Non-Cochrane · intervention · PM39659492
The role of silver diamine fluoride as dental caries preventive and arresting agent: a systematic review and meta-analysis.
Alqalaleef Saeed S, Alnakhli Rabab A, Ezzat Yousef, et al. · Frontiers in oral health · 2024 · PubMed · doi:10.3389/froh.2024.1492762
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
16
current version
GRADE rated
6
No studies
0
Included studies
20
linked below
No studies 0 · 0%Ungraded 10 · 62.5%Very low 0 · 0%Low 2 · 12.5%Moderate 4 · 25%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 and adults without systemic diseases affecting dental health | 20 RCTs; participants aged 1-50 years, mostly preschool children with primary dentition; one study in adults with permanent teeth |
| Intervention | Silver diamine fluoride | 38% SDF (17 studies) and 30% SDF (3 studies); single, annual, bi-annual, or 3 weekly applications |
| Comparison | Placebo, control, and/or other interventions | Placebo; 5% sodium fluoride varnish (NaF); nano-silver fluoride (with/without green tea extract); glass ionomer cement / atraumatic restorative treatment; composite restoration; silver nitrate + NaF; SDF + NaF varnish |
| Outcomes | Effectiveness in arresting and preventing dental caries; adverse reactions | Caries arrestment meta-analyzed at 3 levels (12 RCTs): individual OR 3.86 (0.34-43.96); tooth OR 1.74 (0.88-3.46); surface OR 1.03 (0.47-2.27). Caries prevention (2 RCTs, narrative). Adverse effects (staining; mild transient events). Arrest rate range 25-99%. |
| Study designs | Peer-reviewed randomized controlled trials (full text, English, published 2014-2024) | 20 RCTs included; 12 in meta-analysis |
| Timing | Not specified (follow-up length not prespecified) | Follow-up 1 day to 30 months |
Search date: Not specified (publication window 2014-2024; references accessed July 2024). Databases: PubMed; Google Scholar; CENTRAL
Questions and results
Silver diamine fluoride (SDF) vs Placebo, control, and/or other interventions
Population: Children and adults without systemic diseases affecting dental health
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrestment at the individual level 3 weeks to 12 months SDF showed a higher caries-arrestment proportion at the individual level, but the reported difference was not statistically significant. Source: Results; Discussion (Figure 4) · same question in other reviews | OR 3.86 [0.34, 43.96] 49% vs 58% | 5 studies · 720 participants | Low |
Caries arrestment at the surface level 12 months to 18 months SDF showed no clear advantage for caries arrestment at the surface level. Source: Results; Discussion (Figure 6) · same question in other reviews | OR 1.03 [0.47, 2.27] 49% vs 50% | 3 studies · 5394 participants | Moderate |
Caries arrestment at the tooth level 6 to 12 months · Overall (all comparators pooled) Population: Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition) SDF probably results in a slight increase in tooth-level caries arrestment versus other methods (moderate certainty). Source: Figure 5 (forest plot, overall/pooled diamond); Figure 7 (GRADE SoF, tooth-analysis row) · same question in other reviews | OR 1.74 [0.88, 3.46] 8.2 [-2.3, 14.7] percentage points (more with SDF) | 5 studies · 743 participants | Moderate Downgraded: risk of bias |
Caries arrestment at the individual (patient) level 3 weeks to 12 months · Overall (all comparators pooled) Population: Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition) Compared with other caries-management methods, SDF may increase caries arrestment at the individual level, but the pooled estimate is very imprecise (low certainty). Source: Figure 4 (forest plot, overall/pooled diamond); Figure 7 (GRADE SoF, individual-analysis row) · same question in other reviews | OR 3.86 [0.34, 43.96] 29.7 [-24.4, 48.5] percentage points (more with SDF) | 5 studies · 720 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Caries arrestment at the surface level 12 to 18 months · Overall (all comparators pooled) Population: Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition) SDF probably makes little to no difference to surface-level caries arrestment versus other methods (moderate certainty). Source: Figure 6 (forest plot, overall/pooled diamond); Figure 7 (GRADE SoF, surface-analysis row). N reported as 5394 units (surfaces). · same question in other reviews | OR 1.03 [0.47, 2.27] 0.7 [-17.9, 19.5] percentage points (more with SDF) | 3 studies · 5394 participants | Moderate Downgraded: inconsistency |
Caries arrestment at the tooth level 6 months to 12 months SDF showed a higher caries-free proportion at the tooth level, but the reported difference was not statistically significant. Source: Results; Discussion (Figure 5) · same question in other reviews | OR 1.74 [0.88, 3.46] 78% vs 85% | 5 studies · 743 participants | Moderate |
