A systematic review was performed to evaluate the efficacy of silver diamine fluoride (SDF) in controlling caries progression in children when compared with active treatments or placebos. A search for randomized clinical trials that evaluate the effectiveness of SDF for caries control in children compared to active treatments or placebos with follow-ups longer than 6 months was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and grey literature. The risk of bias tool from the Cochrane Collaboration was used for quality assessment of the studies. The quality of the evidence was evaluated using the GRADE approach. Meta-analysis was performed on studies considered at low risk of bias. A total of 5,980 articles were identified. Eleven remained in the qualitative synthesis. Five studies were at “low,” 2 at “unclear,” and 4 studies at “high” risk of bias in the key domains. The studies from which the information could be extracted were included for meta-analysis. The arrestment of caries at 12 months promoted by SDF was 66% higher (95% CI 41-91%; p < 0.00001) than by other active material, but it was 154% higher (95% CI 67-85%; p < 0.00001) than by placebos. Overall, the caries arrestment was 89% higher (95% CI 49-138%; p < 0.00001) than using active materials/placebo. No heterogeneity was detected. The evidence was graded as high quality. The use of SDF is 89% more effective in controlling/arresting caries than other treatments or placebos. The quality of the evidence was graded as high.

Almeida ICS, Bijella MFTB, Lima JEO, Vono AZ, Freitas SFT: Avaliação dos efeitos cariostático e anticariogênico do diaminofluoreto de prata a 12 por cento (bioride): Estudo longitudinal. Rev Fac Odontol Bauru 1994;2:28-30.
Bönecker M, Abanto J, Tello G, Oliveira LB: Impact of dental caries on preschool children's quality of life: an update. Braz Oral Res 2012;26:103-107.
Braga M, Mendes F, De Benedetto M, Imparato J: Effect of silver diamine fluoride on incipient caries lesions in erupting permanent first molars: a pilot study. J Dent Children 2009;76:28-33.
Brasil, Ministério da Saúde, Coordenação Nacional de Saúde Bucal: Condições de saúde bucal da população brasileira. Resultados principais. Brasília, Ministério da Saúde, 2010.
Byeon SM, Lee MH, Bae TS: The effect of different fluoride application methods on the remineralization of initial carious lesions. Restor Dent Endod 2016;41:121-129.
Cheng LL: Limited evidence suggesting silver diamine fluoride may arrest dental caries in children. J Am Dent Assoc (1939) 2017;148:120-122.
Chu C, Lo E, Lin H: Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. J Dent Res 2002a;81:767-770.
Chu CH, Lee AH, Zheng L, Mei ML, Chan GC: Arresting rampant dental caries with silver diamine fluoride in a young teenager suffering from chronic oral graft versus host disease post-bone marrow transplantation: a case report. BMC Res Notes 2014;7:3.
Chu CH, Lo EC: Promoting caries arrest in children with silver diamine fluoride: a review. Oral Health Prev Dent 2008;6:315-321.
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 2002b;81:767-770.
Craig GG, Knight GM, McIntyre JM: Clinical evaluation of diamine silver fluoride/potassium iodide as a dentine desensitizing agent. A pilot study. Aust Dent J 2012;57:308-311.
Craig GG, Powell KR, Price CA: Clinical evaluation of a modified silver fluoride application technique designed to facilitate lesion assessment in outreach programs. BMC Oral Health 2013;13.
Dos Santos APP, Nadanovsky P, de Oliveira BH: A systematic review and meta-analysis of the effects of fluoride toothpastes on the prevention of dental caries in the primary dentition of preschool children. Community Dent Oral Epidemiol 2013;41:1-12.
Dos Santos VE, de Vasconcelos F, Ribeiro AG, Rosenblatt A: Paradigm shift in the effective treatment of caries in schoolchildren at risk. Int Dent J 2012a;62:47-51.
Dos Santos VE, de Vasconcelos FMN, Ribeiro AG, Rosenblatt A: Paradigm shift in the effective treatment of caries in schoolchildren at risk. Int Dent J 2012b;62:47-51.
