooled ES -0.09, 95% CI -0.48 to 0.29; ungraded). Source: Results 3.6; Figure 3b (application-frequency subgroups) · same question in other reviews | ES -0.09 [-0.48, 0.29] | 2 studies · 117 participants | Ungraded |
SDF applied biannually (every 6 months) vs Other non/minimally-invasive treatment (ART or 5% NaF varnish)
Population: Children (age 1-10 years) with active cavitated dentin caries lesions in primary molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrest Follow-up up to 12 months (biannual application) · SDF application frequency: biannual (every 6 months) Biannual SDF application significantly arrested caries (pooled ES 0.39, 95% CI 0.19-0.60; ungraded). Source: Results 3.6; Figure 3b · same question in other reviews | ES 0.39 [0.19, 0.60] | 2 studies · 381 participants | Ungraded |
38% SDF (applied every 6 or 12 months) vs 12% SDF
Population: Children (age 1-10 years) with active cavitated dentin caries lesions in primary molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrest 24-30 months · SDF application frequency: variable (Fung 2018; 38% vs 12% SDF) 38% SDF arrested more caries than 12% SDF (pooled ES 0.37, 95% CI 0.27-0.47; single study; ungraded). Source: Results 3.6; Figure 3b · same question in other reviews | ES 0.37 [0.27, 0.47] | 1 study · 888 participants | Ungraded |
Silver diamine fluoride (30% SDF) vs Atraumatic restorative treatment (ART)
Population: Children (age 1-10 years) with active cavitated dentin caries lesions in primary molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient discomfort during treatment (anxiety scale) During/after the treatment procedure One study found no significant difference in patient discomfort between SDF and ART (p = 0.15; ungraded). Source: Results 3.3 (Study Characteristics); Ref 41 (Vollu 2019) · same question in other reviews | Only one study assessed patient discomfort during treatment (SDF vs ART) using the patient's anxiety scale, obtaining almost overlapping results (p = 0.15). | 1 study · 67 participants | Ungraded |
Caries arrest Pooled across 3-12 month follow-ups · Comparator: SDF vs ART (moderator analysis by treatment type) SDF was not significantly better than ART at arresting caries (pooled ES 0.05, 95% CI -0.42 to 0.51; ungraded). Source: Results 3.6; Figure 3c · same question in other reviews | ES 0.05 [-0.42, 0.51] | 2 studies · 146 participants | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | No | no |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 16
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Vollú 2019 Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment on dentine caries arrestment in primary molars of… PMID:31279925 | 4 other reviews | not stated | not extracted yet | not extracted yet |
| Abdellatif 2021 Caries arrest effectiveness of silver diamine fluoride compared to alternative restorative technique: randomized clinical trial. PMID:33387347 | 3 other reviews | not stated | not extracted yet | not extracted yet |
| Zhi 2012 Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. PMID:22892463 | 3 other reviews | not stated | not extracted yet | not extracted yet |
| Llodra 2005 Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical… PMID:16040729 | 2 other reviews | not stated | not extracted yet | not extracted yet |
| Mabangkhru 2020 A randomized clinical trial to arrest dentin caries in young children using silver diamine fluoride. PMID:32428523 | 2 other reviews | not stated | not extracted yet | not extracted yet |
| Tirupathi 2019 Comparative cariostatic efficacy of a novel Nano-silver fluoride varnish with 38% silver diamine fluoride varnish a double-blind… PMID:30805113 | 2 other reviews | not stated | not extracted yet | not extracted yet |
| Abdellatif, 2021 Caries arrest effectiveness of silver diamine fluoride compared to alternative restorative technique: randomized clinical trial DOI:10.1007/s40368-020-00592-0 | 1 other review | Caries arrest | not extracted yet | not extracted yet |
| Gao 2020 Arresting early childhood caries using silver and fluoride products - A randomised trial. PMID:33166594 | 1 other review | not stated | not extracted yet | not extracted yet |
| Llodra, 2005 Efficacy of Silver Diamine Fluoride for Caries Reduction in Primary Teeth and First Permanent Molars of Schoolchildren: 36-month Clinical… DOI:10.1177/154405910508400807 | 1 other review | not stated | not extracted yet | not extracted yet |
| Mabangkhru, 2020 A randomized clinical trial to arrest dentin caries in young children using silver diamine fluoride DOI:10.1016/j.jdent.2020.103375 | 1 other review | Caries arrest | not extracted yet | not extracted yet |
| Vollu, 2019 Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment on dentine caries arrestment in primary molars of… DOI:10.1016/j.jdent.2019.07.003 | 1 other review | Caries arrest | not extracted yet | not extracted yet |
| Zhi, 2012 Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children DOI:10.1016/j.jdent.2012.08.002 | 1 other review | not stated | not extracted yet | not extracted yet |
| Daga, 2020 Silver Diamine Fluoride in Arresting Dentinal Caries in School Children DOI:10.37506/ijphrd.v11i3.1218 | this review only | not stated | not extracted yet | not extracted yet |
| Fung, 2018 Randomized Clinical Trial of 12% and 38% Silver Diamine Fluoride Treatment. PMID:28846469 | this review only | Caries arrest | not extracted yet | not extracted yet |
| Gao, 2020 Arresting early childhood caries using silver and fluoride products – A randomised trial DOI:10.1016/j.jdent.2020.103522 | this review only | not stated | not extracted yet | not extracted yet |
| Tirupathi, 2019 Anti-erosive effect of calcium carbonate suspensions. PMID:30305876 | this review only | Caries arrest | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).