Keywords
Dental caries
preschool children
Silver diamine fluoride
preschool children
Silver diamine fluoride
How to Cite
Alimani - Jakupi, J., Dika-Haxhirexha, F., Emini, L., Cana, A., Jusufi, Z., Kurtishi, L., & Mustafai, S. (2025). Dental Caries in Children and the Role of Silver Diamine Fluoride in Its Prevention. Albanian Journal of Trauma and Emergency Surgery, 9(2), 1797 - 1801. https://doi.org/10.32391/ajtes.v9i2.481
Abstract
Background: Silver diamine fluoride (SDF) represents one of the most effective agents for the non-invasive management of dental caries, particularly in pediatric patients, where conventional treatment approaches often present significant challenges.
The aim is to present our clinical experience in the non-invasive management of dental caries in preschool-aged children through the application of silver diamine fluoride (SDF) solution.
Materials and Methods: This study involved 16 children, aged between 2 and 6 years, who were diagnosed with dental caries. All participants were managed using a non-invasive approach through the topical application of silver diamine fluoride (SDF) solution, aiming to arrest carious lesions and reduce the need for conventional restorative treatment, which can often be challenging in this age group.
Results: All children were treated with a silver diamine fluoride (SDF) solution using a specialized applicator. In ten cases, the outcomes were highly satisfactory following the initial application. In five children, however, a second application was required after three months due to suboptimal results. Among these, only one child demonstrated insufficient improvement, necessitating a third application six months later.
Conclusion: The findings of our study, consistent with those of numerous other investigations, unequivocally demonstrate that silver diamine fluoride (SDF) is a highly effective agent for both treating and preventing dental caries in preschool children. This success should instill confidence in the dental community about the potential of SDF in managing dental caries.
References
1. WHO. Ending Childhood Dental Caries: WHO Implementation Manual. Published 2019. https://apps.who.int/iris/bitst ream/handle/10665/ 33064 3/97892 40000 056- eng.pdf
2. World Health Organization. Oral Health Surveys: Basic Methods. World Health Organization; 2013.
3. Uribe S, Maldupa I, Innes N. The Global Prevalence of Early Childhood Caries: A Systematic Review with Meta-Analysis. Published online January 13, 2020. https://osf.io/k7zun/
4. Clemens J, Gold J, Chaffin J. Effect and acceptance of silver diamine fluoride treatment on dental caries in primary teeth. Journal of Public Health Dentistry. 2017;78(1):63-68. doi:10.1111/jphd.12241
5. Martins-Júnior, P.; Vieira-Andrade, R.; Corrêa-Faria, P.; Oliveira-Ferreira, F.; Marques, L.; Ramos-Jorge, M. Impact of early childhood caries on the oral health-related quality of life of preschool children and their parents. Caries Res. 2013, 47, 211–218.
6. Khan SQ, Alzayer HA, Alameer ST, Khan MA, Khan N, AlQuorain H, et al. SEQUEL: Prevalence of dental caries in Saudi Arabia: A systematic review and meta-analysis. ˜the œSaudi Dent J. (2024) 36:963–9. doi: 10.1016/j.sdentj.2024.04.011
7. Mansoori, S.; Mehta, A.; Ansari, M.I. Factors associated with oral health-related quality of life in children with severe early childhood caries. J. Oral Biol. Craniofacial Res. 2019, 9, 222–225
8. Bekes, K.; Omara, M.; Safar, S.; Stamm, T. The German version of Early Childhood Oral Health Impact Scale (ECOHIS-G): Translation, reliability, and validity. Clin. Oral Investig. 2019, 23, 4449–4454
9. Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011–2012. NCHS data brief, no 191. Hyattsville, Md.: National Center for Health Statistics. 2015. Available at: https://www.cdc.gov/nchs/ products/databriefs/db191.htm
10. JA Jakupi, S Iljovska, S Naskova, M Pavlevska, N Nuhii. Assessing the caries risk factor among children at age prom 4-5 using the cariogram program. Int J Sci Eng Res 6 (11), 554-562
11. J Alimani-Jakupi, M Jankulovska, M Pavlevska, E Georgievska, T Veninov. Dietetic regime and oral health in 12-year-old children from Gostivar: Using the Cariogram to assess different dental caries risk factors. Makedonski Stomatološki Pregled. 2010; 34 (1-2):1-7.
