Arresting early childhood caries using silver and fluoride products – A randomised trial

• Published in: Journal of dentistry Vol. 103; p. 103522
• Main Authors: Gao, Sherry Shiqian, Chen, Kitty Jieyi, Duangthip, Duangporn, Wong, May Chun Mei, Lo, Edward Chin Man, Chu, Chun Hung
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-12-2020; Elsevier Limited
• Subjects: Aged; Cariostatic Agents - therapeutic use; Child; Child, Preschool; Children; Clinical trials; Confidence intervals; Dental caries; Dental Caries - prevention & control; Dental Caries Susceptibility; Dentistry; Dentists; Diamines; Early childhood caries; Enamel; Fluorides; Fluorides, Topical - therapeutic use; Humans; Intervention; Laboratories; Lesions; Oral hygiene; Quaternary Ammonium Compounds - therapeutic use; Questionnaires; Remineralisation; Silver Compounds; Silver diamine fluoride; Silver nitrate; Sodium fluoride; Sodium Fluoride - therapeutic use; Teeth; United States > US; China; Japan; Children; Silver nitrate; Remineralisation; Silver diamine fluoride; Sodium fluoride; Early childhood caries
• ISSN: 0300-5712; 1879-176X
• DOI: 10.1016/j.jdent.2020.103522

•This study is a non-inferiority randomised clinical trial with a large scale of participants.•We found that silver and fluoride products are effective in arresting early childhood caries.•Using silver and fluoride products to manage caries is simple, inexpensive, and non-invasive.
The aim of this randomised non-inferiority clinical trial was to compare the effectiveness of semi-annual (every six months) applications of 25 % silver nitrate (AgNO3) solution followed by 5 % sodium fluoride (NaF) varnish to semi-annual applications of 38 % silver diamine fluoride (SDF) solution in arresting early childhood caries (ECC).
Three-year-old children with active cavitated carious lesions were recruited and randomly assigned to two intervention groups. Children in Group A received semi-annual applications of 25 % AgNO3 solution followed by 5 % NaF varnish on carious lesions. Children in Group B received semi-annual applications of 38 % SDF solution followed by a placebo varnish. One trained dentist assessed ECC status at baseline and in all follow-up examinations. An independent operator performed the interventions. The dentist, the children, and their caretakers were blinded to the intervention allocation. Data were analysed using a non-inferiority test. Group A’s non-inferiority would be accepted if the lower limit of the 95 % confidence interval (CI) for the difference in the mean number of arrested decayed surfaces (ds) was greater than −0.5.
At baseline, 1,070 children were recruited, and 535 children were assigned to each group. After 30 months, the mean arrested ds in Groups A (n = 447) and B (n = 433) were 3.7 ± 3.6 and 3.6 ± 3.7, respectively (p = 0.694). The difference in the mean arrested ds between the two groups was 0.088 (95 % CI: -0.351 to 0.526).
Semi-annual application of 25 % AgNO3 followed by 5 % NaF is at least as effective as the semi-annual application of 38 % SDF in arresting ECC.
Silver and fluoride products are effective in arresting caries. As a simple, non-invasive, and inexpensive strategy, it can be used in young children, elderly adults, and people with special needs.