Randomized controlled trial on the effectiveness of silver diamine fluoride in arresting caries in Lagos, Nigeria





Dental caries, Glass ionomer cement, Fluorides, topical


Treatment of dental caries in children still remains challenging due to lack of cooperation with conventional treatment modalities. Recently, the use of Silver Diamine Fluoride (SDF) has proved useful in addressing this challenge. Aim: This clinical trial aimed to evaluate the effectiveness of Silver Diamine Fluoride (SDF) in arresting caries in children in Lagos, Nigeria. Methods: This was a phase III balanced randomized controlled school based interventional study on 240 children. The study group was treated with SDF while GIC was used in the control group. Follow up visits in 2 weeks, 1 month, and 3 months were carried out to assess the treatment outcome. Inferential statistics with the use of Pearson Chi-square test and Independent Student t-test were used at 5% level of significance. Results: There was significant relationship between SDF and caries arrest in 2 weeks, 1 month and 3 months’ assessment period (p = 0.001). The control group showed continuous decline (71.7%, 54.3% and 50.9%) in restorative success from 2 weeks to 3 months respectively. The mean ± SD and Confidence Interval (CI) of arrested caries in the SDF group were 113± 1.24 and 113.1 – 113.5 respectively. In the control group the mean ± SD and CI of restorative success were 69.3±11.8 and 67.2 – 71.4. The effect size was 5.24. Conclusion: The result of the study showed that SDF was effective in arresting caries in children without any harm and there was statistically significant difference in the use of 38% SDF in arresting caries in children.


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Author Biographies

Moses Okechukwu Azouru, Lagos State University Teaching Hospital

Department of Child Dental Health, Lagos State University Teaching Hospital, Lagos, Nigeria.

Modupe Olufunmilayo Ashiwaju, University of Lagos

Department of Child Dental Health, College of Medicine, University of Lagos, Lagos, Nigeria.

Augustine Edomwonyi, University of Medical Sciences

Department of Preventive Dentistry, Faculty of Dentistry, University of Medical Sciences, Ondo State, Nigeria.

Afolabi Oyapero, Lagos State University College of Medicine

Department of Preventive Dentistry, Faculty of Dentistry, Lagos State University College of Medicine, Lagos, Nigeria.

Bola Obisesan, National Postgraduate Medical College of Nigeria

Faculty of Family Dentistry, National Postgraduate Medical College of Nigeria, Lagos, Nigeria.

Aderinsola Omotuyole, Lagos State University College of Medicine

Department of Child Dental Health, Faculty of Dentistry, Lagos State University College of Medicine, Lagos, Nigeria.


GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep;390(10100):1211-59. doi: 10.1016/S0140-6736(17)32154-2.

Adeniyi AA, Oyapero OA, Ekekezie OO, Braimoh MO. Dental caries and nutritional status of School Children In Lagos, Nigeria – a preliminary survey. J West Afr Coll Surg. 2016 Jul-Sep;6(3):15-38.

Oyapero A, Bakare TI, Goncalves TF. Advancing oral health policy for mandatory dental screening before admission into public primary and secondary schools in Lagos, Nigeria. J Family Med Prim Care. 2020 Dec 31;9(12):5988-94. doi: 10.4103/jfmpc.jfmpc_1341_20.

Adeniyi AA, Agbaje O, Onigbinde O, Ashiwaju O, Ogunbanjo O, Orebanjo O, et al. Prevalence and pattern of dental caries among a sample of nigerian public primary school children. Oral Health Prev Dent. 2012;10(3):267-74.

Centres for Disease Control and Prevention. U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Office of the Assistant Secretary for Health, Office of the Secretary. Healthy People 2010. [cited 21 Dec 2013]. Available from: http://www.healthypeople.gov.

Centres for Disease Control and Prevention. National Center for Health Statistics. Healthy People 2010 Final Review. Hyattsville, MD; 2012. Available from: https://www.cdc.gov/nchs/healthy_people/hp2010/hp2010_final_review.htm.

Costa SM, Martins CC, Bonfim ML, Zina LG, Paiva SM, Pordeus IA, et al. A systematic review of socioeconomic indicators and dental caries in adults. Int J Environ Res Public Health. 2012 Oct 10;9(10):3540-74. doi: 10.3390/ijerph9103540.

