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Silver diamine fluoride shows no statistically significant difference from conventional restorative treatment for caries arrestSilver diamine fluoride shows potential for stopping early childhood cavities

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Key Takeaway
Note that silver diamine fluoride shows no statistically significant difference from conventional treatment for caries arrest.

This meta-analysis evaluated the efficacy of silver diamine fluoride (30% to 38%) compared to conventional restorative treatments, including atraumatic restorative treatment and glass ionomer-based restorations, for caries arrest in children with primary teeth. The analysis included 8 randomized trials involving 8,507 children (12,445 teeth/surfaces).

The primary outcome of caries arrest showed no statistically significant difference between silver diamine fluoride and conventional restorative treatment (risk ratio 1.25; 95% CI 0.88 to 1.78). Regarding secondary outcomes, the results favored silver diamine fluoride for treatment-time, though specific effect sizes were not reported.

The authors noted significant limitations, including considerable between-study heterogeneity (I2 = 96.1%) and wide confidence intervals. These factors result in limited confidence in the pooled estimate and preclude conclusions of equivalence. Clinically, silver diamine fluoride may be a practical option when minimally invasive care is preferred or conventional treatment is difficult to deliver. However, clinical selection must account for aesthetic staining, patient cooperation, and caregiver preferences.

How this fits prior evidence

This meta-analysis addresses a gap in comparing silver diamine fluoride to conventional methods. It complements existing evidence that SMART and ART are viable options for caries control in primary teeth, though those results were also noted to have low certainty. While the current finding shows no significant difference between silver diamine fluoride and conventional treatment, the high heterogeneity (I2 = 96.1%) suggests caution when interpreting the results compared to the established viability of SMART and ART.

When a child has a cavity, parents and doctors often face a tough choice. Should they go with a traditional filling or a faster, less invasive method? This analysis looked at how silver diamine fluoride (SDF) compares to traditional restorative treatments for stopping decay in children's primary teeth.

Researchers looked at over 8,000 children across several trials. They found that while SDF was faster to apply than traditional methods, it did not perform significantly better or worse than traditional fillings at stopping the decay. Because the data was inconsistent across different studies, we cannot say for certain that the two treatments are exactly equal.

Choosing between these options depends on the specific situation. SDF can be a practical choice when a child is hard to keep still or when a traditional filling is difficult to perform. However, parents should consider that SDF can cause staining, and the choice should involve looking at the child's needs and the parents' preferences.

What this means for you:
Silver diamine fluoride is faster to apply than traditional fillings but may cause staining on a child's teeth.

Common questions

Is silver diamine fluoride as effective as traditional fillings?

The study found no significant difference between silver diamine fluoride and conventional restorative treatments when it came to stopping decay. However, because the data was inconsistent across different studies, researchers cannot confirm that the two treatments are exactly equal in effectiveness.

Is silver diamine fluoride faster to use than traditional treatments?

Yes, the results showed that silver diamine fluoride was favored over conventional restorative treatments in terms of treatment time. This can make it a practical option when a child is difficult to keep still or when traditional methods are hard to deliver.

Are there any side effects to using silver diamine fluoride?

While the study did not report specific adverse events, it noted that silver diamine fluoride can cause staining. Parents and doctors should consider this staining, along with the child's cooperation and the need for future retreatment, when choosing a treatment.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
OBJECTIVE: Early childhood caries remains a major public health burden, and silver diamine fluoride (SDF) has emerged as a minimally invasive option for managing cavitated lesions in primary teeth. This meta-analysis compared SDF with conventional restorative treatment for caries control in children. METHOD AND MATERIALS: PubMed, Embase, Web of Science, Cochrane Library, and Scopus were searched from January 2010 to June 2025 for randomized controlled trials comparing SDF (30% to 38%) with conventional restorative approaches, including atraumatic restorative treatment and glass ionomer-based restorations, in children with caries in primary teeth. The primary outcome was caries arrest or lesion inactivity; outcomes based solely on restoration survival were summarized separately. Risk of bias was assessed with the Cochrane Risk of Bias 2 (RoB 2) tool, and pooled estimates were calculated using Hartung-Knapp random-effects models, with prespecified sensitivity analyses for outcome compatibility and clustering. RESULTS: Eight randomized trials involving 12,445 teeth/surfaces from 8,507 children were included. Seven trials involving 12,265 teeth/surfaces from 8,317 children contributed to the primary caries arrest meta-analysis. No statistically significant difference was observed between SDF and conventional restorative treatment (risk ratio [RR] = 1.25, 95% CI 0.88 to 1.78), with considerable between-study heterogeneity (I2 = 96.1%). Exploratory subgroup analyses by unit of analysis, SDF concentration, application frequency, comparator type, setting, and follow-up did not resolve the heterogeneity. The treatment-time analysis included only two studies and favored SDF. CONCLUSIONS: Current randomized evidence does not demonstrate a statistically significant difference in caries arrest between SDF and conventional restorative treatment in primary teeth; however, considerable heterogeneity and wide confidence intervals limit confidence in the pooled estimate and preclude conclusions of equivalence. SDF may be practical when minimally invasive care is preferred or conventional restorative treatment is difficult to deliver, but treatment selection should also consider esthetic staining, child cooperation, caregiver preferences, and retreatment needs.
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