Topical silver diamine fluoride for dental caries arrest in preschool children: A randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression.

Abstract

OBJECTIVES:

The Stopping Cavities Trial investigated effectiveness and safety of 38% silver diamine fluoride in arresting caries lesions.

MATERIALS AND METHODS:

The study was a double-blind randomized placebo-controlled superiority trial with 2 parallel groups. The sites were Oregon preschools. Sixty-six preschool children with ≥1 lesion were enrolled. Silver diamine fluoride (38%) or placebo (blue-tinted water), applied topically to the lesion. The primary endpoint was caries arrest (lesion inactivity, Nyvad criteria) 14-21days post intervention. Dental plaque was collected from all children, and microbial composition was assessed by RNA sequencing from 2 lesions and 1 unaffected surface before treatment and at follow-up for 3 children from each group.

RESULTS AND CONCLUSION:

Average proportion of arrested caries lesions in the silver diamine fluoride group was higher (0.72; 95% CI; 0.55, 0.84) than in the placebo group (0.05; 95% CI; 0.00, 0.16). Confirmatory analysis using generalized estimating equation log-linear regression, based on the number of arrested lesions and accounting for the number of treated surfaces and length of follow-up, indicates the risk of arrested caries was significantly higher in the treatment group (relative risk, 17.3; 95% CI: 4.3 to 69.4). No harms were observed. RNA sequencing analysis identified no consistent changes in relative abundance of caries-associated microbes, nor emergence of antibiotic or metal resistance gene expression. Topical 38% silver diamine fluoride is effective and safe in arresting cavities in preschool children.

CLINICAL SIGNIFICANCE:

The treatment is applicable to primary care practice and may reduce the burden of untreated tooth decay in the population.

• Authors: Peter Milgrom, Jeremy A Horst, Sharity Ludwig, Marilynn Rothen, Benjamin W Chaffee, Svetlana Lyalina, Katherine S Pollard, Joseph L DeRisi, Lloyd Mancl
• Journal: Journal of dentistry (J Dent) Vol. 68 Pg. 72-78 (01 2018) ISSN: 1879-176X [Electronic] England
• PMID: 28866468 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Fluorides, Topical
• Quaternary Ammonium Compounds
• Silver Compounds
• silver diamine fluoride

Topics

• Bacteria (drug effects, genetics, isolation & purification)
• Child, Preschool
• Dental Caries (microbiology, prevention & control)
• Dental Plaque (microbiology)
• Double-Blind Method
• Drug Resistance (genetics)
• Female
• Fluorides, Topical (administration & dosage, pharmacology)
• Follow-Up Studies
• Gene Expression Regulation, Bacterial
• Humans
• Male
• Oregon
• Patient Harm
• Quaternary Ammonium Compounds (administration & dosage, pharmacology)
• Sequence Analysis, RNA
• Silver Compounds (administration & dosage, pharmacology)
• Transcriptome
• Treatment Outcome