Silver Diamine Fluoride (SDF) in the management of root caries in dependent elders: a systematic review and meta-analysis

Abstract Objective: To undertake a systematic review and meta-analysis to address the PICO question: Is silver diamine fluoride (SDF) effective in preventing and arresting root caries lesions (RCLs) in dependent elders. Methodology: Systematic literature searches were conducted of electronic databases [PubMed, Embase, and CENTRAL (Cochrane Controlled Register of Trials)] and hand searches were performed to identify studies reporting on the use of SDF in elders to prevent and arrest root caries. Prospective studies were included. Two investigators performed the literature search and data extraction. Results: A total of 277 studies were identified; of those 3 randomised controlled clinical trials (RCTs) were included for data extraction and analysis. A meta analysis, using a fixed-effects model, was performed on the mean active RCLs present after SDF intervention compared to controls at 24-months (3 studies), and 30-months (2 studies) post-intervention. The fixed-effects model revealed a significant decrease in the mean new active RCLs post intervention with SDF compared to controls at both 24- months (95%CI: 0.265 - 0.638; I2=0.0%; Overall: Z=4.749, p<0.001), and at 30-months (95%CI: 0.329 - 0.812; I2=0.0%; Overall: Z=4.629, p<0.001). A funnel plot ruled out any publication bias and the risk of bias was judged to be low. Conclusion: This systematic review and meta-analysis provides robust evidence that application of SDF prevents and arrests root caries in dependent elders