Preventive Effects of Silver Diamine Fluoride on Early Enamel Caries

Summary

Fixed orthodontic patients are at risk of developing dental caries. Topical application of fluoride varnish (FV) around the orthodontic brackets and using fluoridated mouth rinses have been suggested to prevent the formation of white spot lesions (WSLs) on enamel. Recent studies have shown that silver diamine fluoride (SDF) demonstrated better outcomes in dental caries prevention as compared to FV. However, the caries preventive effects of SDF application around the orthodontic brackets have not been established yet.

This study will be conducted to evaluate the effectiveness of SDF in preventing WSLs formation in patients undergoing fixed orthodontic treatment. This study will use a randomised-controlled double-blinded design with three parallel arms. Ninety-nine eligible participants will be recruited. Using their registration number, a random list of patients will be generated using computer software. Each patient will be assigned randomly to three groups: SDF, FV, or placebo. Digital photographs of upper anterior teeth (frontal view) will be taken as a baseline and repeated at every review appointment. The materials will be applied around the orthodontic bracket of upper incisors and canines every 6 months. The formation of WSLs around the bracket will be evaluated at 1, 3, 6, and 12 months using three parameters: the ICDAS scoring system, the laser fluorescence caries detector, and digital photographic analysis using the Gorelick score. The patients' perception of the colour changes of the enamel will be evaluated through patient-reported outcomes. The difference in ICDAS and Gorelick scores and the patients' perceptions will be reported through descriptive statistics. The Kruskal-Wallis or one-way ANOVA statistical test will be used to compare the changes in fluorescence intensity between treatment groups.

The investigators believe that the results of this study will provide insight into the caries preventive protocol among fixed orthodontics patients and subsequently reduce the incidence of WSLs during orthodontic treatment.

Conditions

• Demineralization, Tooth
• White Spot Lesion of Tooth
• Fixed Appliances
• Early Caries Lesions

Interventions

DRUG

Silver diamine fluoride- potassium iodide

SDF , Riva Star, SDI Limited., Australia

DRUG

Fluoride varnish

Duraphat varnish®, Colgate-Palmolive (UK) Ltd.

OTHER

0.9 % saline

Standard oral hygiene instructions every 3 months and application of Normal Saline for every 6 months

Sponsors & Collaborators

• National University of Malaysia

  lead OTHER

Principal Investigators

• Ahmad Shuhud Irfani Zakaria, MClinDent · National University of Malaysia

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2025-01-31

Primary Completion

2026-08-31

Completion

2026-12-31

Countries

• Malaysia

Study Locations