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 Jan;68:72-78. doi: 10.1016/j.jdent.2017.08.015. Epub 2017 Sep 1.


Objectives: The Stopping Cavities Trial investigated effectiveness and safety of 38% silver diamine fluoride in arresting caries lesions.

Materials and methods: The study was a double-blind randomized placebo-controlled superiority trial with 2 parallel groups. The sites were Oregon preschools. Sixty-six preschool children with ≥1 lesion were enrolled. Silver diamine fluoride (38%) or placebo (blue-tinted water), applied topically to the lesion. The primary endpoint was caries arrest (lesion inactivity, Nyvad criteria) 14-21days post intervention. Dental plaque was collected from all children, and microbial composition was assessed by RNA sequencing from 2 lesions and 1 unaffected surface before treatment and at follow-up for 3 children from each group.

Results and conclusion: Average proportion of arrested caries lesions in the silver diamine fluoride group was higher (0.72; 95% CI; 0.55, 0.84) than in the placebo group (0.05; 95% CI; 0.00, 0.16). Confirmatory analysis using generalized estimating equation log-linear regression, based on the number of arrested lesions and accounting for the number of treated surfaces and length of follow-up, indicates the risk of arrested caries was significantly higher in the treatment group (relative risk, 17.3; 95% CI: 4.3 to 69.4). No harms were observed. RNA sequencing analysis identified no consistent changes in relative abundance of caries-associated microbes, nor emergence of antibiotic or metal resistance gene expression. Topical 38% silver diamine fluoride is effective and safe in arresting cavities in preschool children.

Clinical significance: The treatment is applicable to primary care practice and may reduce the burden of untreated tooth decay in the population.

Keywords: Anti-infective agents; Cariostatic agents; Dentin/pathology; Human; Prospective studies; Treatment outcome.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bacteria / drug effects
  • Bacteria / genetics
  • Bacteria / isolation & purification
  • Child, Preschool
  • Dental Caries / microbiology*
  • Dental Caries / prevention & control*
  • Dental Plaque / microbiology
  • Double-Blind Method
  • Drug Resistance / genetics*
  • Female
  • Fluorides, Topical / administration & dosage
  • Fluorides, Topical / pharmacology*
  • Follow-Up Studies
  • Gene Expression Regulation, Bacterial*
  • Humans
  • Male
  • Oregon
  • Patient Harm
  • Quaternary Ammonium Compounds / administration & dosage
  • Quaternary Ammonium Compounds / pharmacology*
  • Sequence Analysis, RNA
  • Silver Compounds / administration & dosage
  • Silver Compounds / pharmacology*
  • Transcriptome
  • Treatment Outcome


  • Fluorides, Topical
  • Quaternary Ammonium Compounds
  • Silver Compounds
  • silver diamine fluoride