Multifactorial analysis of the effectiveness of silver diamine fluoride application in arresting root caries

OBJECTIVES: To evaluate the clinical effectiveness of 38 % silver diamine fluoride (SDF) application in arresting root caries and identify factors associated with the treatment outcome. METHODS: In a two-arm parallel randomized controlled trial, participants were randomly allocated to the SDF group (38 % SDF) and the control group (tonic water). Clinical examinations were carried out at baseline and the 2-month follow-up to assess the status of root caries lesions (active/arrest). Demographic information and oral health-related behaviours were collected via questionnaire interview. Multifactorial analysis was conducted using the generalized estimating equation (GEE) model to investigate factors associated with the arrest rate of root caries. RESULTS: A total of 186 participants (SDF group: 93 participants, 165 root caries lesions; control group: 93 participants, 158 root caries lesions) were recruited at baseline, and 165 (88.7 %) with 286 root caries lesions completed the 2-month follow-up. Most lesions were active (87 %), located on posterior teeth (53 %), and involved a single surface (91 %). The SDF group demonstrated a significantly higher arrest rate compared with the control group at both the individual level (81.2 % vs. 21.3 %; p < 0.001) and the lesion level (84.9 % vs. 20.7 %; p < 0.001). Multivariable GEE analysis revealed that the SDF application (Adjusted Odds Ratio [AOR]=26.12), lesion status at baseline (AOR=6.88), and the absence of plaque on the lesion surface (AOR=6.72) were positively associated with the arrest of root caries lesions (p < 0.05). CONCLUSIONS: It is concluded that the application of 38 % SDF is highly effective in arresting root caries of community-dwelling older adults, irrespective of age, gender, oral health-related behaviour, tooth type (anterior/posterior), tooth position (upper/lower), lesion surface (single/multiple), lesion size and depth.