Early childhood caries (ECC) have long been a major global health problem, affecting around 530 million children according to the World Health Organization (FDI World Dental Federation, 2020). ECC is defined as “the presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any primary tooth in a child at 71 months of age or younger.” A recent clinical trial published May 2020 in the Journal of Dentistry aimed to “compare the effectiveness of 38% SDF solution, and 5% NaF varnish applied semiannually in arresting dentin caries in young children aged 1-3 years.”1
NaF varnish has been utilized for over 50 years as a preventative for the development of ECC. SDF on the other hand has not been utilized for quite as long, therefore a comparison regarding efficacy was needed. Previously published studies show high success rates for SDF in arresting dentin caries, ranging from 65% to 91%. However, there are very few studies that evaluate the safety and efficacy of SDF use in young children as well as a lack of studies comparing SDF and NaF varnish.
The results of this study showed ECC being arrested by SDF was 2 times as likely when compared to 5% NaF varnish, both being applied semiannually. However, the caries arrest rate (35.7%) in this study was lower than the results reported in previous studies (53%-62.6%). The authors state this is possibly due to unfavorable conditions of children in the age range for this study such as poor oral hygiene, increased frequency of milk intake, more frequent snacking, and their inability to cooperate.
Regarding the safety of SDF use in young children, the authors evaluated the high levels of silver and fluoride present in SDF to determine the risk of toxicity. One drop of SDF was used for treatment which contains 1.12 mg of fluoride and 6.34 mg of silver. The toxic dose of fluoride is 5mg/kg and the lethal median dose of silver by oral administration is 380-520 mg/kg. Going by these calculations the amount of fluoride and silver present would be far below the toxic dose. Additionally, no systemic adverse events were reported confirming the safety of use in young children.
A few limitations noted by the authors include the use of only visual-tactile examinations as radiographs were impractical in the community setting. Additionally, the study period was 12 months which is relatively short for confirming caries progression.
SDF is a safe alternative to traditional caries management in toddlers. Additionally, it is quite plausible with training, SDF treatment can be completed by allied healthcare professionals in remote areas with limited access to care.
The authors conclude by stating, “Semiannual application of 38% SDF is more effective than that of 5% NaF varnish in arresting dentin carious lesions in young children with high caries risk. Both topical fluoride agents have no significant side effects and no impact on parental satisfaction with children’s dental appearance.”
Do you utilize SDF in your practice? Considering the ease of use and non-invasive nature, would you consider using it for younger patients instead of sedation and conventional treatment? If you currently utilize SDF in your practice, are parents satisfied?
- Mabangkhru S, Duangthip D, Chu CH, Phonghanyudh A, Jirarattanasopha V. A randomized clinical trial to arrest dentin caries in young children using silver diamine fluoride. J Dent. 2020 Aug;99:103375. doi: 10.1016/j.jdent.2020.103375. Epub 2020 May 16. PMID: 32428523.