Silver diamine fluoride versus non-operative alternatives for caries arrest in primary teeth

Background: Non‐operative methods for caries arrest are in demand to reduce the biological and financial burden of the disease. Silver diamine fluoride (SDF) is one such treatment. It is neither used in the UK; nor is there guidance for its use. Aim: This critical appraisal aims to determine whether SDF is more effective at arresting caries in primary teeth than other active non‐operative treatments. Methods: EMBASE and Medline were searched for systematic reviews and meta‐analyses that assess randomised controlled trials (RCT), as well as for guidelines based on evidence from the former or RCTs that evaluated the effectiveness of SDF for caries arrest in primary teeth compared to other active non‐operative treatments with a minimum follow‐up of 3 months. One systematic review & meta‐analysis and one guideline were identified. They were appraised using AMSTAR 2 and AGREE II, respectively. The quality of evidence was evaluated as per the GRADE approach. Results: The systematic review and meta‐analysis found that SDF is more effective than other active treatments, with a risk ratio of 1.66 (95% CI 1.41‐1.96, P < 0.00001) for caries arrest. The guideline also found SDF to be more effective than the comparators, with a risk ratio of 1.45 (95% CI 0.79‐2.66). The guideline makes a conditional recommendation supporting the use of SDF. Conclusion: The current evidence demonstrates the potential of SDF for caries arrest in primary teeth. However, further research is needed before it can be recommended for use in the UK.