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氟化氨银（silver diamine fluoride，SDF）溶液是一种局部应用的含氟、银和氨离子的溶液，通过作用于龋损部位的牙体组织和细菌防治龋病，国际上正在深入开展相关的研究，一些国家已将其应用于临床和社区工作中。然而，国内相关工作开展很少。本文就SDF的防龋机制及其临床应用与研究做一简要介绍。     

Paradigm shift in the effective treatment of caries in schoolchildren at risk

Background: Silver diamine fluoride (SDF) is an effective agent for the arrest of caries in children, is easy to apply and can be used outside the clinical environment. Interim restorative treatment (IRT) using glass ionomer cement has also been claimed to be a simple and effective method to arrest caries in deciduous teeth. Objective: To examine whether, for underprivileged schoolchildren with cavities, treatment with 30% SDF gives better results than IRT for carries arrest. Method: This randomised controlled study compares the effect of IRT (FUJI IX) with 30% SDF in 91 children aged 5–6 years. Results: After 1 year, treatment with SDF was more effective [relative risk (RR) = 66.9%] than IRT (RR = 38.6%) for the arrest of caries; this was statistically significant (P < 0.05). Conclusion: The SDF technique showed better results than IRT for the arrest of cavities in deciduous teeth, indicating that its use for underprivileged communities may justify a paradigm shift in paediatric dentistry.     

An alternate technique of care using silver fluoride followed by stannous fluoride in the management of root caries in aged care

An alternate technique of care to prevent, arrest and manage root caries using aqueous silver fluoride followed by stannous fluoride (AgF+SnF₂) in aged care is demonstrated by three case studies. With increasing age, the inability to maintain ones own oral care from dementia, illness or frailty and polypharmacy induced salivary gland hypofunction will result in dental caries becoming a progessively greater burden for the elderly. Future generations of elders will live longer and need to maintain many more teeth longer than earlier generations. Both silver diamine fluoride (SDF)and AgF+SnF₂ arrest and prevent caries and are easy to use in residential aged care facilities. Clinical differences between SDF and AgF+SnF₂ are discussed. However, in aged care, AgF+SnF₂ may offer advantages over SDF. AgF+SnF₂ used to arrest and prevent caries in children can be modified to provide effective but minimally invasive care for an ageing and frail population. These techniques are rapid, inexpensive and nonthreatening suited to treat frail elders, dementia patients exhibiting challenging behaviours and patients with multiple rapidly progressing decay. Silver fluoride, applied before placing glass‐ionomer cement (GIC) restorations is an important adjunct to the atraumatic restorative technique and may retard caries reactivation more than GIC used alone.     

Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children

ObjectiveTo compare the effectiveness of annual topical application of silver diamine fluoride (SDF) solution, semi-annual topical application of SDF solution, and annual application of a flowable high fluoride-releasing glass ionomer in arresting active dentine caries in primary teeth.MethodsA total of 212 children, aged 3–4 years, were randomly allocated to one of three groups for treatment of carious dentine cavities in their primary teeth: Gp1-annual application of SDF, Gp2-semi-annual application of SDF, and Gp3-annual application of glass ionomer. Follow-up examinations were carried out every six months to assess whether the treated caries lesions had become arrested.ResultsAfter 24 months, 181 (85%) children remained in the study. The caries arrest rates were 79%, 91% and 82% for Gp1, Gp2 and Gp3, respectively (p = 0.007). In the logistic regression model using GEE to adjust for clustering effect, higher caries arrest rates were found in lesions treated in Gp2 (OR = 2.98, p = 0.007), those in anterior teeth (OR = 5.55, p < 0.001), and those in buccal/lingual smooth surfaces (OR = 15.6, p = 0.004).ConclusionAnnual application of either SDF solution or high fluoride-releasing glass ionomer can arrest active dentine caries. Increasing the frequency of application to every 6 months can increase the caries arrest rate of SDF application.Clinical significanceArrest of active dentine caries in primary teeth by topical application of SDF solution can be enhanced by increasing the frequency of application from annually to every 6 months, whereas annual paint-on of a flowable glass ionomer can also arrest active dentine caries and may provide a more aesthetic outcome.     

Use of silver diamine fluoride for the maintenance of dental prostheses in a high caries-risk patient: A medical management approach

A technique for using silver diamine fluoride (SDF) as part of a regimen to help maintain dental prostheses in a patient with scleroderma and at high risk of caries is presented. Medically compromised, xerostomic, or elderly patients generally face greater risk of caries and specifically with prosthetic retainer teeth. SDF is a minimally invasive solution to this problem. A technique is described for using SDF to arrest and prevent new caries with the goal of maintaining fixed and removable prostheses and supporting teeth in a cost-effective manner.     

