Non-Cochrane · intervention · PM36823765
A systematic review on the effect of silver diamine fluoride for management of dental caries in permanent teeth.
Mungur Alvin, Chen Haoran, Shahid Saroash, et al. · Clinical and experimental dental research · 2023 · PubMed · doi:10.1002/cre2.716
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
37
current version
GRADE rated
0
No studies
1
Included studies
13
linked below
No studies 1 · 2.7%Ungraded 36 · 97.3%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 | Permanent teeth with dental caries (occlusal and root carious lesions), adults and children, regardless of age | 11 included studies (n=11): permanent (first) molars in children/schoolchildren, root caries in older adults, permanent posterior teeth in intellectually disabled individuals, and early enamel lesions |
| Intervention | Silver diamine fluoride (SDF) for the treatment of dental caries | 38% SDF (most common concentration); also SDF+potassium iodide and SDF+oral health education; application frequency varied (annual or every 6 months) |
| Comparison | Current minimally invasive techniques for the treatment of dental caries | Water/no treatment, sodium fluoride, chlorhexidine, ammonium bifluoride, resin sealant, glass ionomer cement + fluoride varnish, resin-modified GIC, atraumatic restorative treatment, tricalcium silicate paste, CPP-ACP |
| Outcomes | Remineralization/arrest/reversal of dental caries | Prevented fraction of new carious lesions/restorations (SDF range ~28-72%; overall agent range 4-73%), caries arrest rates, and remineralization/arrest of early enamel lesions; no pooled estimate (meta-analysis not feasible) |
| Study designs | Clinical studies on permanent teeth; systematic reviews, laboratory/in vitro studies, case studies, and primary-teeth-only studies excluded | 11 clinical trials (described as randomized/double-blinded) |
| Timing | Not specified | Study durations 6 to 36 months |
Search date: December 2022. Databases: PubMed/MEDLINE (also Medline via Ovid), Cochrane Central Register of Controlled Trials, Web of Science, Scopus, Embase, LILACS, DOAJ, and OpenGrey/Open Gray; ClinicalTrials.gov; grey literature via Google, GreyLit and Google Scholar (the database list differs between the abstract and the methods…
Questions and results
38% SDF varnish plus oral health instruction vs oral health instruction plus water
Population: older adults with root caries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
new root-surface carious lesions or restorations 36 months SDF had a 71% preventative fraction at 36 months; no pooled estimate or GRADE rating was reported. Source: Table 3a; Results: Comparison of the studies · same question in other reviews | Preventative fraction (%) 71 | 1 study · 306 participants | Ungraded |
OHI + 38% SDF (applied every 12 months) vs oral health instruction plus water
Population: community-dwelling older adults with root caries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
new root-surface carious lesions or restorations 24 months SDF had a 28% preventative fraction at 24 months; no pooled estimate or GRADE rating was reported. Source: Table 3a; Results: Comparison of the studies · same question in other reviews | Preventative fraction (%) 28 | 1 study · 266 participants | Ungraded |
38% SDF plus oral health education vs oral health instruction plus water
Population: community-dwelling older adults with root caries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
new root-surface carious lesions or restorations 24 months SDF plus oral health education had a 33% preventative fraction at 24 months; no pooled estimate or GRADE rating was reported. Source: Table 3a; Results: Comparison of the studies · same question in other reviews | Preventative fraction (%) 33 | 1 study · 266 participants | Ungraded |
38% SDF plus oral health instruction vs oral health instruction plus tonic water
Population: community-dwelling older adults with root caries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
new root-surface carious lesions or restorations 30 months SDF had a 62% preventative fraction; no pooled estimate or GRADE rating was reported. Source: Table 3a; Discussion · same question in other reviews | Preventative fraction (%) 62 | 1 study · 323 participants | Ungraded |
38% SDF plus potassium iodide and oral health instruction vs oral health instruction plus tonic water
