A new study led by the University of Michigan and published in JAMA Pediatrics suggests that the simple, inexpensive liquid, silver diamine fluoride (SDF), may be an effective avenue for treating cavities and preventing painful infections or dental surgery. Bringing together researchers from the University of Michigan, New York University, and Indiana University and providing more than $12 million in funding from the National Institutes of Health, this successful trial suggests that the paint-on procedure effectively stops the tooth decay responsible for causing cavities.
Yearly, thousands of U.S. children visit emergency departments as a result of untreated cavities — a particularly pressing problem due to the emergency physicians generally being unable to provide the necessary procedures to address the underlying problem. In fact, among American children, tooth decay is the most common chronic disease, with untreated cavities resulting in toothaches, infections, eating and sleeping issues, missing school, and repeated medical appointments. Additionally, conventional methods of treatment have proven to be challenging, especially among younger children due to struggling to stay still during procedures or experiencing general feelings of fear or anxiety.
While SDF is the focus of the study, it has actually already been successfully used to manage cavities in various countries for decades. As for the U.S., the FDA approved it for treating tooth sensitivity in 2014, though dentists would use it off-label to help treat cavities. This most recent investigation is planned to provide a large-scale clinical trial from U.S. populations to establish the safety and effectiveness of SDF on cavities, and by extension, move it away from off-label use as a more accessible treatment.
Beginning in 2018, the investigation was launched and continued despite initial major disruptions caused by the COVID-19 pandemic. Testing the product Advantage Arrest 38% SDF provided by Elevate Oral Care, the Phase III clinical trial included 830 children younger than six — participants coming from dental clinics, pediatric medical practices, and Head Start and Early Head Start programs in Michigan, New York, and Iowa. Results showed the solution successfully halted tooth decay in more than half of the affected baby teeth when treatment was provided at six-month intervals — working through the combined effects of silver helping to combat bacteria associated with the decay and fluoride helping to strengthen the mineral structure of the teeth to resist additional damage. On top of this success, Margherita Fontana, Professor of Dentistry at the University of Michigan School of Dentistry and the study’s lead investigator, would comment that the benefits may extend well beyond children, such as older adults, people with developmental or physical disabilities, those with severe dental anxiety, and those experiencing difficulty getting conventional dental care. One caveat of the treatment that the researchers noted was that the SDF permanently turned the decayed portion of the treated tooth dark, which was particularly noticeable in front teeth.
If this trial successfully manages to extend access to SDF, it could give children an earlier intervention before initially relatively manageable cavities develop into more serious problems down the line — with an application every few months being enough for some to keep a cavity under control until the affected baby tooth naturally falls out. Yet, even beyond children, the study turns to the potential usefulness among adults through managing decay over longer periods of time or simply serving as a temporary solution before a filling or other restorative procedures become available. While the study noted that the treatment is not suitable for all cavities and that stopping decay does not eliminate the need for future dental work, the findings suggest the new procedure may be a viable alternative to more conventional, complicated treatment.
Reflecting on the study, Fontana said, “For almost anyone, this can arrest the decay and stop the infection and the pain it causes […] This could benefit many people.”
