Non-Cochrane · intervention · PM41612282
Silver diamine fluoride versus atraumatic restorative treatment for management of childhood caries: a systematic review and meta-analysis.
Wang Weilin, Mao Tianfu · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-07741-9
Findings
Population Children and adolescents (18 years or younger) with active dental caries in primary or permanent teeth (unit: teeth or surfaces)
12 findings
| Silver diamine fluoride (SDF), any concentration or frequency | Atraumatic restorative treatment (ART) with glass ionomer cement | Caries arrest 12 months · Clinic and school-based settings in Brazil, China, USA, Egypt, Saudi Arabia · Subgroup: follow-up 12 months | RR 1.46 [0.98, 2.20] GRADE not reported 4 studies · 1149 participants |
| Silver diamine fluoride (SDF), any concentration or frequency | Atraumatic restorative treatment (ART) with glass ionomer cement | Caries arrest 12 months or longer follow-up · Clinic and school-based settings in Brazil, China, USA, Egypt, Saudi Arabia · Subgroup: biannual SDF application | RR 1.30 [0.65, 2.59] GRADE not reported 3 studies · 767 participants |
| Silver diamine fluoride (SDF), any concentration or frequency | Atraumatic restorative treatment (ART) with glass ionomer cement | Caries arrest 12 months or longer follow-up · Clinic and school-based settings in Brazil, China, USA, Egypt, Saudi Arabia · Sensitivity analysis: leave-one-out, excluding El-Ghandour 2024 | RR 1.06 [0.95, 1.17] GRADE not reported 6 studies |
| Silver diamine fluoride (SDF), any concentration or frequency | Atraumatic restorative treatment (ART) with glass ionomer cement | Caries arrest 12 months or longer follow-up · Clinic and school-based settings in Brazil, China, USA, Egypt, Saudi Arabia | RR 1.21 [1.02, 1.44] 55.2% vs 64.4% Very low Downgraded: risk of bias 7 studies · 11896 participants |
| Silver diamine fluoride (SDF), any concentration or frequency | Atraumatic restorative treatment (ART) with glass ionomer cement | Caries arrest 12 months or longer follow-up · Clinic and school-based settings in Brazil, China, USA, Egypt, Saudi Arabia · Sensitivity analysis: leave-one-out, excluding Zhi 2012 | RR 1.26 [1.03, 1.54] GRADE not reported 6 studies |
| Silver diamine fluoride (SDF), any concentration or frequency | Atraumatic restorative treatment (ART) with glass ionomer cement | Caries arrest 12 months or longer follow-up · Clinic and school-based settings in Brazil, China, USA, Egypt, Saudi Arabia · Sensitivity analysis: leave-one-out, excluding Ruff 2025 | RR 1.23 [0.94, 1.62] GRADE not reported 6 studies |
| Silver diamine fluoride (SDF), any concentration or frequency | Atraumatic restorative treatment (ART) with glass ionomer cement | Caries arrest 12 months or longer follow-up · Clinic and school-based settings in Brazil, China, USA, Egypt, Saudi Arabia · Sensitivity analysis: leave-one-out, excluding Abdellatif 2021 | RR 1.25 [0.97, 1.59] GRADE not reported 6 studies |
| Silver diamine fluoride (SDF), any concentration or frequency | Atraumatic restorative treatment (ART) with glass ionomer cement | Caries arrest 12 months or longer follow-up · Clinic and school-based settings in Brazil, China, USA, Egypt, Saudi Arabia · Subgroup: single SDF application | RR 1.12 [0.96, 1.31] GRADE not reported 4 studies · 11129 participants |
| Silver diamine fluoride (SDF), any concentration or frequency | Atraumatic restorative treatment (ART) with glass ionomer cement | Caries arrest 12 months or longer follow-up · Clinic and school-based settings in Brazil, China, USA, Egypt, Saudi Arabia · Sensitivity analysis: leave-one-out, excluding Santos 2012 | RR 1.15 [0.96, 1.38] GRADE not reported 6 studies |
| Silver diamine fluoride (SDF), any concentration or frequency | Atraumatic restorative treatment (ART) with glass ionomer cement | Caries arrest More than 12 months · Clinic and school-based settings in Brazil, China, USA, Egypt, Saudi Arabia · Subgroup: follow-up more than 12 months | RR 0.98 [0.83, 1.16] GRADE not reported 3 studies · 10747 participants |
| Silver diamine fluoride (SDF), any concentration or frequency | Atraumatic restorative treatment (ART) with glass ionomer cement | Caries arrest 12 months or longer follow-up · Clinic and school-based settings in Brazil, China, USA, Egypt, Saudi Arabia · Sensitivity analysis: leave-one-out, excluding Vollu 2019 | RR 1.27 [1.04, 1.54] GRADE not reported 6 studies |
| Silver diamine fluoride (SDF), any concentration or frequency | Atraumatic restorative treatment (ART) with glass ionomer cement | Caries arrest 12 months or longer follow-up · Clinic and school-based settings in Brazil, China, USA, Egypt, Saudi Arabia · Sensitivity analysis: leave-one-out, excluding Rodrigues 2025 | RR 1.29 [1.07, 1.55] GRADE not reported 6 studies |
Included primary studies 8
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Vollu 2019 Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment on dentine caries arrestment in primary molars of… PMID:31279925 | 2019 | 5 other reviews | Caries arrest | not extracted yet |
| Abdellatif 2021 Caries arrest effectiveness of silver diamine fluoride compared to alternative restorative technique: randomized clinical trial. PMID:33387347 | 2021 | 4 other reviews | Caries arrest | 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 | 2012 | 4 other reviews | Caries arrest | not extracted yet |
| Braga 2009 Effect of silver diammine fluoride on incipient caries lesions in erupting permanent first molars: a pilot study. PMID:19341576 | 2009 | 2 other reviews | not stated | not extracted yet |
| Santos 2012 Paradigm shift in the effective treatment of caries in schoolchildren at risk. PMID:22251037 | 2012 | 2 other reviews | Caries arrest | not extracted yet |
| El-Ghandour 2024 Effectiveness of silver diamine fluoride in arresting early childhood caries: a randomised controlled clinical trial. PMID:38888598 | 2024 | 1 other review | Caries arrest | not extracted yet |
| Rodrigues 2025 Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment in arresting dentin caries lesions in preschoolers: a… PMID:39641816 | 2024 | this review only | Caries arrest | not extracted yet |
| Ruff 2025 Silver Diamine Fluoride vs Atraumatic Restoration for Managing Dental Caries in Schools: A Cluster Randomized Clinical Trial. PMID:40489112 | 2025 | this review only | Caries arrest | 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). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Pediatric patients (18 years or younger) with active dental caries (primary, permanent or mixed dentition; enamel or dentine lesions without pulpal involvement) | Children aged 2 to 13 years; 6430 SDF and 5466 ART teeth or surfaces in the meta-analysis (n=8 studies, 7 pooled) |
| Intervention | SDF (any concentration or application frequency) | SDF 10% to 38%, single or biannual application (n=8) |
| Comparison | ART using glass ionomer cement | ART with GIC (n=8) |
| Outcomes | Caries arrest or disease control | Caries arrest rate (n=7) |
| Study designs | Randomized controlled trials (parallel, split-mouth, cluster) | Parallel-arm RCTs (n=8) |
| Timing | Follow-up of at least 12 months | 12 to 48 months |
AMSTAR 2 items
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 | Yes | 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 | RCT: Yes · NRSI: N/A | yes |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: No | 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 | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Low | no |