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Updated: May 19, 2026

Systematic Approach to Identify Novel Antimicrobial and Antibiofilm Molecules from Plants' Extracts and Fractions to Prevent Dental Caries
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Managing High-Risk Root Caries with Silver Diamine Fluoride Application: A Markov Simulation Study.

Young S Kim1, Ji W Yoo2, Maryam Tabrizi3

  • 1Department of Anesthesiology and Pain Medicine Korea University Guro Hospital, Seoul, Republic of Korea.

Journal of Health Economics and Outcomes Research
|May 18, 2026
PubMed
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Silver diamine fluoride (SDF) is a cost-effective treatment for managing root caries in Medicaid beneficiaries. This intervention offers more extraction-free tooth-years compared to sodium fluoride varnish, improving oral health outcomes.

Area of Science:

  • Dental Public Health
  • Health Economics
  • Caries Management

Background:

  • Dental caries are a prevalent oral health issue among Medicaid beneficiaries.
  • Silver diamine fluoride (SDF) is an established treatment for managing dental caries.

Purpose of the Study:

  • To evaluate the cost-effectiveness of Silver diamine fluoride (SDF) for managing high-risk root caries in Medicaid beneficiaries.
  • To compare SDF with sodium fluoride (NaF) varnish from a healthcare system perspective.

Main Methods:

  • A Markov simulation model was employed to assess cost-effectiveness over a 19-year period.
  • A simulated 45-year-old subject with 21 residual teeth received twice-yearly 38% SDF applications.
  • Effectiveness was measured in tooth-years free of extraction, compared to 5% NaF varnish.
Keywords:
Markov modelMedicaidcariesorosystemicsilver

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Main Results:

  • 38% SDF application was found to be cost-effective compared to 5% NaF varnish.
  • SDF yielded an additional 6.34 extraction-free tooth-years with an incremental cost-effectiveness ratio of $1229 per tooth-year.
  • Sensitivity analyses confirmed the cost-effectiveness of SDF over NaF.

Conclusions:

  • An integrated orosystemic care model is recommended to promote SDF application benefits.
  • Semiannual 38% SDF application can reduce and delay tooth extractions caused by root caries.
  • This approach is particularly beneficial in underserved areas with limited access to dentists accepting Medicaid.