Silver Diamine Fluoride as a Non-Restorative Treatment for Caries - Systemic Review, Meta-Analysis, And Clinical Practice Online Survey

Abstract

Introduction: Dental caries is a non-communicable disease destroying enamel and dentin and a significant health problem worldwide. Silver Diamine Fluoride (SDF) is a nonrestorative treatment option to arrest caries lesions.

Objective: Determine the SDF’s efficiency as a non-invasive treatment to stop caries lesions and secondarily evaluate the SDF’s action mechanism, indications, contraindications, safety, advantages, and disadvantages. Quiz the knowledge and use of SDF by French and Portuguese dentists through an online survey.

Materials and Methodology: 459 articles published in the Medline/PubMed and EBSCO databases were collected. 28 articles that met the inclusion and exclusion criteria were included for de qualitative analysis. An online survey was disseminated throw the Google Forms platform. A meta-analysis was conducted in 6 randomized clinical trials to study the difference between means and size effect between the intervention and control protocols with a random-effects model (α=.05).

Results: SDF effectively stops dental caries by decreasing the demineralization of the tooth's hard tissue. 38% concentration of SDF is more effective than 30%, and much more if compared to placebo. Furthermore, a biannual application has a better caries arrest rate than an annual one. The online survey shows that SDF is not much used, except in pediatrics. A minority of faculties combine theoretical and practical courses about SDF.

Conclusion: SDF is an effective product for stopping cavities in patients who cannot tolerate invasive treatment due to its remineralization, bactericidal, and collagen degrading enzyme inhibiting properties. It is recommended to apply SDF 38% twice a year.

Funding Information: This work was supported by UNIPRO – Oral Pathology and Rehabilitation Research Unit - within AlignAgen-GI2-CESPU-2022.

Conflict of Interests: The authors declare no conflit of interest.

Ethical Approval: The online survey was submitted to the ethics committee (Research Project 16/CE- IUCS/2022), disseminated for 14 days using the Google Forms platform, and distributed to dentists practicing in France and Portugal. Dentists who voluntarily agreed to answer gave their free and informed consent to collect information for scientific research purposes.

Keywords: silver diamine fluoride, SDF, fluoride, Dental Caries, treatment