12. Milgrom, P.; Horst, J.A.; Ludwig, S.; Rothen, M.; Chaffee, B.W.; Lyalina, S.; Pollard, K.S.; DeRisi, J.L.; Mancl, L. Topical silver diamine fluoride for dental caries arrest in preschool children: A randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. J. Dent. 2018, 68, 72–78.
13. Abbas M, Mahmood Fahmi M. Topical effect of silver diamine fluoride in arresting dental caries in primary teeth. Indian J Pub Health Res Develop. (2019) 10:1285–7. doi: 10.5958/0976-5506.2019.01173.2
14. Duangthip D, Fung M, Wong M, Chu C, Lo E. Adverse effects of silver diamine fluoride treatment among preschool children. J Dent Res. (2017) 97(4):395–401. doi: 10.1177/0022034517746678
15. American Academy of Pediatric Dentistry. 2008. Definition of early childhood caries (ECC) [accessed 2016 July 6]. http://www.aapd.org/assets/1/7/D_ECC.pdf.
16. World Health Organization: WHO. Oral health. (2023). Available online at: https://www.who.int/news-room/fact-sheets/detail/oral-health
17. World Health Organization. Oral Health Surveys: Basic Methods. World Health Organization; 2013.
18. WHO. Ending Childhood Dental Caries: WHO Implementation Manual. Published 2019. https://apps.who.int/iris/bitst ream/handl e/10665/ 33064 3/97892 40000 056- eng.pdf.
19. Baier, K.; Milgrom, P.; Russell, S.; Mancl, L.; Yoshida, T. Children’s fear and behavior in private pediatric dentistry practices. Pediatr. Dent. 2004, 26, 316–321
20. Renugalakshmi, A.; Vinothkumar, T.S.; Hakami, F.B.; Salem, R.M.; Qadri, A.A.; Harbosh, Z.M.; Hakami, Z. Impact of silver diamine fluoride therapy on oral health-related quality of life of uncooperative preschool children: A prospective study. Oral Health Prev. Dent. 2021, 19, 93–99
21. Llodra JC, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res 2005;84(8):721-4
22. Korwar A, Sharma S, Logani A, Shah N. Pulp response to high fluoride-releasing glass ionomer, silver diamine fluoride, and calcium hydroxide used for indirect pulp treatment: An in vivo comparative study. 2015, July 31;6(3):288-292. Retrieved September 15, 2016
23. Nelson T, DDS MSD MPH, Scott JM, PhD, Crystal YO, DMD Berg JH, DDS MS, Milgrom P, DDS. Silver Diamine Fluoride in Pediatric Dentistry Training Programs: Survey of Graduate Program Directors. American Academy of Pediatric Dentistry. 2016, May/June;38(3):212-217. Retrieved September 14, 2016
24. Antibacterial activity of silver-killed bacteria: the "zombies" effect. Wakshlak RB, Pedahzur R, Avnir D Sci Rep. 2015 April 23;5:9555.
25. Mei ML, Li QL, Chu CH et al. Antibacterial effects of silver diamine fluoride on multi-species cariogenic biofilms associated with caries. Ann Clin Microbiol Antimicrob 2013 12: 4.
26. 26. Chu CH, Mei L, Seneviratne CJ et al. Effects of silver diamine fluoride on dentine carious lesions induced by Streptococcus mutans and Actinomyces naeslundii biofilms. Int J Paediatr Dent. 2012;22:2-10
27. Mei ML, Chu CH, Low KH, et al. Caries arresting effect of silver diamine fluoride on dentine carious lesion with S. mutans and L. acidophilus dual-species cariogenic biofilm. Med Oral Patol Oral Cir Bucal 2013;18:824-831.
28. Lansdown AB. Silver in health care: antimicrobial effects and safety in use. Curr Probl Dermatol. 2006;33:17-34
29. Crystal YO, Niederman R. Silver diamine fluoride treatment considerations in children’s caries management: Brief communication and commentary. Pediatr Dent 2016;38(7):466–71.
30. Gao SS, Zhang S, Mei ML, Lo EC, Chu CH. Caries remineralization and arresting effect in children by professionally applied fluoride treatment – A systematic review. BMC Oral Health 2016;16:12.
31. Milgrom, P.; Horst, J.A.; Ludwig, S.; Rothen, M.; Chaffee, B.W.; Lyalina, S.; Pollard, K.S.; DeRisi, J.L.; Mancl, L. Topical silver diamine fluoride for dental caries arrest in preschool children: A randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. J. Dent. 2018, 68, 72–78.