Charles JM. Dental care in children with developmental disabilities: attention deficit disorder, intellectual disabilities, and autism. J Dent Child (Chic). 2010 May-Aug;77(2):84-91..

Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management, Wolraich M, Brown L, Brown RT, DuPaul G, Earls M, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011 Nov;128(5):1007-22. doi: 10.1542/peds.2011-2654.

Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: a report from the American Dental Association. J Am Dent Assoc. 2018 Oct;149(10):837-49.e19. doi: 10.1016/j.adaj.2018.07.002.

Peng JJ, Botelho MG, Matinlinna JP. Silver compounds used in dentistry for caries management: a review. J Dent. 2012 Jul;40(7):531-41. doi: 10.1016/j.jdent.2012.03.009.

Barker C. The Lund Report. Breakthrough Therapy Designation for Silver Diamine Fluoride granted by FDA; 2016 Nov [cited 2019 Jan 12]. Available from: https://www.thelundreport.org/content/breakthrough-therapy-designation-silver-diamine-fluoride-granted-fda.

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.

Rosenblatt A, Stamford TC, Niederman R. Silver diamine fluoride: a caries "silver-fluoride bullet". J Dent Res. 2009 Feb;88(2):116-25. doi: 10.1177/0022034508329406.

Chu CH, Lo EC. Promoting caries arrest in children with silver diamine fluoride: a review. Oral Health Prev Dent. 2008;6(4):315-21.

Yee R, Holmgren C, Mulder J, Lama D, Walker D, van Palenstein Helderman W. Efficacy of silver diamine fluoride for Arresting Caries Treatment. J Dent Res. 2009 Jul;88(7):644-7. doi: 10.1177/0022034509338671.

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 Nov;40(11):962-7. doi: 10.1016/j.jdent.2012.08.002.

Mei ML, Ito L, Cao Y, Lo EC, Li QL, Chu CH. An ex vivo study of arrested primary teeth caries with silver diamine fluoride therapy. J Dent. 2014 Apr;42(4):395-402. doi: 10.1016/j.jdent.2013.12.007.

Milgrom P, Horst JA, Ludwig S, Rothen M, Chaffee BW, Lyalina S, et al. Topical silver diamine fluoride for dental caries arrest in preschool children: A randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. J Dent. 2018 Jan;68:72-8. doi: 10.1016/j.jdent.2017.08.015.

Wikipedia. Lagos State. Lagos State Demographs. 2015 Oct 18 [ cited 2016 Feb 21]. Available from: https://en.m.wikipedia.org>wiki>Lagos.

Nigerian Meteorological Agency. Lagos Climatic Condition. ©2009-2017 [cited 2019 Mar 9. Available from: www.lagos.climatemps.com>humidity.

National Sugar Development Council. Report of the National Wide Survey on Industrial Sugar Consumption in Nigeria; 2014 [cited 2015 Aug 16]. Available from: http://www.nsdcnigeria.org/wp-content/uploads/2016/07/2014-REPORT-ON-ANNUAL-SURVEY-ON-INDUSTRIAL-SUGAR-CONSUMPTION-IN-NIGERIA.pdf

Mei ML, Chu CH, Lo EC, Samaranayake LP. Fluoride and silver concentrations of silver diammine fluoride solutions for dental use. Int J Paediatr Dent. 2013 Jul;23(4):279-85. doi: 10.1111/ipd.12005.

Pitts N. "ICDAS"--an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Community Dent Health. 2004 Sep;21(3):193-8.

Tedequim Products. “Silver Diamine Fluoride – A caries Arrest Agent” [cited 2019 Feb 11. Available from: https://www.tedequim.com.

Prevest Denpro. Glass ionomer restorative self-cure in hand mix version for restoration of primary teeth core build up [cited 2019 Jul 22]. Available from: http://www.prevestdenpro.com.

Sarvas E, KarpJM. Silver diamine fluoride arrests untreated dental caries but has drawbacks. AAP News J. 2016 Aug 5 [cited 2021 Mar 11]. Available from: https://www.aappublications.org/news/aapnewsmag/2016/08/05/SilverDiamine080516.full-text.pdf.

