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Silver Diamine Fluoride for the Prevention and Arresting of Dental Caries or Hypersensitivity: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines

Last updated: July 10, 2017
Project Number: RC0903-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of silver diamine fluoride (SDF) for the prevention of caries, caries arrestment, or for the treatment of tooth hypersensitivity in patients of any age?
  2. What is the cost-effectiveness of SDF for the prevention of caries, caries arrestment, or for the treatment of tooth hypersensitivity in patients of any age?
  3. What are the evidence-based guidelines associated with the use SDF for the prevention of caries, caries arrestment, or for the treatment of tooth hypersensitivity in patients of any age?

Key Message

Five systematic reviews have noted benefits of using silver diamine fluoride for the arrest and prevention in dental caries in children and elderly patients. However, many of the studies that were included in the systematic reviews were small trials and were compared to placebo. Most of the systematic reviews did not provide a summary statistic; therefore, the overall magnitude of benefit for silver diamine fluoride is unknown. Adverse effects of silver diamine fluoride are generally not reported but some studies have suggested some irritation and staining. No serious adverse events have been reported. No evidence was identified for tooth hypersensitivity.Generalizability to the Canadian context may be difficult. The studies were mostly conducted in Asia, which may have different needs compared to the Canadian population, especially for many subgroup populations that may be more vulnerable in Canada, including remote or populations, and the Canadian Aboriginal population.One German economic evaluation demonstrated silver diamine fluoride is more cost-effective than fluoride rinses and chlorhexidine for the prevention of root-caries in the elderly. There were certain model assumptions that may make it difficult to apply to the Canadian population.One clinical guideline from the Northwest Territories was identified that suggests silver diamine fluoride may have benefits; however, the benefit-harm assessment (net benefit rating) was unknown, and the rigour of guideline development was unclear. No recommendation is available as silver diamine fluoride was not approved at the time of publishing. One clinical guideline from the US was identified and it identified silver diamine fluoride as a useful agent in populations that would benefit from a less invasive approach or those who have trouble accessing dental professionals.