Population: community-dwelling older adults with root caries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
new root-surface carious lesions or restorations 30 months SDF plus potassium iodide had a 52% preventative fraction; no pooled estimate or GRADE rating was reported. Source: Table 3a; Discussion · same question in other reviews | Preventative fraction (%) 52 | 1 study · 323 participants | Ungraded |
New root carious lesions (caries prevention) 36 months · Tan 2010 Population: Older adults with root caries (community-dwelling or residential elders) In elders, sodium fluoride varnish gave a 64% prevented fraction for root caries vs water, lower than SDF (71%) (p<0.01; ungraded). Source: Table 2; Table 3a · same question in other reviews | Prevented Fraction 64 | 1 study · 306 participants | Ungraded |
38% SDF (one-time application) vs Inactive control (water or no treatment)
Population: Children with dental caries in permanent (first) molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
New coronal carious lesions or fillings on permanent (first) molars (caries prevention) 18 months · Monse 2012 (SDF one-time, no toothbrushing programme; Philippines) One-time SDF without a brushing programme did not significantly reduce caries in children's permanent first molars (p>0.05; ungraded). Source: Table 3b; Results · same question in other reviews | Mean new caries increment (surfaces) 0.12 | 1 study · 1016 participants | Ungraded |
new carious lesions or fillings 12 months Population: children with caries in permanent first molars SDF had a 57% preventative fraction; the comparator was not reported. Source: Table 3b a; Results: Comparison of the studies · same question in other reviews | Preventative fraction (%) 57 | 1 study · 141 participants | Ungraded |
New coronal carious lesions or fillings on permanent (first) molars (caries prevention) 18 months · Monse 2012 (SDF one-time, with toothbrushing programme) One-time SDF within a brushing programme did not significantly reduce caries vs control (p>0.05; ungraded). Source: Table 3b · same question in other reviews | Mean new caries increment (surfaces) 0.09 | 1 study · 1016 participants | Ungraded |
Inactive (arrested) carious lesions on permanent first molars 36 months · Llodra 2005 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). Source: Table 3b; Results · same question in other reviews | Mean inactive lesions per child 0.3 | 1 study · 452 participants | Ungraded |
New coronal carious lesions or fillings on permanent (first) molars (caries prevention) 12 months · Mauro 2004 (permanent first molars, one-time SDF; Argentina) One-time 38% SDF gave a 57% prevented fraction for caries in children's permanent first molars (single study; ungraded). Source: Table 3b · same question in other reviews | Prevented Fraction 57 | 1 study · 141 participants | Ungraded |
38% SDF every 6 months vs no treatment
Population: schoolchildren with caries in permanent first molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
new active or inactive carious lesions 36 months SDF had a 72% preventative fraction; no pooled estimate or GRADE rating was reported. Source: Table 3b a; Results: Comparison of the studies · same question in other reviews | Preventative fraction (%) 72 | 1 study · 452 participants | Ungraded |
New coronal caries in permanent first molars (caries prevention) 12 months · Mauro 2004 Population: Children with dental caries in permanent (first) molars One-time ammonium bifluoride gave a 56% prevented fraction, similar to SDF (57%) (single study; ungraded). Source: Table 3b; Results · same question in other reviews | Prevented Fraction 56 | 1 study · 141 participants | Ungraded |
Sodium fluoride (5% NaF, one-time [Mauro] or every 6 months [Liu]) vs Control (water or unspecified)
Population: Children with dental caries in permanent (first) molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
New coronal caries in permanent molars (caries prevention) 24 months · Liu 2012 (5% NaF, fissure site) NaF gave a 48% prevented fraction (fissure site) vs water (p<0.002; ungraded). Source: Table 3b · same question in other reviews | Prevented Fraction 48 | 1 study · 501 participants | Ungraded |
