A Randomized Controlled Trial of Silver Diamine Fluoride Application Time.

Area of Science:

• Dentistry
• Pediatric Dentistry
• Cariology

Background:

• Clinicians often recommend extended application times for 38% silver diamine fluoride (SDF) to enhance caries arrest, but scientific evidence supporting this practice is limited.
• The efficacy of varying SDF application durations on arresting active carious lesions requires systematic investigation.

Purpose of the Study:

• To determine the relationship between topical 38% silver diamine fluoride (SDF) application time and the rate of carious lesion activity.
• To identify an optimal SDF application duration for maximizing caries arrest.

Main Methods:

• A 6-month, randomized, double-blind, active-controlled trial involving 665 children aged 3-4 years with 3,024 active carious tooth surfaces.
• Carious teeth were randomized into 9 groups with SDF application times ranging from 3 to 180 seconds.
• Dose-response models were used to analyze the proportion of arrested lesions as a function of SDF application time.

Main Results:

• The proportion of arrested lesions increased with longer SDF application times, reaching 84% at 60 seconds.
• An estimated 16-second application time was sufficient to achieve 80% caries arrest.
• The rate of caries arrest slowed with increasing application times beyond 30 seconds, indicating diminishing returns.

Conclusions:

• Increasing silver diamine fluoride application time enhances caries arrest, but the benefit plateaus after approximately 16-30 seconds.
• Optimal application duration balances efficacy with efficiency, suggesting shorter, effective application times are feasible.
• Caries arrest rates vary based on lesion characteristics and tooth location, necessitating tailored treatment approaches.