Contreras V, Toro MJ, Elías-Boneta AR, Encarnación-Burgos A. Effectiveness of silver diamine fluoride in caries prevention and arrest: a systematic literature review. Gen Dent. 2017 May-Jun;65(3):22-9 [cited 2021 Mar 11]. Available from: https://www.agd.org/docs/default-source/self-instruction-(gendent)/gendent_mj17_contreras.pdf.

Chu CH, Lo EC, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. J Dent Res. 2002 Nov;81(11):767-70. doi: 10.1177/0810767.

Horst JA, Ellenikiotis H, UCSF Silver Caries Arrest Committee, Milgrom PM. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications, and consent. J Calif Dent Assoc. 2016 Jan;44(1):16-28.

Alvear BA, Horst JA, Hirsch JP, Duffin S, Wong A, Young DA. Arresting caries. Dimens Dent Hyg. 2016 Jul;14(7):61-4.

Clemens J, Gold J, Chaffin J. Effect and acceptance of silver diamine fluoride treatment on dental caries in primary teeth. J Public Health Dent. 2018 Dec;78(1):63-68. doi: 10.1111/jphd.12241.

Llodra JC, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res. 2005 Aug;84(8):721-4. doi: 10.1177/154405910508400807.

Nishino M. [Studies on the topical application of ammoniacal silver fluoride for the arrest of dental caries]. Osaka Daigaku Shigaku Zasshi. 1969 Jun;14(1):1-14. Japanese.

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.

Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, Worthington HV. Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD001830. doi: 10.1002/14651858.CD001830.pub4. Update in: Cochrane Database Syst Rev. 2017 Jul 31;7:CD001830.

Santos Jr VE, Vasconcelos Filho A, Targino AG, Flores MA, Galembeck A, Caldas AF Jr, et al. A new "silver-bullet" to treat caries in children--nano silver fluoride: a randomised clinical trial. J Dent. 2014 Aug;42(8):945-51. doi: 10.1016/j.jdent.2014.05.017.

Gao SS, Zhao IS, Hiraishi N, Duangthip D, Mei ML, Lo ECM, et al. Clinical trials of Silver Diamine Fluoride in arresting caries among children: a systematic review. JDR Clin Trans Res. 2016 Oct;1(3):201-10. doi: 10.1177/2380084416661474.

Monse B, Heinrich-Weltzien R, Mulder J, Holmgren C, van Palenstein Helderman WH. Caries preventive efficacy of silver diammine fluoride (SDF) and ART sealants in a school-based daily fluoride toothbrushing program in the Philippines. BMC Oral Health. 2012 Nov 21;12:52. doi: 10.1186/1472-6831-12-52.

Dos Santos VE Jr, de Vasconcelos FM, Ribeiro AG, Rosenblatt A. Paradigm shift in the effective treatment of caries in schoolchildren at risk. Int Dent J. 2012 Feb;62(1):47-51. doi: 10.1111/j.1875-595X.2011.00088.x.

Braga MM, Mendes FM, De Benedetto MS, Imparato JC. Effect of silver diammine fluoride on incipient caries lesions in erupting permanent first molars: a pilot study. J Dent Child (Chic). 2009 Jan-Apr;76(1):28-33.

Castillo JL, Rivera S, Aparicio T, Lazo R, Aw TC, Mancl LL, Milgrom P. The short-term effects of diammine silver fluoride on tooth sensitivity: a randomized controlled trial. J Dent Res. 2011 Feb;90(2):203-8. doi: 10.1177/0022034510388516.




How to Cite

Azouru MO, Ashiwaju MO, Edomwonyi A, Oyapero A, Obisesan B, Omotuyole A. Randomized controlled trial on the effectiveness of silver diamine fluoride in arresting caries in Lagos, Nigeria . Braz. J. Oral Sci. [Internet]. 2021 Nov. 3 [cited 2022 Oct. 4];21(00):e226341. Available from: https://periodicos.sbu.unicamp.br/ojs/index.php/bjos/article/view/8666341



Original Research