Adverse effects (tooth staining; soft-tissue and systemic events) up to 30 months Population: 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). Source: Results (adverse effects); Discussion; Table 2 (adverse effect & dropout column) · same question in other reviews | Black staining of arrested lesions reported in most studies; 4 studies reported mild transient events (gingival blenching/pain; diarrhea/stomachache; burning, bad taste, pain, mouth injury, dissatisfaction with… | NR | Ungraded |
Silver diamine fluoride (SDF; 38% in most trials, 30% in three) vs Atraumatic restorative treatment / glass ionomer cement (ART/GIC)
Population: Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrestment at the individual (patient) level 3 weeks to 12 months · SDF vs ART(GIC) 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. Source: Figure 4 (forest plot, subgroup 20.2.3 SDF vs ART(GIC)) · same question in other reviews | OR 18.03 [7.34, 44.28] | 1 study · 234 participants | Ungraded |
Caries arrestment at the tooth level 6 to 12 months · SDF vs ART(GIC) 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). Source: Figure 5 (forest plot, subgroup 20.1.1 SDF vs ART(GIC)) · same question in other reviews | OR 1.22 [0.09, 16.34] | 2 studies · 273 participants | Ungraded |
Silver diamine fluoride (SDF; 38% in most trials, 30% in three) vs Nano-silver fluoride (NSF; with or without green tea extract)
Population: Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrestment at the individual (patient) level 3 weeks to 12 months · SDF vs NSF Pooling two trials, nano-silver fluoride achieved higher individual-level caries arrestment than SDF (OR 0.39 favoring the comparator; ungraded subgroup). Source: Figure 4 (forest plot, subgroup 20.2.4 SDF vs NSF) · same question in other reviews | OR 0.39 [0.26, 0.60] | 2 studies · 384 participants | Ungraded |
Caries arrestment at the surface level 12 to 18 months · SDF vs NSF In one trial, nano-silver fluoride arrested more surfaces than SDF (OR 0.52 favoring the comparator; ungraded subgroup). Source: Figure 6 (forest plot, subgroup 20.3.3 SDF vs NSF) · same question in other reviews | OR 0.52 [0.43, 0.63] | 1 study · 1853 participants | Ungraded |
Caries arrestment at the tooth level 6 to 12 months · SDF vs NSF Pooling two trials, SDF and nano-silver fluoride showed no significant difference in tooth-level caries arrestment (OR 1.47; ungraded subgroup). Source: Figure 5 (forest plot, subgroup 20.1.2 SDF vs NSF) · same question in other reviews | OR 1.47 [0.93, 2.33] | 2 studies · 408 participants | Ungraded |
Silver diamine fluoride (SDF; 38% in most trials, 30% in three) vs Placebo (inactive control)
Population: Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrestment at the individual (patient) level 3 weeks to 12 months · SDF vs placebo Pooling two trials, SDF markedly increased individual-level caries arrestment versus placebo (OR 18.10; ungraded subgroup). Source: Figure 4 (forest plot, subgroup 20.2.5 SDF vs Placebo) · same question in other reviews | OR 18.10 [3.89, 84.15] | 2 studies · 102 participants | Ungraded |
Silver diamine fluoride (SDF; 38% in most trials, 30% in three) vs Sodium fluoride varnish (5% NaF)
Population: Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries arrestment at the tooth level 6 to 12 months · SDF vs NAF In one trial, SDF increased tooth-level caries arrestment versus 5% sodium fluoride varnish (OR 4.75; ungraded subgroup). Source: Figure 5 (forest plot, subgroup 20.1.3 SDF vs NAF) · same question in other reviews | OR 4.75 [1.57, 14.31] | 1 study · 62 participants | Ungraded |
Caries arrestment at the surface level 12 to 18 months · SDF vs NAF 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). Source: Figure 6 (forest plot, subgroup 20.3.4 SDF vs NAF) · same question in other reviews | OR 1.46 [0.71, 2.98] | 2 studies · 3541 participants | Ungraded |
Silver diamine fluoride (topical application) vs Control (placebo/no treatment or other topical fluoride agents)
Population: Preschool children (primary dentition) at risk of new caries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prevention of new caries (caries development/increment) 6 to 18 months Limited evidence from two trials suggests SDF may help prevent new caries, but preventive efficacy was not meta-analyzed and remains uncertain (ungraded). Source: Results (preventive efficacy); Discussion; references 14 (Zheng 2023) and 15 (Sirivichayakul 2023) · same question in other reviews | Narrative (2 RCTs; not meta-analyzed): Zheng 2023 reported mean decayed surfaces (ds) reduced from 0.7+/-1.9 to 0.4+/-1.5; Sirivichayakul 2023 reported a caries development rate of 27.2%. | 2 studies | 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 | No | no |