32. Mei ML, Ito L, Cao Y et al. Inhibitory effect of silver diamine fluoride on dentine demineralization and collagen degradation. J Dent 2013 41: 809–817
33. Fung M, Duangthip D, Wong M, Lo E, Chu C. Randomized clinical trial of 12% and 38% silver diamine fluoride treatment. J Dent Res. (2017) 97(2):171–8. Doi: 10. 1177/0022034517728496
34. Fung HTM, Duangthip D, Wong MCM, Lo ECM, Chu CH. Arresting dentine caries with different concentrations and periodicity of silver diamine fluoride. JDR Clinical & Translational Research. 2016;1(2):143–152.
35. Zheng FM, Yan IG, Duangthip D, Lo ECM, Gao SS, Chu CH. Caries prevention using silver diamine fluoride: a 12-month clinical trial. Int Dent J. (2023) 73 (5):667–73. doi: 10.1016/j.identj.2022.12.005
36. Zhi QH, Lo ECM, Lin HC. Randomized clinical trial on the effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. J Dent 2012;40(11):962-7.
37. Suzuki T, Nishida M, Sobue S, Moriwaki Y. Effects of diammine silver fluoride on tooth enamel. J Osaka Univ Dent Sch. 1974;14:61-72
38. Magno, M.B.; Silva, L.P.D.; Ferreira, D.M.; Barja-Fidalgo, F.; Fonseca-Gonçalves, A. Aesthetic perception, acceptability, and satisfaction in the treatment of caries lesions with silver diamine fluoride: A scoping review. Int. J. Paediatr. Dent. 2019, 29, 257–266
39. Fung M, Duangthip D, Wong M, Lo E, Chu C. Arresting dentine caries with different concentration and periodicity of silver diamine fluoride. JDR Clin Transl Res 2016;1(2):143–52.
40. Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011–2012. NCHS data brief, no 191. Hyattsville, Md.: National Center for Health Statistics. 2015. Available at: “https://www.cdc.gov/nchs/ products/databriefs/db191.htm”. Accessed September 6, 2017.
41. Gao SS, Zhao IS, Hiraishi N et al. Clinical trials of silver diamine fluoride in arresting caries among children: a systematic review. JDR Clin Trans Res 2016 1: 201–210.
42. Nguyen T, Tonmukayakul U, Hall M, Calache H. Cost-effectiveness analysis of silver diamine fluoride to divert dental general anesthesia compared to standard care. Aust Dent J. (2022) 67(4):352–61. doi: 10.1111/adj.12936
43. Featherstone JD, PhD Horst JA, DDS MS PhD. Long used in other countries, silver diamine fluoride is now approved for use in the U.S. While there is an assumption of use for pediatric caries control, this article explores indications for adults. The Journal of Multidisciplinary Care Decisions in Dentistry, 2015, October 5.
44. Jetmire Alimani - Jakupi, Lindihana E., Hakik D., Adnan J., Drita Vojnika. KEP, KIM, AND MT in primary teeth, permanent teeth, and mixed dentition. Apolonia 52-53 (2023) https://adj.mk/archives/52_53/4.html
45. Casamassimo PS, Thikkurissy S, Edelstein BL, Maiorini E. Beyond the DMFT: the human and economic cost of early childhood caries. J Am Dent Assoc. 2009;140(6):650- 657.
2. World Health Organization. Oral Health Surveys: Basic Methods. World Health Organization; 2013.
3. Uribe S, Maldupa I, Innes N. The Global Prevalence of Early Childhood Caries: A Systematic Review with Meta-Analysis. Published online January 13, 2020. https://osf.io/k7zun/
4. Clemens J, Gold J, Chaffin J. Effect and acceptance of silver diamine fluoride treatment on dental caries in primary teeth. Journal of Public Health Dentistry. 2017;78(1):63-68. doi:10.1111/jphd.12241
5. Martins-Júnior, P.; Vieira-Andrade, R.; Corrêa-Faria, P.; Oliveira-Ferreira, F.; Marques, L.; Ramos-Jorge, M. Impact of early childhood caries on the oral health-related quality of life of preschool children and their parents. Caries Res. 2013, 47, 211–218.
