Dental caries are the most widespread chronic pathology in pediatric age: in industrialized countries they affect between 60 and 90 percent of school-age children. Usually a decayed tooth, even a baby tooth, requires a filling, with all the inconvenience this entails for children, and the financial expense for parents. However, there is an alternative: it is called silver diamine fluoride, and it is a liquid that is applied to the diseased tooth with a simple sponge, capable of blocking the progression of tooth decay. Until now it has always been used “off label”, due to a lack of solid data on its effectiveness. But things could soon change: a clinical study just published on Jama Pediatrics in fact, researchers at the University of Michigan provide the first large-scale scientific data collected on the US population, and could soon push the American Food and Drug Administration to officially approve the substance as a drug against tooth decay (and at that point, our European agency, the EMA, could also do the same).
The University of Michigan clinical trial began in 2018 and involved 830 children under the age of 6, recruited through dental practices, pediatric practices and educational facilities. The protocol involved applying a 38% solution of silver diamine fluoride directly to the surface of the damaged tooth using a disposable micro-applicator, an operation that takes a few seconds and does not require tissue removal or injections.
By checking the oral health status of the participants at six-month intervals, the periodic administration of the liquid allowed dental deterioration to be stopped in more than 50% of the cases examined, confirming a clear reduction in active infection. Silver amino fluoride therefore offers concrete advantages in the management of different categories of patients who encounter difficulties in undergoing conventional dental care: very young children (it can be used as early as one year of age), frail elderly people, people with disabilities or serious anxiety problems linked to traditional dental care.
A solution especially for children
The only contraindication of silver diamine fluoride is of an aesthetic nature: the silver component – which eliminates the bacterial load by blocking the progression of tooth decay – reacts with the oxidized tooth structure, permanently darkening the affected portion of the tooth. In children, obviously the problem is less serious, as they are still destined to change milk teeth with permanent ones. While in adults these blemishes make it more plausible to use it as a bridging therapy, while waiting to carry out a more complex reconstruction.
“Our results – write the study authors – support FDA approval of fluoride for the treatment of tooth decay in young children. Removing it from the status of an off-label therapy would represent an important innovation that could lead to greater use by dentists and higher reimbursements by insurance companies.” And obviously, if it became more common in the United States, it would almost certainly have greater diffusion in Europe too. So all we have to do is wait and see.