SDF versus PVP-I and NaF in arresting root caries

Abstract

Objectives: To compare the effectiveness of annual application of 38% sliver diamine fluoride (SDF) solution with that of 4-monthly application of 10% povidone iodine (PVP-I) followed by 5% sodium fluoride (NaF) varnish in arresting active root caries. Methods: This randomized clinical trial was registered (clinicaltrials.gov # NCT 03654820) and conducted in long-term social welfare care facilities in Hong Kong. Participant inclusion criteria were: 1) had at least one root surface with active caries lesion, 2) aged above 60 years, 3) had at least 6 natural teeth, and 4) had basic self-care and communication ability. Participants were randomly allocated into 2 groups and received the corresponding interventions: Group 1: annual application of 38% SDF solution; Group 2: 4-monthly application of 10% PVP-I followed by 5% NaF varnish (PVP-I/NaF). Included root surface was assessed using the criteria recommended by the International Caries Detection and Assessment System. The participants were examined by the same two calibrated examiners at baseline and follow-up. Results: At baseline, 98 elders (women: 70) (mean age: 74.8±8.5) were examined with 206 active root caries lesions. After 24 months, 76 (77.6%) participants were evaluated. The proportions of root caries lesions that were arrested at the 24-month examination in Group 1 and Group 2 were 99% and 68%, respectively (Fisher’s exact test, p<0.001). In the final multi-level logistic regression model, active root caries lesions in the SDF group (OR=35.3, p=0.001) had a higher chance while those with visible plaque present at 24-month follow-up (OR=0.23, p=0.048) had a lower chance to become arrested. The shallower lesions and those in Group 1 became arrested faster than the deeper lesions and those in Group 2. Conclusions: The effectiveness of annual application of 38% SDF solution is significantly higher than that of 4-monthly application of 10% PVP-I and 5% NaF varnish in arresting active root caries.