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Study examines effectiveness of silver diamine fluoride and sealants in caries arrest and prevention

A recent school-based study has demonstrated that silver diamine fluoride is a cheap and effective alternative for arresting and preventing dental caries in children. (Image: Monkey Business Images/Shutterstock)

NEW YORK, US: In a recent study, researchers investigated the effectiveness of silver diamine fluoride and dental sealants in the arrest and prevention of dental caries in a school-based programme. They found that silver diamine fluoride yielded comparable results to sealants, which are considered the standard of care. Thus, the researchers concluded that using this topical treatment may serve as an efficient and cost-effective alternative for improving children’s oral health in a school-based setting.

Caries is the most common chronic disease in children and is greatly associated with the lower use of dental services. Therefore, children from low-income families are at an increased risk of having caries compared with those from higher-income families, and studies show that caries not only affects children’s quality of life but may also lower student academic performance and school attendance.

In what is considered the nation’s largest school-based caries prevention study, called CarriedAway, researchers from New York University College of Dentistry (NYU Dentistry) compared the effectiveness of two caries prevention techniques, one that uses silver diamine fluoride and fluoride varnish and a more complex one that uses traditional glass ionomer sealants and fluoride varnish. The study included 2,998 children enrolled in classes from kindergarten to third grade at 47 New York City schools. To ensure the inclusion of a racially diverse group of students and low-income families, all selected schools had a student population of at least 50% Hispanic, Latino/Latina and/or black ethnicity and at least 80% of the students received free or reduced-cost lunch. The researchers then randomly assigned either the simple or complex treatment to the schools.

Upon visiting each school, the clinical research team—which included a supervising dentist, dental hygienists, registered nurses and assistants—carried out baseline examinations to measure any caries and then applied fluoride varnish and either sealants or silver diamine fluoride, depending on the treatment assigned.

The initial visits took place in 2019 and early 2020 but were paused during the COVID-19 pandemic, when all school-based care was halted, and resumed two years later.

The researchers found that both the simple and the complex treatments were successful in arresting and preventing caries in children. They reported that a single treatment with silver diamine fluoride prevented 81% of caries and that one treatment with sealants prevented 82% of caries. Additionally, treatment with silver diamine fluoride stopped 56% of caries from progressing compared with 46% when sealants were used.

“Without prevention, dental cavities grow continuously if not treated. One CariedAway cavity prevention treatment, provided just before schools closed during the pandemic, was remarkably effective over the following two-year period,” said senior author Dr Richard Niederman, professor in the Department of Epidemiology and Health Promotion at NYU Dentistry. “I know of no other dental preventive intervention that had this great a beneficial impact across the pandemic,” he added.

Since silver diamine fluoride is a cost-effective treatment that can be applied in less time than dental sealants and can be provided by registered nurses, the researchers believe that it may significantly improve the reach and effectiveness of caries prevention in a school setting.

“Our results support the use of silver diamine fluoride for cavity prevention in school-based oral health programmes and offer an opportunity for expanding access to critical oral health care,” said lead author Dr Ryan Richard Ruff, associate professor in the Department of Epidemiology and Health Promotion at NYU Dentistry.

The study, titled “Effect of silver diamine fluoride on caries arrest and prevention: The CariedAway school-based randomized clinical trial”, was published online on 1 February 2023 in JAMA Network Open.

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