Silver Diamine Fluoride in Arresting Dental Caries Among Young Children: a Randomized Clinical Trial

Dental caries is a biofilm-mediated, sugar-driven disease in which acids from bacterial fermentation of dietary carbohydrates demineralize tooth structure. While early enamel lesions are reversible, progression into dentin allows rapid bacterial advancement toward the pulp due to the tissue's tubular structure.

The primary objective of this study is to evaluate the effectiveness of SDF as a minimally invasive approach for arresting dental caries in young children. The secondary objective was to determine whether the alternating SDF+ FV regimen achieves higher caries arrest rates than SDF alone in uncooperative pediatric patients with early to moderate lesions.

Study Design and Setting: This two-arm, parallel-group randomized controlled trial (RCT) was conducted in two private pediatric dental clinics in Tirana city center, Albania (directed by Dr. Manola Kelmendi and Dr. Enida Petro), both experienced in SDF use. The trial followed CONSORT guidelines, with single-blind outcome assessment, and ran from January 2021 to December 2022.

This randomized trial confirms that semiannual application of SDF is a highly effective and practical method for managing early and moderate caries in primary teeth, particularly in uncooperative children with ECC. Both protocols proved effective over two years. Alternating SDF with FV showed a modest additional benefit, though the difference did not reach statistical significance. Given their ease of application, low cost, and minimal invasiveness, SDF and SDF + FV remain valuable tools. Treatment success was strongly influenced by behavioral and social factors such as oral hygiene, sugar intake, and SES.

This underscores the need for comprehensive caries risk assessment and highlights that SDF-based interventions should be combined with preventive education, dietary counseling, and improved hygiene resources to maximize effectiveness.