School dental program prevents 80 per cent of cavities with one-time, non-invasive treatment

silver diamine fluoride
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In a US study of nearly 3000 schoolchildren, silver diamine fluoride—a liquid that is brushed onto the surface of teeth to prevent cavities or keep them from worsening—was as effective against cavities as dental sealants, the standard of care. 

A single dose of either topical treatment given in elementary schools prevented roughly 80 per cent of cavities and kept 50 per cent of cavities from worsening when children were seen two years later.

The findings—published in JAMA Network Open—offer an efficient and cost-effective approach to improving children’s oral health through school-based care.

In 2017, NYU College of Dentistry researchers ran the nation’s largest school-based cavity prevention study, which they named CariedAway.

CariedAway is a randomised trial comparing the effectiveness of two cavity-prevention techniques: a ‘simple’ treatment using silver diamine fluoride (SDF) and fluoride varnish, and a ‘complex’ treatment using traditional glass ionomer sealants and fluoride varnish. Both are non-invasive and applied to the surface of teeth to prevent and arrest cavities in children, but for the same time and cost, providers can treat more children with the simpler SDF therapy.

The study included 2998 children in kindergarten through third grade at 47 New York City schools. The schools—which serve a racially diverse group of students, most of whom are from low-income families—were randomised to receive either the simple or complex treatment.

Upon visiting each school, the clinical research team did baseline exams to measure any tooth decay, and then applied fluoride varnish and either sealants or SDF, depending on whether the school was assigned to receive the complex or simple treatment.

The initial visits took place in 2019 and early 2020, and were paused when the COVID-19 pandemic temporarily closed New York City schools and halted all school-based care. Two years later, schools allowed the clinical research team to resume, and they returned to each school for follow-up visits.

The researchers found that both the simple and complex treatments were successful: just one cavity prevention treatment prevented more than 80 per cent of cavities (81 per cent for SDF and 82 per ce t for sealants) and stopped half of cavities from progressing (56 per cent for SDF and 46 per cent for sealants).

“Without prevention, dental cavities grow continuously if not treated. One CariedAway cavity prevention treatment, provided just before schools closed during the pandemic, was remarkably effective over the following two-year period,” senior author Dr Richard Niederman said. 

“I know of no other dental preventive intervention that had this great a beneficial impact across the pandemic.”

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