Dos Santos VE, Vasconcelos Filho A, Targino AGR, Flores MAP, Galembeck A, Caldas AF, Rosenblatt A: A new “silver-bullet” to treat caries in children - nano silver fluoride: a randomised clinical trial. J Dent 2014;42:945-951.
Duangthip D, Chu C, Lo E: A randomized clinical trial on arresting dentine caries in preschool children by topical fluorides - 18 month results. J Dent 2016;44:57-63.
Duangthip D, Jiang M, Chu CH, Lo EC: Non-surgical treatment of dentin caries in preschool children? Systematic review. BMC Oral Health 2015;15:44.
Dye BA, Hsu K-LC, Afful J: Prevalence and measurement of dental caries in young children. Pediatr Dent 2015;37:200-216.
Engelmann JL, Tomazoni F, Oliveira MDM, Ardenghi TM: Association between dental caries and socioeconomic factors in schoolchildren - a multilevel analysis. Braz Dent J 2016;27:72-78.
Fung M, Duangthip D, Wong M, Lo E, Chu C: Arresting dentine caries with different concentration and periodicity of silver diamine fluoride. JDR Clin Transl Res 2016;1:143-152.
Gao S, Zhao I, Hiraishi N, Duangthip D, Mei M, Lo E, Chu C: Clinical trials of silver diamine fluoride in arresting caries among children a systematic review. JDR Clin Transl Res 2016a:2380084416661474.
Gao SS, Zhang S, Mei ML, Lo EC-M, Chu C-H: Caries remineralisation and arresting effect in children by professionally applied fluoride treatment - a systematic review. BMC Oral Health 2016b;16:12.
Guyatt GH, Oxman AD, Schunemann HJ, Tugwell P, Knottnerus A: GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol 2011;64:380-382.
Hahnel S, Ionescu AC, Cazzaniga G, Ottobelli M, Brambilla E: Biofilm formation and release of fluoride from dental restorative materials in relation to their surface properties. J Dent 2017;60:14-24.
Higgins J, Thompson S, Deeks J, Altman D: Measuring inconsistency in meta-analysis. Br Med J 2003;327:557-560.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA; Cochrane Bias Methods Group; Cochrane Statistical Methods Group: The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ (Clin Res Ed) 2011;343:d5928.
Horst JA, Ellenikiotis H, Milgrom PM: UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications, and consent. J Calif Dent Assoc 2016;44:16-28.
Kalnina J, Care R: Prevention of occlusal caries using a ozone, sealant and fluoride varnish in children. Stomatologija 2016;18:26-31.
Knight G, McIntyre J, Craig G, Zilm P, Gully N: Differences between normal and demineralized dentine pretreated with silver fluoride and potassium iodide after an in vitro challenge by Streptococcus mutans. Aust Dent J 2007;52:16-21.
Koh R, Pukallus ML, Newman B, Foley M, Walsh LJ, Seow WK: Effects of water fluoridation on caries experience in the primary dentition in a high caries risk community in Queensland, Australia. Caries Res 2015;49:184-191.
Kuhn E, Reis A, Chibinski AC, Wambier DS: The influence of the lining material on the repair of the infected dentin in young permanent molars after restoration: a randomized clinical trial. J Conserv Dent 2016;19:516-521.
Liu B, Lo E, Chu C, Lin H: Randomized trial on fluorides and sealants for fissure caries prevention. J Dent Res 2012;91:753-758.
Llodra J, 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;84:721-724.
Lo E, Chu C, Lin H: A community-based caries control program for pre-school children using topical fluorides: 18-month results. J Dent Res 2001;80:2071-2074.
McDonald S, Sheiham A: A clinical comparison of non-traumatic methods of treating dental caries. Int Dent J 1994;44:465-470.
McGrady MG, Ellwood RP, Maguire A, Goodwin M, Boothman N, Pretty IA: The association between social deprivation and the prevalence and severity of dental caries and fluorosis in populations with and without water fluoridation. BMC Public Health 2012;12:1122.
