SDF may be as effective as sealants in pediatric patients

Silver diamine fluoride (SDF) may work as well as dental sealants in preventing tooth decay in school-age children, offering another inexpensive strategy to combat caries, according to a study published on March 4 in JAMA Pediatrics.  

When adjusted for various factors, SDF was equally effective as dental sealants and atraumatic restorative treatment (ART) in preventing caries in pediatric patients. Also, sealants and SDF reduced the risk of tooth decay at follow-up dental visits, the authors wrote.  

"Application of SDF resulted in nearly identical caries incidence compared to dental sealants and ART and was noninferior in the longitudinal prevalence of caries," wrote the authors, led by Dr. Richard Niederman of the New York University College of Dentistry.  

Though school sealant programs have shown to be effective in decreasing the risk of caries, they aren't used enough due to the high costs of care. Due to this burden, many children continue to live with untreated dental disease. SDF is an inexpensive cavity-fighting liquid that could provide an alternative way to prevent tooth decay for more children. 

To compare the effectiveness of SDF and sealants, 4,100 students at New York City schools between the ages of 5 and 13 were treated with one of the cavity prevention tools and followed for four years.  

The initial prevalence of dental caries was approximately 27%. Over time, the odds of decay decreased (odds ratio [OR], 0.79), showing that SDF was noninferior to sealants and ART (OR, 0.94).

Furthermore, the incidence of caries was 10.2 per 1,000 tooth-years for children treated with SDF. It was 9.8 per for those treated with sealants and ART, they wrote. 

With short application times per tooth, more children can be treated quickly with SDF. SDF as a caries management strategy reduces Medicaid expenditures, especially in high-risk populations, the authors wrote.  

However, the study had limitations. As a pragmatic trial, there were concerns about subjects dropping out and potential biases from outside care, they wrote.  

Compared to placebo, dental sealants have been estimated to prevent 50% of caries. Therefore, dental sealants have prevented an estimated more than 3 million cavities.  

 "(This study) may support a similar conclusion for the application of SDF," Niederman et al added.