Study: SDF as effective as sealants for preventing, halting cavities

A study of 3,000 children in New York City found that a single dose of silver diamine fluoride (SDF) offers the same level of protection as a dental sealant in preventing cavities or keeping them from worsening.

The findings are from CariedAway, the largest school-based cavity-prevention study in the US, which includes children from ages 5-13 in 47 New York City primary schools. The results, released earlier this month in JAMA Network Open, show that a single dose of SDF or a sealant given in elementary schools prevented roughly 80% of cavities and kept 50% of cavities from worsening when children were seen two years later.

According to a statement from New York University College of Dentistry, which received funding to implement CariedAway, the study is a randomized trial comparing the effectiveness of two cavity-prevention techniques: a “simple” treatment using SDF and fluoride varnish, and a “complex” treatment using traditional glass ionomer sealants and fluoride varnish.

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The researchers found that both the simple and complex treatments were successful: just one cavity prevention treatment prevented more than 80% of cavities (81% for SDF and 82% for sealants) and stopped half of cavities from progressing (56% for SDF and 46% for sealants). But for the same time and cost, providers (including those through school-based care) could treat more children with the simpler SDF therapy.

According to JAMA Network Open, “These findings are comparable to those from other more controlled clinical studies, which indicated no differences in the 6- and 12-month caries arrest rates comparing SDF vs. atraumatic restorative treatment. In addition, a prior review on the effect of SDF in preventing caries in primary dentition showed significant reductions in the development of new caries vs. placebo after 24 months and was not more or less effective after 12 months compared with glass ionomer sealants.”

The initial school visits started in 2019 and 2020 but were paused during pandemic shutdowns, which made the program’s overall efficacy more notable, said the study’s senior author: “Without prevention, dental cavities grow continuously if not treated. One CariedAway cavity prevention treatment, provided just before schools closed during the pandemic, was remarkably effective over the following two-year period,” said Richard Niederman, DMD, professor in the department of epidemiology and health promotion at NYU Dentistry, in NYU’s statement. “I know of no other dental preventive intervention that had this great a beneficial impact across the pandemic.”