Fung M H T, Duangthip D, Wong M C M, Lo E C M, Chu C H
Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong.
JDR Clin Trans Res. 2016 Jul;1(2):143-152. doi: 10.1177/2380084416649150. Epub 2016 May 10.
Different regimens of silver diamine fluoride (SDF) have been used to manage early childhood caries. So far, there is limited information regarding the concentrations and frequency of applications for effective caries control in primary teeth. This study aimed to compare the efficacy of 2 commercially available SDF solutions at preprepared concentrations of 38% and 12% when applied annually or biannually over 18 mo in arresting dentine caries in primary teeth. This randomized double-blinded clinical trial recruited kindergarten children aged 3 to 4 y who had at least 1 tooth with dentine caries. The children were randomly allocated to receive 4 treatment protocols: group 1, annual application of 12% SDF; group 2, biannual application of 12% SDF; group 3, annual application of 38% SDF; and group 4, biannual application of 38% SDF. Clinical examinations at 6-mo intervals were conducted to assess whether active carious lesions became arrested. Information on the children's background and oral hygiene habits was collected through a parental questionnaire at baseline and follow-up examinations. A total of 888 children with 4,220 dentine carious tooth surfaces received treatment at baseline. After 18 mo, 831 children (94%) were examined. The caries arrest rates were 50%, 55%, 64%, and 74% for groups 1, 2, 3, and 4, respectively ( < 0.001). Lesions treated with SDF biannual application had a higher chance of becoming arrested compared with those receiving SDF annual application (odds ratio, 1.33; 95% confidence interval, 1.04-1.71; = 0.025). The interaction between concentration and lesion site was statistically significant ( < 0.001). Compared with 12% SDF, the use of 38% SDF increased a chance of becoming arrested ( < 0.05), except lesions on occlusal surfaces. Based on the 18-mo results, SDF is more effective in arresting dentin caries in the primary teeth of preschool children at 38% concentration than 12% concentration and when applied biannually rather than annually. The results of this study can be used by clinicians and dental public health professionals when deciding which concentrations and frequency of application of silver diamine fluoride solution should be adopted for arresting dentine caries. With consideration of caries arrest treatment with silver diamine fluoride, which is painless, simple, and low cost, this information could lead to more appropriate therapeutic decisions for caries control in young children or those who lack access to affordable conventional dental care.
不同的氟化亚锡（SDF）治疗方案已被用于管理幼儿龋齿。到目前为止，关于有效控制乳牙龋齿的应用浓度和频率的信息有限。本研究旨在比较两种市售SDF溶液在预先配制的38%和12%浓度下，每年或每半年应用18个月时，对乳牙牙本质龋的抑制效果。这项随机双盲临床试验招募了3至4岁至少有一颗牙患有牙本质龋的幼儿园儿童。这些儿童被随机分配接受4种治疗方案：第1组，每年应用12% SDF；第2组，每半年应用12% SDF；第3组，每年应用38% SDF；第4组，每半年应用38% SDF。每隔6个月进行临床检查，以评估活动性龋损是否得到抑制。通过在基线和随访检查时向家长发放问卷，收集有关儿童背景和口腔卫生习惯的信息。共有888名患有4220个牙本质龋牙面的儿童在基线时接受了治疗。18个月后，对831名儿童（94%）进行了检查。第1、2、3和4组的龋病抑制率分别为50%、55%、64%和74%（<0.001）。与每年应用SDF的情况相比，每半年应用SDF治疗的龋损更有可能得到抑制（优势比，1.33；95%置信区间，1.04 - 1.71；P = 0.025）。浓度与龋损部位之间的相互作用具有统计学意义（<0.001）。与12% SDF相比，使用38% SDF增加了龋损得到抑制的可能性（<0.05），磨牙面龋损除外。基于18个月的结果，SDF在抑制学龄前儿童乳牙牙本质龋方面，38%浓度比12%浓度更有效，每半年应用比每年应用更有效。临床医生和牙科公共卫生专业人员在决定采用何种浓度和频率的氟化亚锡溶液来抑制牙本质龋时，可以参考本研究结果。考虑到氟化亚锡龋病抑制治疗无痛、操作简单且成本低，这些信息可为幼儿或无法获得负担得起的传统牙科护理的人群的龋病控制带来更合适的治疗决策。