Silver Diamine Fluoride: Transforming Community Dental Caries Program

IntroductionUntreated dental caries is the most frequent childhood chronic disease worldwide. Silver diamine fluoride (SDF) offers a safe and effective alternative treatment, especially for children.ObjectiveTo inform the dental community about the efficacy of SDF in community dental caries programs and to advocate for its use as an affordable and equitable approach to promote health and well-being within the dental setting.MethodsA summary of the literature shared during a webinar about the use and efficacy of SDF in community dental programs hosted by the Oral Health Working Group of the World Federation of Public Health AssociationsResultsBased on the traditional “drill-and-fill” approach, the current treatment for severe caries is associated with pain, fear, and poor oral health outcomes in later life. Innovative approaches to prevent and control caries are needed. SDF offers an alternative treatment option for caries. It is a practical, affordable, and acceptable option for caries treatment, eliminating the need for general anaesthetic in young children, and improving long-term oral health outcomes.ConclusionSDF can improve oral health outcomes for community members, especially for individuals from low-socioeconomic settings.     

Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial

We hypothesized that the six-monthly application of silver diamine fluoride (SDF) can arrest the development of caries in the deciduous dentition of six-year-old schoolchildren and prevent caries in their first permanent molars. A prospective controlled clinical trial was conducted on the efficacy of a 38% SDF solution for caries reduction. Four hundred and twenty-five six-year-old children were divided into two groups: One group received SDF solution in primary canines and molars and first permanent molars every 6 mos for 36 mos. The second group served as controls. The 36-month follow-up was completed by 373 children. The mean number of new decayed surfaces appearing in primary teeth during the study was 0.29 in the SDF group vs. 1.43 in controls. The mean of new decayed surfaces in first permanent molars was 0.37 in the SDF group vs. 1.06 in controls. The SDF solution was found to be effective for caries reduction in primary teeth and first permanent molars in schoolchildren.     

Parental perceptions and acceptance of silver diamine fluoride staining

Background

The caries arrest that can be achieved by using silver diamine fluoride (SDF) offers a minimally invasive and inexpensive alternative to traditional restorative caries treatment. The authors evaluated how the dentinal staining that is associated with SDF influences the acceptance of this treatment among parents of young children in the New York City metropolitan area.

12岁少年龋活跃性之研究分析

目的 :了解少年之龋活跃性表现及检测结果。方法 :以 2 2 8名 (男 115名 ,女 113名 ) 12岁少年为对象 ,均经口腔检查及以DentocultSM法检测龋活跃性。分析患龋率、DFT、CSI在DentocultSM各度之表现及相关性。结果 :( 1)统计资料表明患龋率为 5 1 3 2 %,DFT为 0 89± 1 13 ,CSI为 1 70± 2 4 0。 ( 2 )男女间患龋率、DFT、CSI和DentocultSM各度之分布均无显著差异。 ( 3 )DentocultSM各度在患龋率、DFT、CSI无显著差异 ,在男女分组之表现亦无显著差异。 ( 4 )等级相关表明DentocultSM各度与DFT、CSI无相关性。结论 :本文之报告结果与不少幼儿期之报告结果截然不一 ,DentocultSM又为当今较为肯定之龋活跃性检测法。所示之结果或与此年龄组之DFT、CSI较低有关 ,也提示龋活跃性检测之应用意义在小于 12岁幼儿期。     

APFI凝胶防龋效果观察

目的 观察小学生采用离子增补酸性氟磷酸盐（APFI）凝胶防龋的效果。方法 选取城乡4所小学2918例6－13例的小学生,按学校以班、组为单位随机抽样分成实验、对照两组。实验组2160例,采用APFI凝胶防龋;对照组758例,不用APF1凝胶。相同时间观察两组的患龋情况。结果 与对照组相比,实验组新患龋率降低52．3％,新增龋均降低60．14％,P＜0．01;第一恒磨牙新患龋率降低52．43％,新增龋均降低65．52％（P＜0．01）。结论 采用APFI凝胶防龋,可获得满意效果。     

Longitudinal caries prevalence in a comprehensive,multicomponent, school-based prevention program

