Silver Diamine Fluoride Prevents Cavities and Prevents Worsening of Existing School Curriculum

An inexpensive cavity-fighting liquid called silver diamine fluoride (SDF) works as well as dental sealants to keep tooth decay at bay in a school cavity prevention and treatment program, according to a new study by researchers at the NYU College of Dentistry.

The study, which followed more than 4,000 elementary school students over four years and is published in JAMA Pediatricsshows that SDF is an effective alternative to sealants and can increase access to dental care while reducing costs.

Dental cavities are the most common chronic disease in children and can lead to pain, absenteeism and lower academic performance. To prevent tooth decay, especially among children who are less likely to visit a dentist, the The Centers for Disease Control and Prevention (CDC) supports the use of school sealant programs. In sealing programs, dental professionals visit schools to apply a thin, protective coating to the surface of teeth that hardens and protects against tooth decay.

SDF has emerged as another promising treatment to fight tooth decay. Originally approved by the FDA to treat tooth sensitivity, the solution is brushed onto the surface of the teeth, killing the bacteria that cause cavities and renewing the teeth to prevent further decay.

“A growing body of research shows that SDF—which is applied more quickly and less expensively than sealants—can prevent and arrest cavities, reducing the need for drilling and filling,” said Richard Niederman, DMD, professor of epidemiology and advancement of Health at NYU. College of Dentistry and the study’s senior author.

SDF in schools

Researchers at NYU College of Dentistry led CariedAway, the nation’s largest school-based cavity prevention study, to compare the use of SDF and traditional sealants. The study included about 4,100 children in New York City elementary schools. more than a quarter of the children had untreated cavities at the start of the study.

At each school visit, a team of health professionals examined the children’s teeth and applied either sealants or SDF followed by fluoride varnish, depending on which treatment the school was randomly assigned to receive. Sealants were administered by dentists, while SDF was administered by either dental hygienists or registered nurses, all under the supervision of a dentist. Beginning in 2018, the team visited each school twice a year, although the COVID-19 pandemic and school closures resulted in missed visits.

The researchers reported last year in the journal JAMA Network Open that a simple treatment of either SDF or sealants prevented 80% of cavities and kept 50% of existing cavities from worsening two years later.

The team continued their study for another two years and in their study published in JAMA Pediatrics, found that SDF and sealants prevented about the same number of cavities after following children for a total of four years. In addition, both sealants and SDFs reduced the risk of wear at each follow-up visit.

“Our longitudinal study confirms that both sealants and SDF are effective against caries. SDF is a promising alternative that can support cavity prevention at school – not to replace the dental sealant model, but as a another option that also prevents and inhibits tooth decay,” he said. Ryan Richard Ruff, Ph.D., MPH, associate professor of epidemiology and 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 showed that SDF can prevent tooth decay in the first place,” said Tamarinda Barry Godín, DDS, MPH, associate program director and supervising dentist for CarriedAway, researcher. at NYU College of Dentistry, and co-author of the study.

An “untapped” oral health workforce

Adopting the SDF for cavity prevention and treatment in schools could prevent children from needing fillings, saving families and the health care system money. However, these programs can only succeed if there are enough health professionals to provide care.

The NYU researchers found that children who had SDF applied by dental hygienists and registered nurses had similar outcomes, suggesting that nurses—including school nurses—could play a critical role in cavity prevention programs.

“Nurses may be an untapped resource in addressing oral health disparities,” 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.”