Comparative Efficacy of Silver Diamine Fluoride and Sodium Fluoride in Managing Early Childhood Caries: An Updated Systematic Review and Meta-Analysis

Abstract

BackgroundEarly childhood caries (ECC) is a prevalent condition in preschool children that can impair nutrition and development. Comparative evidence on silver diamine fluoride (SDF) versus sodium fluoride (NaF) for arresting ECC remains limited. ObjectivesTo compare the efficacy of topical SDF and NaF in arresting ECC lesions and to evaluate effects on decayed, missing, and filled surfaces (DMFS). Data SourcesPubMed (Medline), Scopus, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched from January 1990 through April 2024. Reference lists of included studies were hand-searched. Eligibility CriteriaRandomized controlled trials (RCTs) directly comparing topical SDF and NaF in children aged 0-6 years with ECC and reporting outcomes for lesion arrest or DMFS. Study Selection and Data ExtractionTwo reviewers independently screened records, extracted data, and assessed risk of bias using RoB 2. Discrepancies were resolved by a third reviewer. Number of Studies and ParticipantsNine RCTs met inclusion criteria (total sample size reported in main text). Synthesis MethodsRandom-effects meta-analysis (DerSimonian-Laird) was used to pool odds ratios (ORs) with 95 confidence intervals (CIs). Heterogeneity was assessed with I2 and Cochran's Q; publication bias was evaluated with Egger's test. Preplanned subgroup analyses examined follow-up duration. ResultsPooled analysis showed higher odds of caries arrest with SDF compared to NaF (OR 1.41; 95 CI 1.03 -1.94), while no statistically significant difference was observed for DMFS (OR 1.07; 95 CI 0.70-1.64). Heterogeneity across analyses was low to moderate, and risk-of-bias assessments identified some concerns in several trials. According to the GRADE evaluation, the certainty of evidence was rated moderate for caries arrest (downgraded for inconsistency) and low for DMFS (downgraded for risk of bias and imprecision). ConclusionsCompared with NaF, 38 SDF increases the likelihood of arresting ECC lesions while producing similar effects on DMFS. Clinical selection should balance lesion depth, aesthetic considerations, and patient-level factors.