BackgroundGlobally, children’s caries prevalence exceeds 30% and has not markedly changed in 30 years. School-based caries prevention programs can be an effective method to reduce caries prevalence, obviate traditional barriers to care, and use aerosol-free interventions. The objective of this study was to explore the clinical effectiveness of a comprehensive school-based, aerosol-free, caries prevention program.MethodsThe authors conducted a 6-year prospective open cohort study in 33 US public elementary schools, providing care to 6,927 children in communities with and without water fluoridation. After dental examinations, dental hygienists provided twice-yearly prophylaxis, glass ionomer sealants, glass ionomer interim therapeutic restorations, fluoride varnish, toothbrushes, fluoride toothpaste, oral hygiene instruction, and referral to community dentists as needed. The authors used generalized estimating equations to estimate the change in the prevalence of untreated caries over time.ResultsThe prevalence of untreated caries decreased by more than 50%: from 39% through 18% in phase 1, and from 28% through 10% in phase 2. The per-visit adjusted odds ratio of untreated caries was 0.79 (95% confidence interval, 0.73 to 0.85).Conclusions and Practical ImplicationsThis school-based comprehensive caries prevention program was associated with substantial reductions in children’s untreated caries, supporting the concept of expanding traditional practices to include office- and community-based aerosol-free care.     

Caries preventive efficacy of silver diammine fluoride (SDF) and ART sealants in a school-based daily fluoride toothbrushing program in the Philippines

Background

Occlusal surfaces of erupting and newly erupted permanent molars are particularly susceptible to caries.The objective of the study was to assess and compare the effect of a single application of 38% SDF with ART sealants and no treatment in preventing dentinal (D3) caries lesions on occlusal surfaces of permanent first molars of school children who participated in a daily school-based toothbrushing program with fluoride toothpaste.

Methods

The prospective community clinical trial in the Philippines was conducted over a period of 18 months and included 704 six- to eight-year-old school children in eight public elementary schools with a daily school-based fluoride toothpaste brushing program. Children were randomly assigned for SDF application or ART sealant treatment. Children from two of the eight schools did not receive SDF or ART sealant treatment and served as controls. SDF or ART sealant treatment was applied on sound occlusal surfaces of permanent first molars. Surfaces that were originally defined as sound at baseline but which changed to dentinal (D3) caries lesions were defined as surfaces with new caries (caries increment). Non-compliance to the daily toothbrushing program in three schools offered the opportunity to analyze the caries preventive effect of SDF and sealants separately in fluoride toothpaste brushing and in non-toothbrushing children.

Results

In the brushing group, caries increment in the SDF treatment group was comparable with the non-treatment group but caries increment in the sealant group was lower than in the non-treatment group with a statistically significant lower hazard ratio of 0.12 (0.02-0.61). In the non-brushing group, caries increment in the SDF treatment group and the sealant group was lower than the non-treatment group but the hazard ratio was only statistically significant for the sealant group (HR 0.33; 0.20-0.54). Caries increment was lower in toothbrushing children than in non-toothbrushing children. Hazard ratios reached statistical significance for the non-treated children (HR 0.43; 0.21-0.87) and the sealant-treated children (HR 0.15; 0.03-0.072).

Conclusions

A one-time application of 38% SDF on the occlusal surfaces of permanent first molars of six- to eight-year-old children is not an effective method to prevent dentinal (D3) caries lesions. ART sealants significantly reduced the onset of caries over a period of 18 months.

Trial registration number

German Clinical Trial Register DRKS00003427

     

A Review of the Protocol of SDF Therapy for Arresting Caries

ObjectiveThe aim of this work was to review the protocol of the use of silver diamine fluoride (SDF) for arresting caries, specifically the application time.MethodTwo researchers searched manufacturers’ instructions, YouTube videos, and 5 databases (Embase, Medline, PubMed, Scopus, and Web of Science). Manufacturers’ instructions, videos from national dental organisations, and peer-reviewed journal articles that published the SDF application protocol in English for arresting caries were selected.ResultsThe review included 14 protocols from 15 publications from 4 manufacturers, 3 dental associations, and 7 author teams (one team had 2 articles). The American Dental Association and the British Society of Paediatric Dentistry provided their SDF application protocols on YouTube. The American Academy of Paediatric Dentistry and 7 author teams published their protocols in journal articles. Seven publications suggested an SDF application time of 60 seconds. Seven publications suggested a time range of 10 seconds to 240 seconds. Two publications suggested caries excavation, but 4 publications suggested no caries excavation before SDF application. The procedures from at least 5 publications involved protecting the gingiva with petroleum jelly, isolating the carious tooth with cotton rolls, drying the carious lesion with a 3-in-1 syringe, applying SDF solution with a micro brush for 60 seconds, removing excess SDF solution with gauze, and applying fluoride varnish to the SDF-treated lesion.ConclusionsAlthough the SDF application protocol is simple and straightforward, the published protocols could be different. Most publications suggested an SDF application time of 60 seconds, which can be long, particularly for young children and older adults.     

