Atraumatic restorative treatment (ART) has become known as an inexpensive way to treat early childhood caries in public health settings, but silver diamine fluoride (SDF) also has been investigated as a low-cost method. Researchers conducted a randomized controlled trial to determine which method may be better to use when treatment access is limited.
They randomly assigned 68 children with 118 active dentine caries lesions on the occlusal surface of primary molars to treatment with SDF or ART and followed them for 12 months. They found that SDF was the preferred option, according to the results published in the Journal of Dentistry (July 4, 2019).
While ART is useful in treating early childhood caries in geographic locations without electricity or running water, SDF shows potential in pediatric and community dentistry settings for inexpensively arresting dentine caries, despite its side effect of staining teeth black, the researchers noted.
In the current study, they recruited healthy children from 2 years to 5 years old who sought care at a university pediatric dental clinic in Rio de Janeiro with at least one untreated cavitated active caries lesion involving only the occlusal surface of a primary molar.
The investigators compared the effectiveness of the treatments by quantifying the time required for treatment, arrested lesions, and other factors. Treatment also included oral hygiene and diet recommendations given to caregivers and children.
The mean treatment time per tooth with SDF was 6.97 minutes compared with 13.88 minutes for ART, as performed by a pediatric dental specialist. However, the authors noted that SDF is easier to apply than ART and could be performed by a general dentist.
The proportion of teeth with arrested lesions at 12 months was 0.89 (55 of 62) in the SDF group and 0.96 (43 of 45) in the ART group.
The authors concluded that SDF is a better treatment option compared with ART, especially when treatment access is difficult, since it is less dependent on specific dental equipment and operator skill and training, and it takes almost half the time to complete.
"SDF requires much less chair time and [has] similar results as ART in arresting caries lesion, anxiety, adverse effects, aesthetic perception, and quality of life," wrote the authors, led by Ana LĂşcia VollĂş of the department of pediatric dentistry and orthodontics at the Federal Unversity of Rio de Janeiro School of Dentistry in Brazil.