6. Khan SQ, Alzayer HA, Alameer ST, Khan MA, Khan N, AlQuorain H, et al. SEQUEL: Prevalence of dental caries in Saudi Arabia: A systematic review and meta-analysis. ˜the œSaudi Dent J. (2024) 36:963–9. doi: 10.1016/j.sdentj.2024.04.011
7. Mansoori, S.; Mehta, A.; Ansari, M.I. Factors associated with oral health-related quality of life in children with severe early childhood caries. J. Oral Biol. Craniofacial Res. 2019, 9, 222–225
8. Bekes, K.; Omara, M.; Safar, S.; Stamm, T. The German version of Early Childhood Oral Health Impact Scale (ECOHIS-G): Translation, reliability, and validity. Clin. Oral Investig. 2019, 23, 4449–4454
9. Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011–2012. NCHS data brief, no 191. Hyattsville, Md.: National Center for Health Statistics. 2015. Available at: https://www.cdc.gov/nchs/ products/databriefs/db191.htm
10. JA Jakupi, S Iljovska, S Naskova, M Pavlevska, N Nuhii. Assessing the caries risk factor among children at age prom 4-5 using the cariogram program. Int J Sci Eng Res 6 (11), 554-562
11. J Alimani-Jakupi, M Jankulovska, M Pavlevska, E Georgievska, T Veninov. Dietetic regime and oral health in 12-year-old children from Gostivar: Using the Cariogram to assess different dental caries risk factors. Makedonski Stomatološki Pregled. 2010; 34 (1-2):1-7.
12. Milgrom, P.; Horst, J.A.; Ludwig, S.; Rothen, M.; Chaffee, B.W.; Lyalina, S.; Pollard, K.S.; DeRisi, J.L.; Mancl, L. Topical silver diamine fluoride for dental caries arrest in preschool children: A randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. J. Dent. 2018, 68, 72–78.
13. Abbas M, Mahmood Fahmi M. Topical effect of silver diamine fluoride in arresting dental caries in primary teeth. Indian J Pub Health Res Develop. (2019) 10:1285–7. doi: 10.5958/0976-5506.2019.01173.2
14. Duangthip D, Fung M, Wong M, Chu C, Lo E. Adverse effects of silver diamine fluoride treatment among preschool children. J Dent Res. (2017) 97(4):395–401. doi: 10.1177/0022034517746678
15. American Academy of Pediatric Dentistry. 2008. Definition of early childhood caries (ECC) [accessed 2016 July 6]. http://www.aapd.org/assets/1/7/D_ECC.pdf.
16. World Health Organization: WHO. Oral health. (2023). Available online at: https://www.who.int/news-room/fact-sheets/detail/oral-health
17. World Health Organization. Oral Health Surveys: Basic Methods. World Health Organization; 2013.
18. WHO. Ending Childhood Dental Caries: WHO Implementation Manual. Published 2019. https://apps.who.int/iris/bitst ream/handl e/10665/ 33064 3/97892 40000 056- eng.pdf.
19. Baier, K.; Milgrom, P.; Russell, S.; Mancl, L.; Yoshida, T. Children’s fear and behavior in private pediatric dentistry practices. Pediatr. Dent. 2004, 26, 316–321
20. Renugalakshmi, A.; Vinothkumar, T.S.; Hakami, F.B.; Salem, R.M.; Qadri, A.A.; Harbosh, Z.M.; Hakami, Z. Impact of silver diamine fluoride therapy on oral health-related quality of life of uncooperative preschool children: A prospective study. Oral Health Prev. Dent. 2021, 19, 93–99
21. Llodra JC, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res 2005;84(8):721-4
22. Korwar A, Sharma S, Logani A, Shah N. Pulp response to high fluoride-releasing glass ionomer, silver diamine fluoride, and calcium hydroxide used for indirect pulp treatment: An in vivo comparative study. 2015, July 31;6(3):288-292. Retrieved September 15, 2016
23. Nelson T, DDS MSD MPH, Scott JM, PhD, Crystal YO, DMD Berg JH, DDS MS, Milgrom P, DDS. Silver Diamine Fluoride in Pediatric Dentistry Training Programs: Survey of Graduate Program Directors. American Academy of Pediatric Dentistry. 2016, May/June;38(3):212-217. Retrieved September 14, 2016
24. Antibacterial activity of silver-killed bacteria: the "zombies" effect. Wakshlak RB, Pedahzur R, Avnir D Sci Rep. 2015 April 23;5:9555.
25. Mei ML, Li QL, Chu CH et al. Antibacterial effects of silver diamine fluoride on multi-species cariogenic biofilms associated with caries. Ann Clin Microbiol Antimicrob 2013 12: 4.
