Silver Solution: School-Based Fluoride Treatment Matches Dental Sealants in Preventing Cavities
A Simpler, Cost-Effective Way to Fight Childhood Tooth Decay
Tooth decay remains the world’s most common chronic childhood disease, often striking hardest in low-income communities where access to dental care is limited. In the U.S. alone, millions of schoolchildren experience untreated cavities, leading to pain, infections, and even missed school days.
To tackle this, public health programs have long relied on dental sealants—thin protective coatings applied to the teeth—to prevent cavities. But what if there were a simpler, faster, and cheaper alternative that worked just as well?
A new clinical trial suggests that silver diamine fluoride (SDF), a liquid treatment painted onto teeth, could be that solution.
The “CariedAway” Study: Taking Cavity Prevention to Schools
Researchers from New York University College of Dentistry led the CariedAway trial—a large, school-based study conducted between 2019 and 2023 across 47 public schools in New York City.
Nearly 3,000 children aged 5 to 13 participated, most from Hispanic or Black communities and low-income families—groups disproportionately affected by dental disease.
The children were randomly assigned to receive one of two treatments:
SDF with fluoride varnish, or
Traditional glass ionomer sealants with fluoride varnish (the current standard of care).
The study aimed to find out whether SDF was noninferior—that is, at least as effective—as sealants in preventing and halting cavities over two years.
The Results: Silver Holds Its Own
After two years, the findings were striking:
Cavity arrest (stopping existing decay) occurred in 56% of children treated with SDF versus 46% in the sealant group.
Cavity prevention (no new decay) was almost identical between groups—81% for SDF and 82% for sealants.
Importantly, no adverse effects were reported.
This means that SDF—applied quickly and easily with a brush—was just as effective as traditional sealants that require more time, equipment, and trained dental professionals.
Why It Matters: Expanding Access to Oral Health Care
The implications for public health are significant. Because SDF can be applied by nurses, not just dentists, it offers a scalable and affordable way to bring preventive care directly into schools—especially in underserved areas.
The treatment is also fast and inexpensive, removing major barriers that have limited the reach of school sealant programs. In resource-limited settings or countries with shortages of dental professionals, SDF could play a vital role in improving children’s oral health outcomes.
Lead author Dr. Ryan Richard Ruff notes that these findings “support the use of silver diamine fluoride as an arresting and preventive agent in school-based oral health programs.”
Cautions and Future Directions
The researchers acknowledge some limitations—mainly that the COVID-19 pandemic interrupted school access and follow-ups, reducing the number of children re-examined. Still, even with those challenges, the data remained consistent and robust.
Future phases of the CariedAway study will explore long-term effects of SDF, including impacts on children’s quality of life, academic performance, and school attendance.
A Bright Future for a Silver Solution
With dental caries continuing to burden children worldwide, especially those from low-income families, the evidence from this large-scale trial offers hope.
A simple, paint-on “silver” treatment could help transform preventive dentistry—bringing healthier smiles to millions of children, right where they learn.
Original Study:
Ruff RR, Barry-Godín T, Niederman R. Effect of Silver Diamine Fluoride on Caries Arrest and Prevention: The CariedAway School-Based Randomized Clinical Trial.
JAMA Network Open. 2023;6(2):e2255458.
DOI: 10.1001/jamanetworkopen.2022.55458