An inexpensive liquid called silver diamine fluoride (SDF) can be used as an alternative to dental sealants to prevent and treat tooth decay in children. A new study by researchers at NYU College of Dentistry shows that SDF is as effective as sealants in treating cavities and can increase access to dental care while reducing costs. The study followed over 4,000 elementary school students for four years and was published in JAMA Pediatrics.
Dental cavities are a common chronic disease in children, which can cause pain. This is an indirect cost of children’s school absences and lower academic performance. To prevent cavities, especially among children who are less likely to see a dentist, the Centers for Disease Control and Prevention (CDC) supports the use of school sealant programs. In these programs, dental professionals visit schools to apply a thin, protective coating to the surface of teeth that hardens and safeguards against decay.
SDF is an emerging treatment for fighting cavities. SDF can be brushed onto the surface of teeth to kill the decay-causing bacteria and remineralize teeth to prevent further decay. This solution is approved by the FDA for treating tooth sensitivity.
“A growing body of research shows that SDF—which is quicker to apply and less expensive than sealants—can prevent and arrest cavities, reducing the need for drilling and filling,” said Richard Niederman, DMD, professor of epidemiology & health promotion at NYU College of Dentistry and senior author.
A study called CariedAway, conducted by researchers at NYU College of Dentistry, aimed to compare the effectiveness of SDF (silver diamine fluoride) and traditional sealants in preventing cavities in children. The study involved around 4,100 children in elementary schools in New York City, with over a quarter of them having untreated cavities at the start of the study.
During each visit to the schools, a team of health professionals examined the children’s teeth and applied either SDF or sealants, depending on which treatment the school was randomly assigned to receive. Dental hygienists administered sealants, while either dental hygienists or registered nurses applied SDF, all under the supervision of a dentist. The team visited each school twice a year, starting in 2018, but missed some visits due to the COVID-19 pandemic and school closures.
Last year, the researchers published their findings in the journal JAMA Network Open, reporting that a single treatment of either SDF or sealants prevented 80% of cavities and kept 50% of existing cavities from worsening after two years. They continued the study for another two years and published their results in JAMA Pediatrics, which showed that both SDF and sealants were effective in preventing cavities in children for a total of four years. Additionally, both treatments reduced the risk of decay at each follow-up visit.
“Our longitudinal study reaffirms that both sealants and SDF are effective against cavities. SDF is a promising alternative that can support school-based cavity prevention—not to replace the dental sealant model, but as another option that also prevents and arrests decay,” said Ryan Richard Ruff, PhD, MPH, associate professor of epidemiology & health promotion at NYU College of Dentistry and the study’s first author.
“Most research shows that SDF can stop a cavity from progressing further. Our study demonstrated that SDF can prevent cavities from happening in the first place,” said Tamarinda Barry Godín, DDS, MPH, associate program director and supervising dentist for CariedAway, research scientist at NYU College of Dentistry, and the study’s co-author.
There is an opportunity to prevent cavities in children by using Silver Diamine Fluoride (SDF) in schools. This can help avoid the need for fillings, resulting in cost savings for families and the healthcare system. However, the success of such programs depends on the availability of healthcare professionals to provide care. According to a study conducted by NYU researchers, children who received SDF treatment from dental hygienists and registered nurses had similar outcomes. This suggests that nurses, including school nurses, can play a crucial role in cavity prevention programs.
“Nurses may be an untapped resource for addressing oral health inequities,” added Ruff. “Our results suggest that nurses can effectively provide this preventive care, which could dramatically improve access, given the role of school nurses and the size of the nursing workforce.”
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References:
1. Ruff RR, Barry Godín TJ, Niederman R. Noninferiority of Silver Diamine Fluoride vs Sealants for Reducing Dental Caries Prevalence and Incidence: A Randomized Clinical Trial. JAMA Pediatr. Published online March 04, 2024. doi: 10.1001/jamapediatrics.2023.6770
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3. National Institute of Dental and Craniofacial Research. Dental caries (tooth decay) in children age 2 to 11. Accessed August 10, 2022. https://www.nidcr.nih.gov/research/data-statistics/dental-caries/children
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