Dissertation
Effectiveness of silver diammine fluoride in arresting initial approximal caries lesions in adults: a triple blinded, randomized, controlled, clinical trial
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2021
DOI: 10.17077/etd.006107
Abstract
Objectives: The aim of this study was to evaluate the effectiveness of Silver Diammine Fluoride (SDF) in arresting initial non-cavitated approximal carious lesion in adults aged 21-64 years utilizing three methods: pairwise comparison of individual radiographs, visual assessment of subtraction radiographs and histogram analysis of subtraction radiographs. Methods: This study was a randomized, triple blinded, and placebo-controlled clinical trial (ClinicalTrials.gov identifier-NCT02591147). The study population consisted of adults aged 21-64 years old seeking care at the University of Iowa, College of Dentistry and Dental Clinics. Eligibility for the study included having at least one initial non-cavitated approximal posterior carious lesion (Radiologic scores RA1, RA2, or RA3 using the International Caries Classification and Management System (ICCMS) scoring system) that was in contact with adjacent non-restored tooth surface.
Participants were randomly assigned to one of the two study arms. One randomly selected lesion received either treatment (SDF solution) or control (water) designated as solutions “A” and “B”. Participants completed beverage intake and caries risk questionnaires at baseline and 12 months. The selected lesion was followed at 6 and 12 months. A bitewing radiograph was made at baseline utilizing a bite registration holder to ensure close geometrical alignment of subsequent follow up radiographs. Lesion progression was monitored radiographically through three methods: pairwise comparison of individual bitewing radiographs (VA), visual assessment of subtraction radiographs (DSR) and histogram analysis of subtraction radiographs (HA).
Results: 54 participants were initially enrolled in the study. Forty-one participants completed the study. twenty (48.8%) were assigned to the SDF group , while 21 (51.2%) were assigned to the control group . The mean age was 32 years, ranging from 20 to 61 years. Most participants were female (65% of SDF group and 61% of control group ), white ((84.2% of SDF group and 100% of control group ), with a high caries risk (65% of SDF group and 71% of control group).
The SDF group had an overall 93% and 56% arrested lesions compared to 92% and 44% in the placebo group assessed by VA and DSR. There were no significant differences between the two groups for any of the visual assessment data or digital subtraction data except for the subtraction between baseline and 6 months, where the difference almost reached statistical significance (p=0.053). for histogram analysis, there were no significant differences between the two groups (p>0.4).
Conclusions: Within the limitations of this research study, we concluded that SDF treatment was effective to arrest non-cavitated initial approximal caries lesions at 6 months. We also concluded that SDF treatment for non-cavitated initial approximal caries lesions did not add a clinical benefit compared to fluoride varnish in arresting initial approximal caries lesions in adults at 12 months. DSR was more effective and reproducible than VA for detection of radiographic change of initial approximal caries lesions.
Details
- Title: Subtitle
- Effectiveness of silver diammine fluoride in arresting initial approximal caries lesions in adults: a triple blinded, randomized, controlled, clinical trial
- Creators
- Maram Emad Jaradat
- Contributors
- Justine Kolker (Advisor)Arwa Owais (Committee Member)Sandra Guzman-Armstrong (Committee Member)Sindhura Anamali (Committee Member)Erliang Zeng (Committee Member)Amanda Haes (Committee Member)Michael Kanellis (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Operative Dentistry
- Date degree season
- Spring 2021
- DOI
- 10.17077/etd.006107
- Publisher
- University of Iowa
- Number of pages
- xii, 131 pages
- Copyright
- Copyright 2021 Maram Emad Jaradat
- Language
- English
- Description illustrations
- illustrations (some color)
- Description bibliographic
- Includes bibliographical references (pages 123-125).
- Public Abstract (ETD)
This research study was a clinical trial that aimed to evaluate a novel material called silver diammine fluoride (SDF). The SDF was used as a topical antibiotic on very small cavities that did not require a filling at the time of the study. We aimed to evaluate the effect of SDF on these small cavities to see if it helps stop these cavities from getting bigger and eventually needing a filling.
The study consisted of two groups. One group received the SDF in addition to fluoride varnish. The other group received fluoride varnish alone. We tested SDF on adults aged 21-64. We followed the participants for up to 12 months. The cavities were monitored using radiographs. The size of the cavities was evaluated through three methods to assess if they progress, regress, or stay the same.
The results of this study showed that the SDF group performed similar to the fluoride varnish group.
Within the limitations of this study, we concluded that SDF may have an effect initially on the small cavities by preventing them from getting bigger but may not have an added benefit for small cavities on posterior teeth after 12 months.
- Academic Unit
- Operative Dentistry
- Record Identifier
- 9984096977202771
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