Silver diamine fluoride for caries prevention in primary teeth


Untreated decay in primary teeth is an important public health problem being the 10th most common health problem in the 2010 Global Burden of Disease Study.  Silver diamine fluoride (SDF) has been used for a number of years in several countries, Argentina, Brazil, China and India to promote caries arrest as application is simple and inexpensive.  Reviews have demonstrated that it can arrest decay but not on the prevention of new lesions.

The aim of this review was to investigate whether silver diamine fluoride (SDF) is effective in preventing new caries lesions in primary teeth when compared to placebo or active treatments.


Searches were conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Medline/PubMed, Scopus, Web of Science, Lilacs, BBO, Scielo,, Brazilian Register of Clinical Trials, EU Clinical Trials Register, ISRCTN registry and Current Controlled Trials, ANZC- TR-Australian New Zealand Clinical Trials Register, and Capes dissertations databases. Parallel-group, randomised or quasi-randomised, clinical trials comparing topical SDF solution against placebo, topical anticariostatic agents, pit and fissure sealants or dental restoratives with at least 1 year of follow-up were considered.

The primary outcome was the difference in caries increment between SDF and control groups. Preventive fraction (PF) was a secondary outcome. Two reviewers independently selected studies, abstracted data and assessed risk of bias using the Cochrane risk of bias tool. Meta-analyses were grouped according to the duration of their follow-up in: less than 24 months and 24 months or more.


  • Six reports of 4 trials randomising 1118 patients and analysing 915 were included.
  • All studies had at least 1 domain with unclear or high risk of bias.
  • 2 studies contributed to a meta-analysis
  • SDF applications significantly reduced the development of dentin caries lesions in treated and untreated primary teeth
    • WMD =  –1.15 (95%CI; –1.48 to –0.82)
    • PF=  77.5% (95%CI; 67.8– 87.2%)
  • Two studies mentioned that adverse events were assessed.


The authors concluded: –

When applied to caries lesions in primary teeth, SDF compared to no treatment, placebo or FV appears to effectively prevent dental caries in the entire dentition. However, trials specifically designed to assess this outcome are needed.


The authors have taken a sound methodological approach and undertaken and extensive search of the literature. While there is a growing literature on SDF only a small number of studies were available that address the research question. None of the available trials were of high quality and only 2 of them could be included in the meta-analysis.  The authors highlight that there are currently 6 ongoing trials registered although only one of them is planning to assess caries incidence in other teeth.

So as the authors note while the findings point SDF proving an important impact on caries prevention more high quality well-reported studies are needed to assess this outcome as they highlight that of the 6 ongoing trials currently registered only 1 is planning assess this outcome.


Primary Paper

Oliveira BH, Rajendra A, Veitz-Keenan A, Niederman R. The Effect of Silver Diamine Fluoride in Preventing Caries in the Primary Dentition: A Systematic Review and Meta-Analysis. Caries Res. 2018 Jun 6;53(1):24-32. doi:10.1159/000488686. [Epub ahead of print] PubMed PMID: 29874642.

Original review protocol PROSPERO

Other references

Dental Elf 31st Jan 2018

Silver diamine fluoride for caries in primary teeth

Dental Elf – Silver Diamine Blogs



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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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