New coronal caries in permanent molars (caries prevention) 12 months · Mauro 2004 (5% NaF one-time) One-time NaF gave a 47% prevented fraction, lower than SDF (57%) (single study; ungraded). Source: Table 3b · same question in other reviews | Prevented Fraction 47 | 1 study · 141 participants | Ungraded |
New coronal caries in permanent molars (caries prevention) 24 months · Liu 2012 (5% NaF, tooth level) NaF varnish gave a 41% prevented fraction (tooth level) for caries in children's permanent molars vs water (p<0.04; ungraded). Source: Table 3b · same question in other reviews | Prevented Fraction 41 | 1 study · 501 participants | Ungraded |
new carious lesions or fillings 18 months Population: schoolchildren with caries in permanent first molars The review reported no significant result for SDF; no effect estimate or GRADE rating was reported. Source: Table 3b a; Results: Comparison of the studies · same question in other reviews | Mean new caries increment (surfaces) 0.12 | 1 study · 1016 participants | Ungraded |
Resin sealant (one-time) vs Control (water)
Population: Children with dental caries in permanent (first) molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
New coronal caries in permanent molars (caries prevention) 24 months · Liu 2012 (resin sealant, tooth level) Resin sealant gave a 60% prevented fraction (tooth level) for caries in children's permanent molars vs water (p<0.04; ungraded). Source: Table 3b · same question in other reviews | Prevented Fraction 60 | 1 study · 501 participants | Ungraded |
New coronal caries in permanent molars (caries prevention) 24 months · Liu 2012 (resin sealant, fissure site) Resin sealant gave a 65% prevented fraction (fissure site) vs water, the highest fissure-site value (p<0.002; ungraded). Source: Table 3b · same question in other reviews | Prevented Fraction 65 | 1 study · 501 participants | Ungraded |
new carious lesions or fillings at tooth level 24 months Population: children with caries in permanent molars SDF had a 41% preventative fraction at tooth level; no pooled estimate or GRADE rating was reported. Source: Table 3b a · same question in other reviews | Preventative fraction (%) 41 | 1 study · 501 participants | Ungraded |
new carious lesions or fillings at fissure-site level 24 months Population: children with caries in permanent molars SDF had a 52% preventative fraction at fissure-site level; no pooled estimate or GRADE rating was reported. Source: Table 3b a · same question in other reviews | Preventative fraction (%) 52 | 1 study · 501 participants | Ungraded |
38% SDF vs glass ionomer cement plus 5% fluoride varnish
Population: intellectually disabled individuals with caries in permanent posterior teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries prevention (preventive fraction, SDF vs GIC+5% fluoride varnish) 6 months SDF had a 45% preventative fraction versus glass ionomer cement plus fluoride varnish; no pooled estimate or GRADE rating was reported. Source: Table 3b a; Results: Comparison of the studies · same question in other reviews | Preventative fraction (%) 45 | 1 study · 82 participants | Ungraded |
New coronal caries in permanent first molars (caries prevention) 18 months · Monse 2012 (ART one-time, with brushing programme) Population: Children with dental caries in permanent (first) molars ART within a brushing programme significantly reduced caries vs control (p<0.01; ungraded). Source: Table 3b · same question in other reviews | Mean new caries increment (surfaces) 0.01 | 1 study · 1016 participants | Ungraded |
New coronal caries in permanent first molars (caries prevention) 18 months · Monse 2012 (ART one-time, no brushing programme) Population: Children with dental caries in permanent (first) molars ART sealant significantly reduced caries in children's permanent first molars vs no treatment (p<0.001; ungraded). Source: Table 3b · same question in other reviews | Mean new caries increment (surfaces) 0.06 | 1 study · 1016 participants | Ungraded |
38% SDF as indirect pulp capping material vs resin-modified glass ionomer cement as indirect pulp capping material
Population: children with deep occlusal carious lesions in permanent molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
secondary caries prevention 12 months No significant difference in secondary caries prevention was reported; no effect estimate or GRADE rating was reported. Source: Table 3b a; Results: Comparison of the studies · same question in other reviews | no estimate extracted | 1 study · 49 participants | Ungraded |
