Sealants, fluoride varnish and silver diamine fluoride compared


Dental caries is unfortunately still a common problem among children worldwide.  Cochrane reviews have shown the effectiveness of pit and fissure sealants (Hiiri et al  2009)  and fluoride varnishes (Marinho et al 2002) . While other reviews have found silver diamine fluoride (SDF) to be effective (Rosenblatt et al 2009).  The aim of this trial was to investigate the effectiveness of resin fissure sealant, NaF varnish, and SDF solution in preventing pit and fissure caries in permanent molars of schoolchildren.

What did they do

In the Guangzhou in southern China where there was  no systemic fluoridation, but around 90% of the toothpastes on sale contained fluoride. Children were randomised to either a single placement of a resin sealant, 5% NaF varnish, semi-annual application; annual application of 38% silver diamine fluoride (SDF) solution or placebo (water). Follow-up examinations were conducted every 6 months by a masked examiner for 24 months. The primary outcome was carious cavity development into dentine.

What did they find

  • 501 children (average age 9.1 years) were enrolled 485 children (97%)were examined at 24 months.
  • A multi-level logistic regression analysis accounting for the effects of data clustering and confounding factors showed that fissures in any of the three treatment groups had significantly lower risks of carious cavity development into dentin than did controls (p < 0.05)

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 The authors concluded

Placement of resin sealant, semi-annual application of NaF varnish, and annual application of SDF solution are all effective in preventing pit and fissure caries in permanent molars.


Liu BY, Lo ECM,Chu CH.Lin HC. Randomized Trial on Fluorides and Sealants for Fissure Caries Prevention. J Dent Res. Published online Jun 26, 2012

The original trial protocol is available on the Clinical website

Hiiri A, Ahovuo-Saloranta A, Nordblad A, Mäkelä M. Pit and fissure sealants versus fluoride varnishes for preventing dental decay in children and adolescents. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD003067. DOI: 10.1002/14651858.CD003067.pub3.

Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002279. DOI: 10.1002/14651858.CD002279.

Rosenblatt A, Stamford TC, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet”. J Dent Res. 2009 Feb;88(2):116-25. Review. PubMed PMID: 19278981.


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