| 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 | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: No | RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | Yes | no |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 20
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Vollu et al. 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 | Caries arrestment at the tooth level | not extracted yet | not extracted yet |
| Abdellatif et al. 2021 Caries arrest effectiveness of silver diamine fluoride compared to alternative restorative technique: randomized clinical trial. PMID:33387347 | 3 other reviews | Caries arrestment at the tooth level | not extracted yet | not extracted yet |
| Mabangkhru et al. 2020 A randomized clinical trial to arrest dentin caries in young children using silver diamine fluoride. PMID:32428523 | 2 other reviews | Caries arrestment at the surface level | not extracted yet | not extracted yet |
| Tirupathi et al. 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 |
| Abbas et al. 2019 Topical Effect of Silver Diamine Fluoride in Arresting Dental Caries in Primary Teeth DOI:10.5958/0976-5506.2019.01173.2 | 1 other review | Caries arrestment at the individual (patient) level | not extracted yet | not extracted yet |
| Abdellatif et al. 2023 Silver diamine fluoride with sodium fluoride varnish versus silver diamine fluoride in arresting early childhood caries: a 6-months follow… PMID:37978488 | 1 other review | not stated | not extracted yet | not extracted yet |
| Al-Nerabieah et al. 2020b Cariostatic efficacy and children acceptance of nano-silver fluoride versus silver diamine fluoride: a randomized controlled clinical trial DOI:10.5114/jos.2020.96939 | 1 other review | Caries arrestment at the tooth level | not extracted yet | not extracted yet |
| Cleary et al. 2022 A 12-Month Randomized Clinical Trial of 38% SDF vs. Restorative Treatment. PMID:35120408 | 1 other review | not stated | not extracted yet | not extracted yet |
| Duangthip et al. 2016 A randomized clinical trial on arresting dentine caries in preschool children by topical fluorides--18 month results. PMID:26037274 | 1 other review | not stated | not extracted yet | not extracted yet |
| Duangthip et al. 2018 Caries arrest by topical fluorides in preschool children: 30-month results. PMID:29289726 | 1 other review | not stated | not extracted yet | not extracted yet |
| Gao et al. 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 |
| Prakash et al. 2022 Evaluation of caries arresting potential of silver diamine fluoride and sodium fluoride varnish in primary molars: A randomized controlled… PMID:36861553 | 1 other review | Caries arrestment at the tooth level | not extracted yet | not extracted yet |
| Quritum et al. 2024 Effectiveness of nanosilver fluoride and silver diamine fluoride in arresting early childhood caries: a randomized controlled clinical… PMID:38890627 | 1 other review | not stated | not extracted yet | not extracted yet |
| Zheng et al. 2023 Caries Prevention Using Silver Diamine Fluoride: A 12-Month Clinical Trial. PMID:36682908 | 1 other review | Prevention of new caries (caries development/increment) | not extracted yet | not extracted yet |
| Al-Nerabieah et al. 2020a Effectiveness of a Novel Nano-Silver Fluoride with Green Tea Extract Compared with Silver Diamine Fluoride: A Randomized, Controlled,… DOI:10.19070/2377-8075-20000148 | this review only | Caries arrestment at the tooth level | not extracted yet | not extracted yet |
| Aly et al. 2023 Success rate of silver nano-particles in comparison to silver diamine fluoride in management of deep carious lesions: a randomized… DOI:10.4322/bds.2023.e3956 | this review only | Caries arrestment at the individual (patient) level | not extracted yet | not extracted yet |
| Azuoru et al. 2021 Randomized controlled trial on the effectiveness of silver diamine fluoride in arresting caries in Lagos, Nigeria DOI:10.20396/bjos.v21i00.8666341 | this review only | Caries arrestment at the individual (patient) level | not extracted yet | not extracted yet |
| Milgrom et al. 2018 Topical silver diamine fluoride for dental caries arrest in preschool children: A randomized controlled trial and microbiological analysis… PMID:28866468 | this review only | Caries arrestment at the individual (patient) level | not extracted yet | not extracted yet |
| Phonghanyudh et al. 2022 Is Silver Diamine Fluoride Effective in Arresting Enamel Caries? A Randomized Clinical Trial. PMID:35897363 | this review only | Caries arrestment at the surface level | not extracted yet | not extracted yet |
| Sirivichayakul et al. 2023 The effectiveness of topical fluoride agents on preventing development of approximal caries in primary teeth: a randomized clinical trial. PMID:37268914 | this review only | Prevention of new caries (caries development/increment) | 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).