Crystal Yasmi O, Marghalani Abdullah A, Ureles Steven D, Wright John Timothy, Sulyanto Rosalyn, Divaris Kimon, Fontana Margherita, Graham Laurel
SDF workgroup chair, is a clinical associate professor of pediatric dentistry, at NYU College of Dentistry, New York, N.Y., USA; and a pediatric dentist in private practice, in New Yersey, N.J. and New York City, N.Y., USA.
Pediatric dental fellow, Division of Pediatric Dentistry, at the University of Maryland Dental School, Baltimore, Md., USA.
Pediatr Dent. 2017 Sep 15;39(5):135-145.
This manuscript presents evidence-based guidance on the use of 38 percent silver diamine fluoride (SDF) for dental caries management in children and adolescents, including those with special health care needs. A guideline workgroup formed by the American Academy of Pediatric Dentistry developed guidance and an evidence-based recommendation regarding the application of 38 percent SDF to arrest cavitated caries lesions in primary teeth.
The basis of the guideline's recommendation is evidence from an existing systematic review "Clinical trials of silver diamine fluoride in arresting caries among children: A systematic review." (JDR Clin Transl Res 2016;1[3]:201-10). A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and gray literature databases to identify randomized controlled trials and systematic reviews reporting on the effect of silver diamine fluoride and address peripheral issues such as adverse effects and cost. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of the evidence and the evidence-to-decision framework was employed to formulate a recommendation.
The panel made a conditional recommendation regarding the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program. After taking into consideration the low cost of the treatment and the disease burden of caries, panel members were confident that the benefits of SDF application in the target populations outweigh its possible undesirable effects. Per GRADE, this is a conditional recommendation based on low-quality evidence. Conclusions and practical implications: The guideline intends to inform the clinical practices involving the application of 38 percent SDF to enhance dental caries management outcomes in children and adolescents, including those with special health care needs. These recommended practices are based upon the best available evidence to-date. A 38 percent SDF protocol is included in Appendix II.
本手稿提供了关于使用38%氟化亚锡（SDF）对儿童和青少年（包括有特殊医疗需求的儿童和青少年）进行龋齿管理的循证指南。由美国儿科学会组建的一个指南工作组就应用38% SDF来阻止乳牙龋洞病变制定了指南及循证建议。
该指南建议的依据是来自一项现有系统评价“氟化亚锡在儿童龋齿防治中的临床试验：一项系统评价”（《牙科研究杂志：临床与转化研究》2016年；1[3]：201 - 210）的证据。在PubMed®/MEDLINE、Embase®、Cochrane对照试验中心注册库及灰色文献数据库中进行了系统检索，以识别报告氟化亚锡效果并涉及不良反应和成本等周边问题的随机对照试验及系统评价。采用推荐分级的评估、制定与评价（GRADE）方法来评估证据质量，并运用证据 - 决策框架来制定建议。
专家组做出了一项有条件的建议，即在全面龋齿管理计划中，使用38% SDF来阻止乳牙龋洞病变。在考虑到治疗成本低及龋齿的疾病负担后，专家组成员确信在目标人群中应用SDF的益处大于其可能产生的不良影响。根据GRADE标准，这是一项基于低质量证据的有条件建议。结论及实际意义：该指南旨在为涉及应用38% SDF的临床实践提供信息，以改善儿童和青少年（包括有特殊医疗需求的儿童和青少年）的龋齿管理效果。这些推荐做法基于目前可得的最佳证据。附录II中包含了38% SDF的方案。
