Silver diamine fluoride (SDF) may be more effective than fluoride varnish (FV) at combating caries in first permanent molars and partially erupted teeth. The study was recently published in the Journal of Dentistry.
Compared to FV, SDF may serve as a more practical, cost-efficient option for managing caries, especially in pediatric and public health settings, the authors wrote.
“38% SDF is more effective than 5% fluoride varnish in arresting early-stage occlusal caries lesions in first permanent molars, regardless of the eruption stage,” wrote the authors, led by Rafaela Sabino e Andrade, PhD, of the University of Brasilia in Brazil (J Dent, March 21, 2026, 106647).
This study compared the effectiveness of 38% SDF and 5% FV in treating early caries on the chewing surfaces of first permanent molars in 165 children ages 6 to 12 enrolled in two primary schools in Brazil. It was conducted as a single-blind randomized controlled trial with a six-month follow-up period completed in February 2020, they wrote.
Children with at least one active early carious lesion with International Caries Detection and Assessment System (ICDAS) scores of 1 or 2 on first permanent molars at various eruption stages were included and assigned to either the SDF or FV treatment group. The main outcome measured was the proportion of teeth that achieved caries arrest at six months, defined as lesions progressing from ICDAS scores of 1 or 2 to 0.
After six months, 38% SDF achieved a significantly higher caries arrest rate than 5% FV, with 88.1% of teeth reaching an ICDAS score of 0 compared to 65.6% (p < 0.001). Both groups showed significant reductions in ICDAS scores from baseline (p < 0.001), but SDF demonstrated superior effectiveness. Furthermore, the eruption stage did not significantly affect outcomes (p = 0.99), they wrote.
The study had limitations. Though they are known to influence caries development, factors such as plaque buildup, sugar consumption, and oral hygiene habits were not controlled, the authors added.
“Considering its non-invasive approach, simplicity of application, and high clinical effectiveness achieved with a single session, SDF represents a practical and cost-effective option for caries management,” they concluded.
More on silver diamine fluoride from DrBicuspid.com
Research into SDF continues to evolve. Researchers are developing a new zinc-based cavity-fighter that ditches silver to address SDF's staining drawback. Other recent findings show SDF may help prevent dental erosion in permanent teeth and that SDF outperforms other topical antimicrobials for caries prevention.
