RESUMO
The use of silver diamine fluoride (SDF) for management of dental caries has gained considerable attention due to recent regulatory clearance in the United States. The primary focus of policies, presentations, and publications has been the arrest of caries lesions (cavities) because of the material's unique ability to non-invasively achieve this elusive and clinically important goal. However, SDF also has proven efficacy in prevention, ie, decreasing the incidence of new caries lesions. Analysis of nine clinical trials in children shows that SDF prevented 61% of new lesions compared to controls. To prevent one new caries lesion, clinicians need to treat four primary teeth (one patient) or 12.1 permanent molars (three patients) with SDF. The preventive effect appears to be immediate and maintains at the same fraction over time. Direct comparisons of SDF applied once per year with alternative treatments show that SDF is more effective than other topical fluorides placed two to four times per year and more cost-effective than dental sealants. Enamel lesions may be even more responsive than cavitated dentin lesions. Annual application of SDF to high-risk surfaces (eg, mesial surfaces of permanent first molars where the distal surface of the second primary molar is carious) in patients with any risk of new caries lesions appears to be the most cost-effective approach available to prevent dental caries. SDF is an underutilized evidence-based preventive agent for dental caries.
Assuntos
Cárie Dentária/prevenção & controle , Compostos de Amônio Quaternário/uso terapêutico , Compostos de Prata/uso terapêutico , Criança , Análise Custo-Benefício , Cárie Dentária/história , Fluoretos Tópicos/efeitos adversos , Fluoretos Tópicos/história , Fluoretos Tópicos/uso terapêutico , História do Século XX , Humanos , Compostos de Amônio Quaternário/efeitos adversos , Compostos de Amônio Quaternário/história , Compostos de Prata/efeitos adversos , Compostos de Prata/históriaRESUMO
Dr. Basil Bibby assumed many roles during his productive career as a researcher, teacher, and administrator. Although best known for his research on oral microbiology and on foodstuff as it relates to dental caries, and for fostering the careers of many distinguished researchers, he played an important generative role in determining the local cariostatic effects of fluoride. His seminal work in this area has not received its due because of the mixed success of his initial clinical studies. We hope that a review of his contributions in this area will bring those contributions into focus and illustrate his open personality and multi-dimensional approach to research.