38% SDF (indirect pulp capping) vs Resin-modified GIC (RMGIC)
Population: Children with deep occlusal caries in young permanent first molars (indirect pulp capping)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Restoration color, marginal staining and luster (esthetics) 12 months · Baraka 2022 RMGIC gave significantly better restoration esthetics than SDF, which caused black staining (p=0.03; ungraded). Source: Results · same question in other reviews | Baraka et al. (2022): significant differences in restoration color, marginal staining and luster favoring RMGIC over both SDF groups (p=0.03); SDF caused black staining that darkened over time. | 1 study · 49 participants | Ungraded |
Secondary caries prevention in young permanent first molars 12 months · Baraka 2022 (indirect pulp capping, Egypt) SDF and RMGIC did not differ significantly for secondary caries prevention in young permanent molars (no events; p>0.05; ungraded). Source: Table 3b; Results · same question in other reviews | Baraka et al. (2022): no significant difference in secondary caries prevention between 38% SDF and RMGIC (no secondary caries in either group through 12 months; p=0.63 at 12 months; overall p=0.26). | 1 study · 49 participants | Ungraded |
secondary caries prevention 12 months Population: children with deep occlusal carious lesions in permanent molars No significant difference in secondary caries prevention was reported; no effect estimate or GRADE rating was reported. Source: Table 3b a; Results: Comparison of the studies · same question in other reviews | SDF+KI 2 (8%) vs RMGIC 0 (0%); p=0.63 (NS), 12 months | 1 study · 49 participants | Ungraded |
38% SDF plus potassium iodide (KI) (indirect pulp capping) vs Resin-modified GIC (RMGIC)
Population: Children with deep occlusal caries in young permanent first molars (indirect pulp capping)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Secondary caries prevention in young permanent first molars 12 months · Baraka 2022 SDF+KI and RMGIC did not differ significantly for secondary caries prevention (p>0.05; ungraded). Source: Table 3b; Results · same question in other reviews | SDF+KI 2 (8%) vs RMGIC 0 (0%); p=0.63 (NS), 12 months | 1 study · 49 participants | Ungraded |
restoration and caries status 9 months Population: children with caries in permanent molars The review reported SDF was beneficial for arresting caries; no effect estimate or GRADE rating was reported. Source: Table 3b a; Results: Comparison of the studies · same question in other reviews | no estimate extracted | 1 study · 190 participants | Ungraded |
38% SDF vs Atraumatic restorative treatment (ART)
Population: Children with dental caries in permanent (first) molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries/restoration status in permanent molars 9 months · Satyarup 2022 (school setting, India) SDF gave significantly better caries/restoration outcomes than ART over 9 months in children's permanent molars (p=0.004; ungraded). Source: Table 3b; Results · same question in other reviews | Satyarup et al. (2022): 38% SDF vs ART; SDF group 5.6% carious teeth with partly lost restorations vs ART 16.7% carious with partly lost and 8.9% carious with completely lost restorations (p=0.004, favoring SDF). | 1 study · 190 participants | Ungraded |
caries arrest 24 months Population: Patients with early enamel carious lesions on permanent molars (n=45) SDF plus potassium iodide arrested 54.8% of early enamel lesions at 24 months; no pooled estimate or GRADE rating was reported. Source: Table 3a; Results: Comparison of the studies · same question in other reviews | Caries arrest (%) 54.8 | 1 study · 45 participants | Ungraded |
38% SDF plus KI (applied annually) vs Tricalcium silicate (TCS) paste (applied twice daily)
Population: Patients with early enamel carious lesions on permanent molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Remineralization/arrest of early enamel carious lesions 24 months · Hamdi 2022 (early enamel lesions, Egypt) 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). Source: Table 3a; Results; Discussion · same question in other reviews | Proportion of lesions arrested (%) 54.8 | 1 study · 45 participants | Ungraded |
