SILVER DIAMINE FLUORIDE IN CARIES MANAGEMENT: A COMPREHENSIVE SYNTHESIS OF CLINICAL EFFICACY AND MECHANISTIC PATHWAYS

Abstract

This paper synthesizes a comprehensive body of evidence on Silver Diamine Fluoride [SDF] for caries management, addressing a critical global need for non-invasive, cost-effective interventions in pediatric and underserved populations. We systematically integrated quantitative clinical data, biological mechanism studies, economic evaluations, and qualitative stakeholder analyses. Our multi-phase approach extracted variables including study design, patient demographics, SDF concentration and application frequency, arrest rates, cost-effectiveness ratios, and psychosocial responses. The synthesis consistently demonstrates strong clinical efficacy: SDF achieves arrest rates of 47% to 90% in cavitated primary teeth after a single application, with pooled two-year estimates stabilizing near 68%. A large pragmatic trial further showed that a single preventive SDF application was noninferior to sealants and atraumatic restorative treatment. Mechanistic evidence reveals that 38% SDF inhibits matrix metalloproteinases [e.g., 94% inhibition of MMP-8], suppresses cariogenic biofilms, and reinforces mineral content within the outer 50 micrometers of dentin. Economic projections across seven U.S. states found averted restorative visit costs ranging from $100 to $350 per visit, with particularly high savings in nonmetropolitan counties. However, the primary limitation remains psychosocial: black staining of arrested lesions generates significant parental and child concerns, especially for anterior teeth, though acceptance increases when the alternative is invasive care like general anesthesia. This work's primary contribution is the holistic integration of clinical, mechanistic, economic, and perceptual evidence, which positions SDF as a transformative tool in public health dentistry. The findings underscore the need for careful shared decision-making regarding staining, while confirming that SDF's safety, efficacy, and cost-saving profile make it a viable first-line therapy for caries management in primary dentition and community-based settings.