A longitudinal study of early childhood caries risk,dental caries,and life style

The objectives of this longitudinal study were to assess children's caries risk and mean number of decayed teeth and determine their life style factors that influence their caries activity. A total of 283 children were selected based on the following criteria: they had 1.5, 2.5, and 3.5-year-old oral examinations, participated in Cariostat microbial sampling and the mother of a child filled out the questionnaires. Caries experiences of children were 2.1% for the 1.5-year-old, 8.1% for the 2.5-year-old, and 14.8% for 3.5-year-old period, respectively. Caries risk at the 1.5-year-old period showed significant differences (P<0.001) for mean number of decayed teeth when children were at the 2.5-, and 3.5-year-old period. A significant difference (P<0.01) was also seen for caries risk at the 2.5-year-old period. Regarding children's lifestyle factors at the 1.5-year-old period, pre-chewing food and breastfeeding produced significant caries susceptibility in both 2.5- and 3.5-year-old period. Additionally, children's life styles were analyzed to have an impact on caries only at the 2.5-year-old period. For children's life style at the 2.5-year-old period, increased frequency of snack, irregular snack time, and brushing without assistance by the mother put 3.5-year-old children at high risk of developing caries. A caries activity test could predict 2.5-, and 3.5-year-old children's caries risk based on the 1.5-year-old test result. Some children's life styles at an early age showed a higher risk of developing caries at a later age.     

Effect of pit and fissure sealants on caries detection by a fluorescent camera system

Objective

The aim of this study was to evaluate the effect of sealant placement on the detection of caries by a fluorescent camera (FC), the Spectra caries detector.

Materials and methods

In a laboratory study, FC images and readings were obtained from 31 extracted teeth, before and following application of clear sealants (Shofu Clear or Delton unfilled), or opaque sealants (3M Clinpro or Delton FS). Teeth were then sectioned and examined for enamel or dentine caries. Using each tooth's true caries diagnosis, the sensitivity and specificity of the FC measurements in detecting dentine caries was calculated. In the clinical study, FC readings were obtained from 41 molars in children prior to and following application of clear sealants.

Results

Following application of Shofu or Delton unfilled there were reductions in the mean FC readings of 10% (p = 0.5) and 8.2% (p = 0.009), respectively. Application of two opaque sealants, 3M or Delton FS significantly reduced mean FC readings 16.2% and 20.8% (p < 0.5), respectively. Although the carious lesions could still be observed in FC images from teeth with opaque sealants there was a significant loss of sensitivity in detecting dentinal caries. Clear sealant application caused an insignificant loss of detection sensitivity. Following application of clear sealants to children's molars there was a small (4.01%) but significant (p < 0.01) reduction in FC readings recorded from these teeth.

Conclusions

The FC can detect caries under clear sealants with little loss of sensitivity. Although lesions can be seen through opaque sealants, loss of sensitivity precludes accurate lesion assessment.     

CHANGES IN PARENTAL SATISFACTION AND ORAL HEALTH-RELATED QUALITY OF LIFE OF PRESCHOOL CHILDREN AFTER RECEIVING ATRAUMATIC RESTORATIVE TREATMENT WITH OR WITHOUT PRIOR SILVER DIAMINE FLUORIDE APPLICATION

