Silver nitrate with sodium fluoride for caries arrest: 18-month results

Abstract

Objectives: This randomized clinical trial aimed to compare 25% silver nitrate (AgNO3) solution followed by 5% sodium fluoride (NaF) varnish with that of 38% silver diamine fluoride (SDF) solution in arresting cavitated dental caries among preschool children. Methods: Healthy 3-year-old children with active dentine caries were randomly allocated into 2 groups. Group A received semi-annual application of 25% AgNO3 solution followed by 5% NaF varnish. Group B received semi-annual application of 38% SDF solution followed by placebo varnish. Caries experience (in dmfs) and visual plaque index (VPI) were recorded at baseline and follow-up examinations. The examiner, children and their caretakers were blinded to the intervention allocation. Questionnaire was used to obtain information on the child’s oral-health-related habits and socio-economic background. Intention-to-treat analysis was adopted in this study. Non-inferiority test and logistic regression analysis were conducted. Non-inferiority of Group A was accepted if the lower limit of 95% confidence interval (CI) for difference of mean number of arrested caries tooth surfaces was greater than -0.5. Results: A total of 1,070 children were recruited at baseline. After 18 months, 484 and 476 children remained in Group A and B. The mean number of arrested caries tooth surfaces in Groups A and B were 3.3±3.4 and 3.2±3.5, respectively (p=0.690). The 95% CI of the estimated difference between the two groups was -0.329 to 0.498. In the logistic regression model, newly developed dmfs, VPI, tooth and surface location of the carious lesions were significantly associated with caries status, i.e. active or arrest. The arrested caries lesions were mostly stained black. No other significant side effect was observed. Conclusions: Semi-annual application of 25% AgNO3 followed by 5% NaF is at least not appreciably less effective than 38% SDF in arresting dentine caries among preschool children over an 18-month period.