Trial shows biannual application of silver diamine fluoride better than annual application at arresting caries


There has been a recent surge of interest in use of sliver-fluoride regimens for caries control as sadly dental caries is still a significant problem worldwide.  The aim of this trial was to compare the effectiveness of annual topical application of silver diamine fluoride (SDF) solution, semi-annual topical application of SDF solution, and annual application of a flowable high fluoride-releasing glass ionomer in arresting active dentine caries in primary teeth. The study was conducted in Guangzhou, Guangdong Province in southern China in an area where we reported and earlier study by Liu et al (Dental Elf 27th Jun 2012)

A total of 212 children, aged 3–4 years, were randomly allocated to one of three groups for treatment of carious dentine cavities in their primary teeth: Gp1-annual application of SDF (n=71), Gp2-semi-annual application of SDF (n=69), and Gp3-annual application of glass ionomer (n=72). Follow-up examinations were carried out every six months to assess whether the treated caries lesions had become arrested. Information on brushing behaviour, use of fluoride toothpaste, frequency of sweet snack intake between meals, and parent’s satisfaction with the child’s dental appearance was collected by questionnaire at baseline and at 24 months.

After 24 months, 181 (85%) children remained in the study, 60, 59 and 62 children in Groups 1–3, respectively. They found that:-

  • The caries arrest rates were 79%, 91% and 82% for Gp1, Gp2 and Gp3, respectively (p=0.007).

Using a regression model and adjusting for clustering,

  • higher caries arrest rates were found in lesions treated in Gp2 (OR = 2.98, p = 0.007),
  • those in anterior teeth (OR = 5.55, p < 0.001), and
  • those in buccal/lingual smooth surfaces (OR = 15.6, p = 0.004)

The authors concluded

that while the effectiveness of annual application of SDF solution and that of annual application of a flowable high fluoride-releasing glass ionomer in arresting active dentine caries in primary teeth does not differ significantly, increasing the frequency of application of SDF solution to every 6 months can increase the caries arrest rate.


A systematic review by Rosenblatt et al in 2009 suggested that silver diamine fluoride was more effective than fluoride varnish in arresting caries although only 2 studies were included.  Since then a number of  other studies have been published prior to this current one and at least two further trials are underway in Brazil. In addition a Cochrane review is currently underway (Jas et al) which may provide further information in due course.


Zhi QH, Lo EC, Lin HC. Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. J Dent. 2012 Aug 11. [Epub ahead of print]

Dental Elf 27th Jun 2012

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

Jaz S, Marinho VCC, Croucher R, Onwude O, Rutterford C. Professionally applied fluoride paint-on solutions for the control of dental caries in children and adolescents (Protocol). Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD008364. DOI: 10.1002/14651858.CD008364









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