Silver diamine fluoride: effectiveness in older adults

shutterstock_34500700 - caries sign

Silver diamine fluoride (SDF) is emerging as an effective caries preventive agent with evidence to support its use in children.  However, the risk of caries remains throughout life.  With improving oral health in recent decades and a large increase in the proportion of older people with their own teeth there is a need for effective preventive approaches. As SDF is inexpensive and easy to administer it may also be beneficial in this age group.

This review examines the effectiveness of silver diamine fluoride  in the management of caries in older adults.


Searches were undertaken in the PubMed, PubMed Clinical Queries, EMBASE, the American Dental Association’s Evidence-Based Dentistry Website, Cochrane Library, Web of Science, repository of the Journal of the American Dental Association and Google Scholar. Bibliographies of selected manuscripts hand-searched.  Randomised controlled trials or cohort studies of SDF in older adults were considered. Study quality was assessed using modified Centre for Evidence-Based Medicine (CEBM) worksheets. Prevented fraction (PF), number needed to treat (NNT) and relative risk (RR) were calculated.


  • 3 RCTs involving a total of 655 patients were included.
  • All 3 studies investigated root caries were considered to be high quality.
  • 385 SDF was used by all 3 studies application regimens and comparisons varied across the studies.
  •  The PF for caries prevention for SDF compared to placebo was 71% in a 3-year study and 25% in a 2-year study.
  • The PF for caries arrest for SDF was 725% greater in a 24-month study and 100% greater than placebo in a 30-month study.
  • No severe adverse effects were observed.


The authors concluded: –

This systematic review evaluates the use of SDF for both root caries prevention and arrest in older adults. Existing reports of SDF trials support effectiveness in root caries prevention and arrest, remineralisation of deep occlusal lesions and treatment of hypersensitive dentin.


A broad search strategy was used for this review and some methodological details of the review are not included, such as whether, selection, data extraction and quality assessment was carried out independently and in duplicate by two or more reviewers.  The CEBM worksheets were used to assess study quality and while the results of this are presented in one of the tables it would have been more helpful to have used the validated Cochrane risk of bias tool.

While all 3 included studies  ( Tan,HP 2010, Zhang, W 2013 and Li, R 2016) demonstrated the arrest and prevention of root caries difference in the application frequency and the comparison agents and interventions makes meta-analysis difficult.  As the authors note there is no established application frequency for SDF in adults in addition none of the studies considered coronal cries. Further well designed and reported high quality studies are needed to clarify the best application frequencies for SDF and to full establish its effectiveness in the older adult. There also needs to be further consideration of its effectiveness on coronal caries and more work in relation to patient satisfaction and acceptability of this agent given the staining produced with its use.


Primary paper

Hendre AD, Taylor GW, Chávez EM, Hyde S. A systematic review of silver diamine fluoride: Effectiveness and application in older adults. Gerodontology. 2017 Aug 15. doi: 10.1111/ger.12294. [Epub ahead of print] Review. PubMed PMID: 28812312.

Other references

Dental Elf – 22nd Aug 2016

Silver Diamine Fluoride can arrest caries in children

Dental Elf – 19th Nov 2014

Root caries: review suggests potential benefits from 5000ppm fluoride, chlorhexidine and silver diamine varnishes


Tan HP, Lo EC, Dyson JE, Luo Y, Corbet EF. A randomized trial on root caries prevention in elders. J Dent Res. 2010 Oct;89(10):1086-90. doi: 10.1177/0022034510375825. Epub 2010 Jul 29. PubMed PMID: 20671206.

Zhang W, McGrath C, Lo EC, Li JY. Silver diamine fluoride and education to prevent and arrest root caries among community-dwelling elders. Caries Res.2013;47(4):284-90. doi: 10.1159/000346620. Epub 2013 Feb 5. PubMed PMID: 23392087.

Li R, Lo EC, Liu BY, Wong MC, Chu CH. Randomized clinical trial on arresting dental root caries through silver diammine fluoride applications in community-dwelling elders. J Dent. 2016 Aug;51:15-20. doi: 10.1016/j.jdent.2016.05.005. Epub 2016 May 18. PubMed PMID: 27208876.






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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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