Background: Silver diamine fluoride (SDF) was cleared for use by the Food and Drug Administration (FDA) in August 2014 and became commercially available in April 2015. SDF can be used for treatment of dental caries and dentin hypersensitivity, similar to fluoride varnish. Just as fluoride varnish is used off-label to treat and prevent dental caries, the authors present evidence and guidelines for using SDF off-label for caries arrest and prevention.
Clinical question: What is the evidence for SDF as an agent for caries arrest and prevention? If the evidence is sufficient to recommend SDF use for caries arrest, what are appropriate clinical guidelines for that application?
Summary of methods: A subcommittee of the University of California, San Francisco School of Dentistry paradigm shift committee examined the evidence from the literature for various clinical indications for SDF and developed a protocol for its use.
Critical appraisal: The evidence presented is useful for understanding the mechanism of action of SDF, indications for its use, the clinical situations and populations for which it provides beneficial and costeffective treatment, and the proper technique for its application. Though the authors indicate that a systematic review of the literature was conducted, the article does not provide a grading of the evidence for the nine randomized clinical trials that were retrieved.
Practical implications: There appears to be good evidence for the use of SDF for caries arrest and prevention. SDF will be especially useful for difficult-to-treat carious lesions and vulnerable populations who cannot tolerate treatment or who lack access to care.