Mei ML, Ito L, Cao Y, Li Q, Lo EC, Chu C: Inhibitory effect of silver diamine fluoride on dentine demineralisation and collagen degradation. J Dent 2013;41:809-817.
Mei ML, Ito L, Cao Y, Lo EC, Li Q, Chu C: An ex vivo study of arrested primary teeth caries with silver diamine fluoride therapy. J Dent 2014;42:395-402.
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010;8:336-341.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:1.
Monse B, Heinrich-Weltzien R, Mulder J, Holmgren C, van Palenstein Helderman WH: Caries preventive efficacy of silver diamine fluoride (SDF) and art sealants in a school-based daily fluoride toothbrushing program in the Philippines. BMC Oral Health 2012;12:52.
Naidu S, Tandon S, Nayak R, Ratnanag PV, Prajapati D, Kamath N: Efficacy of concomitant therapy with fluoride and chlorhexidine varnish on remineralization of incipient lesions in young children. Int J Clin Pediatr Dent 2016;9:296-302.
Nassar F, Rosenblatt A, Niederman R, Nelson L: Silver diamine fluoride to reduce caries in children: a cohort. J Dent Res 89 (Spec Iss B): 48, 2010 (www.iadr.org).
Nelson T, Scott JM, Crystal YO, Berg JH, Milgrom P: Silver diamine fluoride in pediatric dentistry training programs: survey of graduate program directors. Pediatr Dent 2016;38:212-217.
Nishino M, Yoshida S, Sobue S, Kato J, Nishida M: Effect of topically applied ammoniacal silver fluoride on dental caries in children. J Osaka Univ Dent School 1969;9:149-155.
Pitts N, Amaechi B, Niederman R, Acevedo A-M, Vianna R, Ganss C, Ismail A, Honkala E: Global oral health inequalities dental caries task group - research agenda. Adv Dent Res 2011;23:211-220.
Rosenblatt A, Stamford T, Niederman R: Silver diamine fluoride: a caries “silver-fluoride bullet”. J Dent Res 2009;88:116-125.
Schünemann HJ, Oxman AD, Higgins JPT, Vist GE, Glasziou P, Guyatt GH: Presenting results and “summary of findings” tables; in Higgins JPT, Green S (eds): Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.handbook.cochrane.org.
Seberol E, Ökte Z: Caries arresting effect of silver diamine fluoride on primary teeth. J Dent Res 88 (Spec Iss C):48, 2013 (www.iadr.org).
Splieth CH, Christiansen J, Foster Page LA: Caries epidemiology and community dentistry: chances for future improvements in caries risk groups. Outcomes of the ORCA saturday afternoon symposium, Greifswald, 2014. Part 1. Caries Res 2016;50:9-16.
Thanatvarakorn O, Islam MS, Nakashima S, Alireza S, Nikaido T, Tagami J: Effects of zinc fluoride on inhibiting dentin demineralization and collagen degradation in vitro: a comparison of various topical fluoride agents. Dent Mater J 2016;35:769-775.
Vachirarojpisan T, Umanan D, Krisdapong S: Silver diamine fluoride and fluoride vanish for control caries development. J Dent Res 92 (Spec Iss C):113, 2009 (www.iadr.org).
Vasconcelos FMN: Tratamento atraumático para paralisar cárie na dentição decídua e seu impacto na dentição permanente: ensaio clínico. Pernambuco, Faculdade de Odontologia Camaragibe, Universidade de Pernambuco (FOP/ UPE), 2011, vol PhD, pp 1-104.
Willershausen I, Schulte D, Azaripour A, Weyer V, Briseno B, Willershausen B: Penetration potential of a silver diamine fluoride solution on dentin surfaces. An ex vivo study. Clin Lab 2015;61:1695-1701.
Yee R, Holmgren C, Mulder J, Lama D, Walker D, Helderman WV: Efficacy of silver diamine fluoride for arresting caries treatment. J Dent Res 2009a;88:644-647.
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 2009b;88:644-647.
Zhi QH, Lo ECM, Lin HC: Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. J Dent 2012;40:962-967.
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