Silver Diamine Fluoride Works as Well as Sealants to Prevent Cavities, Study Finds
A Simple Liquid Matches Traditional Sealants in Protecting Kids’ Teeth
A Persistent Oral Health Inequity
Tooth decay (dental caries) remains the world’s most common noncommunicable disease, disproportionately affecting children from low-income and minority communities. Traditional school sealant programs where protective coatings are applied to children’s teeth are effective but often costly and difficult to sustain in under-resourced areas.
Silver diamine fluoride (SDF), a colorless liquid combining silver’s antibacterial power and fluoride’s tooth-strengthening effects, has emerged as a potential low-cost alternative. Recognized by the World Health Organization as an essential medicine, SDF can be applied quickly and inexpensively, making it an attractive option for public health programs.
The CariedAway Trial: Testing a Simpler Approach
Researchers from New York University conducted a large, real-world clinical trial known as the CariedAway study to determine whether SDF could match (or be “noninferior” to) traditional sealants and atraumatic restorative treatment (ART) in preventing and stopping cavities.
Between 2018 and 2023, the team enrolled more than 7,400 children aged 5 to 13 from 48 New York City schools, most serving low-income Black and Hispanic students. Schools were randomly assigned to receive either:
SDF with fluoride varnish, or
Glass ionomer sealants and ART, also with fluoride varnish.
Over the course of four years, children received treatments and follow-ups to monitor tooth decay.
What the Study Found
The results were striking:
The overall cavity rate declined similarly in both groups.
The incidence of new cavities was nearly identical 10.2 per 1,000 tooth-years for SDF versus 9.8 per 1,000 tooth-years for sealants.
Statistically, SDF was noninferior to traditional sealants in preventing dental decay.
Children treated with SDF by nurses performed just as well as those treated by dental hygienists.
In short, SDF proved to be an equally effective and far simpler method of protecting children’s teeth in school settings.
Why It Matters
The study’s implications are significant for public health and education systems.
SDF applications take only seconds per tooth, require minimal equipment, and cost far less than sealant-based programs. Because registered nurses can apply SDF, schools without on-site dentists can still provide preventive care potentially reaching millions of children who currently lack access to dental treatment.
These findings could help bridge the oral health equity gap in underserved communities and reduce healthcare costs related to untreated cavities.
Addressing Concerns
One common concern about SDF is the black staining it leaves on decayed areas. However, the researchers reported no major adverse effects or complaints during the study. Prior work also shows that parents generally accept the appearance change, especially when SDF is used on back teeth.
A Step Toward Global Oral Health Equity
After decades of relying on sealants, this study supports a paradigm shift: a simple, affordable liquid can achieve the same preventive results as more complex dental procedures.
As lead author Dr. Ryan Ruff concluded, “Silver diamine fluoride offers an effective, school-based strategy to fight tooth decay and promote oral health equity.”
Reference:
Ruff RR, Barry Godín TJ, Niederman R. Noninferiority of Silver Diamine Fluoride vs Sealants for Reducing Dental Caries Prevalence and Incidence: A Randomized Clinical Trial. JAMA Pediatrics. 2024;178(4):354–361. doi:10.1001/jamapediatrics.2023.6770