38% SDF plus KI (annual) vs CPP-ACP (casein phosphopeptide-amorphous calcium phosphate, twice daily)
Population: Patients with early enamel carious lesions on permanent molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Remineralization/arrest of early enamel carious lesions 24 months · Hamdi 2022 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). Source: Table 3a; Results; Discussion · same question in other reviews | Proportion of lesions arrested (%) 54.8 | 1 study · 45 participants | Ungraded |
Silver diamine fluoride (SDF) vs Any (current minimally invasive techniques)
Population: Adults with coronal (crown) dental caries in permanent teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Not applicable (no eligible studies) No eligible studies assessed SDF for coronal caries in adults; this is an evidence gap identified by the review. Source: Discussion (limitations) · same question in other reviews | The review states there was a lack of studies on the effects of SDF on coronal caries in adults; included adult studies addressed only root caries. | 0 studies | No studies |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
New active carious lesions (permanent first molars) Llodra 2005 (6-monthly SDF, Cuba) | Mean new active carious lesions per child 0.4 vs 1.1 | 1 study | Ungraded |
Caries arrest rate in permanent posterior teeth Mendiratta 2021 (intellectually disabled, India) | Caries arrest rate (%) 94.5 vs 90.1 (p=0.405, NS) | 1 study | 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 | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Partial Yes · NRSI: N/A | NRSI: N/A · RCT: No | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: N/A | NRSI: N/A · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | N/A | N/A | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | N/A | N/A | yes |
| 16Conflicts of interest reported | Yes | No | no |
| Overall | Low | Critically Low | no |
Included primary studies 13
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Llodra 2005 matched by author and year (probable) | 2 other reviews | not stated | not extracted yet | not extracted yet |
| Baraka 2022 Twelve-month randomized controlled trial of 38% silver diamine fluoride with or without potassium iodide in indirect pulp capping of young… DOI:10.1016/j.adaj.2022.08.008 | 1 other review | not stated | not extracted yet | not extracted yet |
| Llodra et al. 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 |
| Zhang 2013 matched by author and year (probable) | 1 other review | not stated | not extracted yet | not extracted yet |
| Hamdi 2022 Long‐term evaluation of early‐enamel lesions treated with novel experimental tricalcium silicate paste: A 2‐year randomized clinical trial DOI:10.1111/jerd.12941 | this review only | not stated | not extracted yet | not extracted yet |
| Li 2017 Randomized Clinical Trial on Preventing Root Caries among Community-Dwelling Elders DOI:10.1177/2380084416668491 | this review only | not stated | not extracted yet | not extracted yet |
| Liu 2012 Does urinary tract infection cause residents' mental status change? PMID:20122012 | this review only | not stated | not extracted yet | not extracted yet |
| Mauro 2004 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Mendiratta 2021 Effectiveness of silver diamine fluoride and glass ionomer cement combined with fluoride varnish in arresting dental caries among… DOI:10.1111/scd.12607 | this review only | not stated | not extracted yet | not extracted yet |
| Monse 2012 Caries preventive efficacy of silver diammine fluoride (SDF) and ART sealants in a school-based daily fluoride toothbrushing program in… PMID:23171244 | this review only | not stated | not extracted yet | not extracted yet |
| Satyarup 2022 Comparison of the effectiveness of 38% silver diamine fluoride and atraumatic restorative treatment for treating dental caries in a school… DOI:10.17219/dmp/143547 | this review only | not stated | not extracted yet | not extracted yet |
| Tan et al. 2010 A Randomized Trial on Root Caries Prevention in Elders DOI:10.1177/0022034510375825 | this review only | not stated | not extracted yet | not extracted yet |
| Zhang et al. 2013 Silver Diamine Fluoride and Education to Prevent and Arrest Root Caries among Community-Dwelling Elders DOI:10.1159/000346620 | this review only | not stated | 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).