Faculty of Odontology, Malmö University, Malmo, Sweden.
Institute of Odontology, The Sahlgrenska Academy of Gothenburg, Gothenburg, Sweden.
Gerodontology. 2023 Sep;40(3):390-397. doi: 10.1111/ger.12668. Epub 2022 Nov 20.
Silver diamine fluoride (SDF) has been shown to be highly effective against caries, in particular for arresting root surface caries and for dentine caries in primary teeth. SDF may complement fluoride varnish routines for treatment of root caries in nursing home residents. The aim of this randomised, single-blinded, placebo-controlled trial was to evaluate the additive effect of a single annual application of SDF for prevention and treatment of incipient root caries in older adult nursing home residents.
Four hundred older adult nursing home residents (≥70 years old) with at least one exposed root surface (on teeth 15, 14, 13, 23, 24, or 25) were identified during routine dental examination visits in the domiciliary dental care setting. Eligible patients, who were able to understand the implication of consenting to the study, were invited to participate. Their cleaned root surfaces were randomly allocated to treatment with SDF (Advantage Arrest Silver Diamine Fluoride 38%, Advantage Arrest, LLC, Redmond, OR 97756, USA, Lot 16 152) or with placebo (tap water), each for 1 minute.
Of the 400 eligible individuals, 42 declined to participate and two forms were destroyed. The remaining 356 participants (89.0%; mean age 87.7 years) were randomly allocated, with 174 going to the SDF group and 182 to the placebo group. At 1 year, 273 participants (76.7%) were available for assessment: 135 in the SDF group and 138 in the placebo group. By that time, 109 individuals (39.9%) demonstrated root caries progression or regression. Among those 118 (16.7%) of the 708 included root surfaces had developed caries There were no statistically significant differences in the primary outcome related to treatment with SDF or placebo, at either patient or root surface level.
Based on the finding of this clinical trial, it is concluded that a single SDF application to complement a risk-based preventive programme including fluoride varnish applications did not have a statistically significant additional preventive effect on root caries development in a group of older adult nursing home residents with limited caries activity and cognitive capacity to cooperate in oral care activities.
银胺氟化物（SDF）已被证明对龋齿非常有效，特别是对阻止根面龋齿和乳牙牙本质龋齿。SDF 可能会补充氟化物漆常规治疗养老院居民的根龋。本随机、单盲、安慰剂对照试验的目的是评估 SDF 每年一次的应用对预防和治疗老年养老院居民早期根龋的附加效果。
在家庭牙科护理环境中进行常规牙科检查时，共确定了 400 名年龄在 70 岁以上的老年养老院居民（至少有一个暴露的牙根表面[在牙齿 15、14、13、23、24 或 25 上]）。邀请符合条件的患者（能够理解同意参加研究的含义）参加。对他们清洁后的牙根表面进行随机分配，用 SDF（Advantage Arrest Silver Diamine Fluoride 38%，Advantage Arrest，LLC，Redmond，OR 97756，USA，Lot 16152）或安慰剂（自来水）处理，各处理 1 分钟。
在 400 名符合条件的个体中，42 人拒绝参加，2 份表格被销毁。其余 356 名参与者（89.0%；平均年龄 87.7 岁）被随机分配，174 人进入 SDF 组，182 人进入安慰剂组。在 1 年内，有 273 名参与者（76.7%）可进行评估：SDF 组 135 名，安慰剂组 138 名。到那时，109 人（39.9%）出现根龋进展或消退。在纳入的 708 个牙根表面中，有 118 个（16.7%）出现了龋齿。在患者或牙根表面水平，用 SDF 或安慰剂治疗与主要结局之间没有统计学上的显著差异。
根据这项临床试验的结果，结论是，在一组龋齿活动有限且认知能力有限的老年养老院居民中，用 SDF 进行单次应用，以补充包括氟化物漆应用在内的基于风险的预防方案，对根龋的发展没有统计学上的显著额外预防作用。
