Application of silver diamine fluoride (SDF) solution versus atraumatic restorative treatment (ART) restoration in treating dentine caries lesions in primary teeth

Abstract

OBJECTIVE: The objective of the randomized clinical trial of the PhD research was to compare the effectiveness and cost of using a non-restorative approach by application of silver diamine fluoride (SDF) solution and a minimally invasive restorative approach by placement of fillings using atraumatic restorative treatment (ART) in treating cavitated caries lesions in the primary teeth of preschool children in Hong Kong. MATERIAL AND METHODS: Preschool children with cavitated dentine caries were recruited in kindergartens in Hong Kong and were randomized for treatments for the caries lesion using either biannual application of SDF solution or placement of ART restoration. Questionnaires were completed by parents to assess the oral health related quality of life (OHRQoL) of the children, as well as the parents’ acceptance of the study treatments for their child’s decayed teeth. Biannual follow-ups were carried out to evaluate the success of treatments in both study groups. The short-term and long-term rates of success of the treatment of carious lesions in the primary teeth, defined as no symptoms from the treated tooth, no active caries and no need for further treatment, in the two groups were compared. The OHRQoL of children treated by ART and SDF treatments, and parental acceptance of the two treatments were also compared.

RESULTS: A total of 426 preschool children, aged 3 to 4 years, were recruited and treated at baseline. There were no significant differences in the socio-demographic background and baseline status, as well as caries experience, OHRQoL, oral hygiene and snacking habits between the two groups at baseline. At the 6-month follow-up, the overall success rate of treatment in the SDF and ART groups were 83.9% and 60.7%, respectively (p<0.001). At the 24-month follow-up, the overall success rate of treatment in the SDF and ART groups were 71.1% and 28.5%, respectively (p<0.001). Moreover, there were no significant differences in the child’s OHRQoL as well as parental acceptance of treatment, between the two study groups at the 24-month follow-up. The cost of providing biannual application of SDF was lower than the placement of ART fillings.

CONCLUSIONS: It can be concluded that SDF treatment has superior clinical outcomes compared to ART restorations, both in short term and long term, and can be used to effectively manage cavitated dentine caries lesions in the primary teeth of preschool children. Parental acceptance of the two treatments, as well as the OHRQoL of children treated by either of the treatments, do not differ significantly. The cost of treatment is lower for the provision of biannual SDF solution application.