Transition probabilities for caries in children receiving silver diamine fluoride: a community-based randomized clinical trial

Silver diamine fluoride (SDF) can effectively prevent and control dental caries, the world's most pervasive noncommunicable disease. This study estimated the transition probabilities for caries in children receiving SDF. The CariedAway study was a community-based cluster-randomized trial of SDF, glass ionomer sealants, and atraumatic restorations conducted in 48 primary schools enrolling predominately low-income minority children in New York, USA. For enrolled children receiving SDF, probabilities were computed for transitions between healthy (sound), diseased (carious), and disease-controlled (arrested) states for 6-year molars using multistate Markov models. Subject-level transition probabilities over one- and two-year periods were then calculated by aggregating states of all 6-year molars and first and second bicuspids. Tooth state progression was treated as a relapsing-remitting condition. A total of 7418 children were enrolled in CariedAway, of which 1352 received SDF and completed at least three study observations. Among eligible participants, the baseline prevalence of untreated decay was 29% and the prevalence of preexisting dental sealants was 8%. The probability of transitioning between sound and carious states in 6-year molars ranged from 0.0022 to 0.0074. At the subject-level, the sound to carious transition probabilities were 0.07 and 0.12 after one and two years, respectively. Once in a fully arrested state, the probability of remaining arrested was 0.72 and 0.60 after 1 and 2 years. While the overall probabilities of teeth remaining in disease-free or arrested states was high after receiving SDF, multiple applications might be needed for consistent caries control.