26. 26. Chu CH, Mei L, Seneviratne CJ et al. Effects of silver diamine fluoride on dentine carious lesions induced by Streptococcus mutans and Actinomyces naeslundii biofilms. Int J Paediatr Dent. 2012;22:2-10
27. Mei ML, Chu CH, Low KH, et al. Caries arresting effect of silver diamine fluoride on dentine carious lesion with S. mutans and L. acidophilus dual-species cariogenic biofilm. Med Oral Patol Oral Cir Bucal 2013;18:824-831.
28. Lansdown AB. Silver in health care: antimicrobial effects and safety in use. Curr Probl Dermatol. 2006;33:17-34
29. Crystal YO, Niederman R. Silver diamine fluoride treatment considerations in children’s caries management: Brief communication and commentary. Pediatr Dent 2016;38(7):466–71.
30. Gao SS, Zhang S, Mei ML, Lo EC, Chu CH. Caries remineralization and arresting effect in children by professionally applied fluoride treatment – A systematic review. BMC Oral Health 2016;16:12.
31. Milgrom, P.; Horst, J.A.; Ludwig, S.; Rothen, M.; Chaffee, B.W.; Lyalina, S.; Pollard, K.S.; DeRisi, J.L.; Mancl, L. Topical silver diamine fluoride for dental caries arrest in preschool children: A randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. J. Dent. 2018, 68, 72–78.
32. Mei ML, Ito L, Cao Y et al. Inhibitory effect of silver diamine fluoride on dentine demineralization and collagen degradation. J Dent 2013 41: 809–817
33. Fung M, Duangthip D, Wong M, Lo E, Chu C. Randomized clinical trial of 12% and 38% silver diamine fluoride treatment. J Dent Res. (2017) 97(2):171–8. Doi: 10. 1177/0022034517728496
34. Fung HTM, Duangthip D, Wong MCM, Lo ECM, Chu CH. Arresting dentine caries with different concentrations and periodicity of silver diamine fluoride. JDR Clinical & Translational Research. 2016;1(2):143–152.
35. Zheng FM, Yan IG, Duangthip D, Lo ECM, Gao SS, Chu CH. Caries prevention using silver diamine fluoride: a 12-month clinical trial. Int Dent J. (2023) 73 (5):667–73. doi: 10.1016/j.identj.2022.12.005
36. Zhi QH, Lo ECM, Lin HC. Randomized clinical trial on the effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. J Dent 2012;40(11):962-7.
37. Suzuki T, Nishida M, Sobue S, Moriwaki Y. Effects of diammine silver fluoride on tooth enamel. J Osaka Univ Dent Sch. 1974;14:61-72
38. Magno, M.B.; Silva, L.P.D.; Ferreira, D.M.; Barja-Fidalgo, F.; Fonseca-Gonçalves, A. Aesthetic perception, acceptability, and satisfaction in the treatment of caries lesions with silver diamine fluoride: A scoping review. Int. J. Paediatr. Dent. 2019, 29, 257–266
39. Fung M, Duangthip D, Wong M, Lo E, Chu C. Arresting dentine caries with different concentration and periodicity of silver diamine fluoride. JDR Clin Transl Res 2016;1(2):143–52.
40. Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011–2012. NCHS data brief, no 191. Hyattsville, Md.: National Center for Health Statistics. 2015. Available at: “https://www.cdc.gov/nchs/ products/databriefs/db191.htm”. Accessed September 6, 2017.
41. Gao SS, Zhao IS, Hiraishi N et al. Clinical trials of silver diamine fluoride in arresting caries among children: a systematic review. JDR Clin Trans Res 2016 1: 201–210.
42. Nguyen T, Tonmukayakul U, Hall M, Calache H. Cost-effectiveness analysis of silver diamine fluoride to divert dental general anesthesia compared to standard care. Aust Dent J. (2022) 67(4):352–61. doi: 10.1111/adj.12936
43. Featherstone JD, PhD Horst JA, DDS MS PhD. Long used in other countries, silver diamine fluoride is now approved for use in the U.S. While there is an assumption of use for pediatric caries control, this article explores indications for adults. The Journal of Multidisciplinary Care Decisions in Dentistry, 2015, October 5.
44. Jetmire Alimani - Jakupi, Lindihana E., Hakik D., Adnan J., Drita Vojnika. KEP, KIM, AND MT in primary teeth, permanent teeth, and mixed dentition. Apolonia 52-53 (2023) https://adj.mk/archives/52_53/4.html
45. Casamassimo PS, Thikkurissy S, Edelstein BL, Maiorini E. Beyond the DMFT: the human and economic cost of early childhood caries. J Am Dent Assoc. 2009;140(6):650- 657.
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