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Cited by 21Dental Health and Care Utilizationdental development and anomaliesDental Erosion and Treatment

Silver diamine fluoride with sodium fluoride varnish versus silver diamine fluoride in arresting early childhood caries: a 6-months follow up of a randomized field trial

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Abdellatif, Enas B., El Kashlan, Mona K., El Tantawi, Maha·2023·BMC Oral Health
DOI 10.1186/s12903-023-03597-5PMC PMC10656986

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Abstract

Background: Early childhood caries (ECC) is the most prevalent chronic health problem in young children, and it can be arrested using professionally applied fluoride such as Sodium fluoride (NaF) varnish and Silver Diamine Fluoride (SDF). This trial compared two interventions to arrest ECC lesions: 38% SDF combined with 5% NaF varnish versus 38% SDF and assessed whether the arrest rate was affected by baseline lesion severity measured by ICDAS. Methods: Children aged ≤ 4 years from 4 nurseries in a rural area in Alexandria, Egypt joined the study in March 2022. They were included if they had at least one active carious lesion with ICDAS codes ≥ 3. They were randomized to receive either 38% SDF with 5% NaF varnish or 38% SDF alone. In both groups, the agents were applied at baseline and after 6 months on the caries lesions. NaF was additionally applied on all teeth in the oral cavity, and it was also applied after three months. The primary outcome was lesion arrest status after six months. Parents’ satisfaction with their children’s appearance was the secondary outcome. Pearson Chi-Square test was used for bivariate comparison and multi-level multiple logistic regression was used to assess the effect of the intervention on caries arrest controlling for confounders. The interaction between the intervention and baseline lesion severity (categorized into moderate and severe lesions) was assessed and the p value was calculated. Results: The study included 1606 lesions in 220 children, median (IQR) age = 48(9) months. The percentages of arrested lesions after the application of SDF + NaF and SDF only were 77.7% and 73.2% (p = 0.035). In multivariable analysis, SDF + NaF had significantly greater caries arrest effect than SDF alone (AOR = 2.12, p = 0.03) with significant difference (p = 0.03) between moderate (AOR = 4.10, p = 0.005) and advanced (AOR = 1.92, p = 0.08) lesions. Most parents were satisfied with their children’s appearance with no significant difference between groups (SDF + NaF = 84.5%, SDF = 78.18%, p = 0.23). Conclusion: SDF + NaF had a higher arrest rate than SDF alone and this difference was significant in moderate but not advanced lesions. The findings have implications for the non-invasive management of ECC. Trial registration: This trial was registered in the clinicaltrials.gov registry (#NCT05642494).

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  • Large trials in other settings have examined SDF regimens and comparisons, including kindergarten-based contexts, showing that regimen effects exist but are intertwined with staining, acceptability, oral health-related quality of life, and setting-specific realities.

    “Large trials in other settings have examined SDF regimens and comparisons, including kindergarten-based contexts, showing that regimen effects exist but are intertwined with staining, acceptability, oral health-related quality of life, and setting-specific realities [13,15,16,17,18].”

    From Equity or Two-Tier Care? Guardrails for Silver Diamine Fluoride and Delegated Early Childhood Caries Pathways (2026) · cites this paper as [16]

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Authors
Abdellatif, E. B., El Kashlan, M. K., & El Tantawi, M.
Affiliations
Alexandria University (EG)
Corresponding author
Abdellatif, Enas B.
ORCID
Abdellatif, Enas B.
Venue
BMC Oral Health
Publisher
Springer Science and Business Media LLC
Published
2023-11-17
Volume
23
Issue
1
Pages
875-875
ISSN
1472-6831 (ISSN-L)
DOI
10.1186/s12903-023-03597-5
PMC
PMC10656986
OpenAlex
W4388758703
Cited by
21
References
35
Citations by year
2026: 2 · 2025: 11 · 2024: 8
FWCI
5.92
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Oral Health (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Alexandria University
Topics
  • Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › dental development and anomalies
  • Health Sciences › Dentistry › Orthodontics › Dental Erosion and Treatment
Keywords
early childhood caries, silver diamine fluoride, sodium fluoride varnish, caries arrest, topical fluoride, parental satisfaction, preschool children, dental caries prevention
MeSH terms
Quaternary Ammonium Compounds, Cariostatic Agents, Child, Child, Preschool, Dental Caries, Dental Caries Susceptibility, Fluorides, Topical, Follow-Up Studies, Humans, Sodium, Sodium Fluoride, Silver Compounds

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