ObjectiveTo investigate the short-term and long-term changes in parental satisfaction and oral health-related quality of life (OHRQoL) of preschool children after receiving atraumatic restorative treatment (ART) with or without prior silver diamine fluoride (SDF) application.MethodsIn a randomized controlled trial, preschool children with cavitated dentine caries lesions in their primary teeth were randomly assigned into two groups to receive either application of SDF solution or placebo (tonic water) on the caries lesions 10 weeks before receiving ART restorations. The information on parental satisfaction and OHRQoL of the children were collected through self-completed questionnaires at baseline, the 6-month and the 24-month follow-up. A five-point scale, from 1 (very dissatisfied) to 5 (very satisfied), was used by parents to indicate their satisfaction with their child's dental conditions. A higher parental satisfaction score indicates that parents were more satisfied with their child's dental condition. In addition, the Chinese version of Early Childhood Oral Health Impact Scale (ECOHIS) was adopted to assess the children's OHRQoL, and a higher ECOHIS score indicates greater negative impacts of oral health on the child's OHRQoL.ResultsA total of 194 children participated in this study, with 101 and 93 children receiving SDF and placebo application before ART restorations, respectively. After placement of ART restorations, at 6-month and 24-month follow-up, parental satisfaction scores with their child's dental health status were significantly higher compared with those at baseline (P <.001) indicating the parents were more satisfied at follow-ups. Regarding OHRQoL, no statistically significant changes were found in the child impact section (CIS), family impact section (FIS) and total ECOHIS scores in both study groups at the 6-month follow-up. In contrast, at the 24-month follow-up, the CIS (P = .025) and total ECOHIS scores (P = .015) of the children in the control group were significantly higher than those at baseline (greater negative impacts), but not the FIS score.ConclusionIn this study, after one-off placement of ART restorations irrespective of prior SDF application, short-term and long-term parental satisfaction with their child's dental health status was improved, but not the children's OHRQoL.     

Silver Diamine Fluoride Protocol for Reducing Preventable Dental Hospitalisations in Victorian Children

IntroductionThis study was designed to assess whether a dental caries management protocol combining a single application of 38% silver diamine fluoride (SDF) with comprehensive oral health education will successfully divert high-risk children from dental treatment under dental general anaesthesia (DGA), arrest active caries in primary teeth, and improve parent-reported child oral health–related quality of life (OHRQoL).MethodsChildren aged 2 to 10 years, who attended two public dental agencies in Victoria, Australia, and were unable to tolerate restorative treatments in the clinic setting, elected to participate in either a 38% SDF intervention protocol or, alternatively, referral for DGA. Follow-up examinations were completed at 6 months to assess caries progression, decayed missing filled tooth index, PUFA index (pulpal involvement, ulceration, fistula, abscess), DGA referral rates, and OHRQoL (Early Childhood Oral Health Impact Scale [ECOHIS]).ResultsOf the total sample, 89.5% of children (n = 102) [mean (SD) age, 4.1 (1.0) years] with 401 active carious lesions elected to participate in the 38% SDF protocol; 10.5% (n = 12) of parents opted for referral for treatment under DGA. The proportion of active caries subsequently arrested at follow-up (number of arrested lesions/number of lesions treated) was 0.78 (95% CI, 0.69 to 0.87). There was an 88% reduction in referrals for DGA in eligible children over the 6-month period. The 38% SDF intervention group showed a significant improvement in ECOHIS scores at follow-up (P < .001).DiscussionAdoption of the 38% SDF intervention protocol resulted in a significant reduction in the rate of preventable dental hospitalisations. Most parents opted against referral for DGA. Parent-reported OHRQoL for children improved significantly.     

Effects of silver diamine fluoride on dentine carious lesions induced by Streptococcus mutans and Actinomyces naeslundii biofilms

BACKGROUND. Silver diamine fluoride (SDF) has been shown to be a successful treatment for arresting caries. However, the mechanism of SDF is to be elucidated. AIM. To characterize the effects of SDF on dentine carious induced by Streptococcus mutans and Actinomyces naeslundii. DESIGN. Thirty-two artificially demineralized human dentine blocks were inoculated: 16 with S. mutans and 16 with A. naeslundii. Either SDF or water was applied to eight blocks in each group. Biofilm morphology, microbial kinetics and viability were evaluated by scanning electron microscopy, colony forming units, and confocal microscopy. The crosssection of the dentine carious lesions were assessed by microhardness testing, scanning electron microscopy with energy-dispersive x-ray spectroscopy and Fourier transform infrared spectroscopy. RESULTS. Biofilm counts were reduced in SDF group than control (P < 0.01). Surfaces of carious lesions were harder after SDF application than after water application (P < 0.05), in S. mutans group, Ca and P weight percentage after SDF application than after water application (P < 0.05). Lesions showed a significantly reduced level of matrix to phosphate after SDF treatment (P < 0.05). CONCLUSION. Present study showed that SDF posses an anti-microbial activity against cariogenic biofilm of S. mutans or A. naeslundii formed on dentine surfaces. SDF slowed down demineralization of dentine. This dual activity could be the reason behind clinical success of SDF.