Effectiveness of silver diamine fluoride in children with early childhood caries: A systematic review and meta-analysis

Abstract

Aim: Silver diamine fluoride (SDF) has been used globally in several countries and there are many published reports stating its effectiveness against dental caries. However, dosage and timing of application are controversial, as many authors have recommended various treatment protocols. The objective of this review was to evaluate the effectiveness of SDF in children with early childhood caries (ECC). Materials and methods: Literature searches involved PubMed, ScienceDirect, and Cochrane Library from January 2005 to December 2016. The search generated 146 articles for screening (69 from PubMed, 71 from ScienceDirect, and 6 from Cochrane Library). From the imported references, 133 were screened against title and abstract by the two reviewers after duplicates were removed. Out of these, 126 studies were excluded based upon the inclusion criteria and seven were assessed for full-text eligibility in which one study was excluded (ex vivo study). Finally, six articles were selected for the full-text analysis and quality assessment. The meta-analysis was performed with Review Manager (version 5.3). Only studies that reported the results as dichotomous data were analyzed with Cochran–Mantel–Haenszel test. Results: In the overall meta-analysis, there was an association between caries arrest in the groups using SDF and the other control groups [odds ratio = 0.66 (0.5–0.78)]. Subgroup analysis showed the following associations at 3 months interval [odds ratio = 0.55 (00.43–0.73)] and 6 months interval [odds ratio = 0.56 (00.43–0.74)]. At 18 months and above, however, there was no association seen [odds ratio = 1.01 (0.75–1.36)]. Conclusion: Early childhood caries is a global health issue that should be addressed in the primitive stages. Silver diamine fluoride is a material that is effective in caries arrest and progression and thus is useful in halting the spread of the disease. Its rationale is justified as compared with other materials used in the treatment of ECC due to the higher percentage of caries arrest seen. Clinical significance: At concentrations of 30 and 38%, SDF shows potential caries arrest in children suffering from ECC.