# Comparative Efficacy of Silver Diamine Fluoride and Sodium Fluoride in Managing Early Childhood Caries: An Updated Systematic Review and Meta‐Analysis

## TL;DR

This study compares silver diamine fluoride and sodium fluoride for treating early childhood tooth decay, finding that silver diamine fluoride is more effective at stopping decay but has similar effects on overall dental surfaces.

## Contribution

The study provides updated evidence showing silver diamine fluoride is more effective than sodium fluoride for arresting early childhood caries.

## Key findings

- Silver diamine fluoride increases the likelihood of arresting ECC lesions by 38% compared to sodium fluoride.
- No significant difference was found between the treatments for decayed, missing, and filled surfaces.
- Moderate certainty evidence supports the effectiveness of silver diamine fluoride for caries arrest.

## Abstract

Early childhood caries (ECC) is a prevalent condition in preschool children that can impair nutrition and development. Comparative evidence on silver diamine fluoride (SDF) versus sodium fluoride (NaF) for arresting ECC remains limited.

To compare the efficacy of topical SDF and NaF in arresting ECC lesions and to evaluate effects on decayed, missing, and filled surfaces (DMFS).

PubMed (Medline), Scopus, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched from January 1990 through April 2024. Reference lists of included studies were hand‐searched.

Randomized controlled trials (RCTs) directly comparing topical SDF and NaF in children aged 0–6 years with ECC and reporting outcomes for lesion arrest or DMFS.

Two reviewers independently screened records, extracted data, and assessed risk of bias using RoB 2. Discrepancies were resolved by a third reviewer.

Nine RCTs met inclusion criteria (total sample size reported in main text).

Random‐effects meta‐analysis (DerSimonian–Laird) was used to pool odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed with I
2 and Cochran’s Q; publication bias was evaluated with Egger’s test. Preplanned subgroup analyses examined follow‐up duration.

Pooled analysis showed higher odds of caries arrest with SDF compared to NaF (OR 1.41; 95% CI 1.03 –1.94), while no statistically significant difference was observed for DMFS (OR 1.07; 95% CI 0.70–1.64). Heterogeneity across analyses was low to moderate, and risk‐of‐bias assessments identified some concerns in several trials. According to the GRADE evaluation, the certainty of evidence was rated moderate for caries arrest (downgraded for inconsistency) and low for DMFS (downgraded for risk of bias and imprecision).

Compared with NaF, 38% SDF increases the likelihood of arresting ECC lesions while producing similar effects on DMFS. Clinical selection should balance lesion depth, aesthetic considerations, and patient‐level factors.