Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment in arresting dentin caries lesions in preschoolers: a randomized clinical trial

Objective: To compare the efficacy of silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) in arresting caries lesions. Variables such as treatment time, adverse effects/parental aesthetic perception, anxiety and patients' behavior were also evaluated.

Materials and methods: Children (3.53 ± 1.03 years) with dentin caries lesions on the occlusal surface of primary molars were randomized into test (SDF) and control (ART) groups. To determine the presence of caries, dmf-t and ICDAS indexes were used. Caries lesions were also classified according to activity (active or inactive). The time required to perform treatments was recorded and the children's anxiety was assessed by a Facial Image Scale. The adverse events/aesthetic perception were registered by the operator and caregivers. The Frankl Behavioral Scale assessed patients' behavior. The chi-square/Fisher's exact and Mann-Whitney tests were used for comparisons between the groups.

Results: Of the 118 participants who received treatment (SDF, n = 59; ART, n = 59), after 12-month follow-up, 91.5% (43/47) of caries lesions in the SDF and 90.2% (46/51) in the ART group were arrested (p = 1.000). After 24 months, 72% (18/25) were arrested in the SDF group and 95.2% (20/21) in the ART. The treatment times were 6.08 ± 1.72 and 13.58 ± 4.83, for SDF and ART, respectively (p < 0.001). No statistically significant difference of adverse effects, aesthetic perception, anxiety, and patients' behavior were found between the groups.

Conclusions: SDF was similar to ART in arresting caries lesion but required less time for treatment. The anxiety, adverse effects/aesthetic perception and patients' behavior were also similar between the groups. CLINICAL RELEVANCE: The use of SDF may be a faster and less invasive alternative for the treatment of caries lesions. Clinical trial registration number and date of registration: NCT03063307. September 2016.