A 12-Month Randomized Clinical Trial of 38% SDF vs. Restorative Treatment

Area of Science:

• Pediatric Dentistry
• Cariology
• Dental Public Health

Background:

• Cavitated caries lesions in primary teeth pose a significant challenge in pediatric dentistry.
• Effective management strategies are crucial to prevent pain, infection, and tooth loss.
• Silver diamine fluoride (SDF) offers a minimally invasive alternative to traditional restorative treatment (RT).

Purpose of the Study:

• To compare the effectiveness of semiannual 38% SDF applications versus RT in managing cavitated primary teeth lesions.
• To assess clinical failure rates and treatment acceptability in a diverse pediatric population over 12 months.

Main Methods:

• A 12-month randomized clinical trial involving children aged 2-10 years with cavitated lesions (ICDAS 5-6).
• Participants were randomized to receive either twice-yearly SDF application or RT for one lesion.
• Clinical failures (minor and major) and treatment acceptability were primary outcome measures.

Main Results:

• The SDF group experienced significantly higher rates of minor (65% vs. 23%) and major (13% vs. 3%) failures compared to the RT group.
• Despite higher failure rates, 74% of SDF-treated lesions remained hard at 12 months.
• Providers found SDF easier and faster, but children in the RT group reported better tooth appearance and less discomfort.

Conclusions:

• Semiannual SDF application resulted in more clinical failures than RT for cavitated primary teeth lesions at 12 months.
• SDF-treated teeth require close monitoring, particularly in high-caries-risk populations.
• While SDF is efficient for providers, RT may offer better esthetic and comfort outcomes for children.