Clinical Trial Shows Effectiveness of Silver Diamine Fluoride for School-based Caries

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Dental hygienists play a vital role in promoting oral health among children, and recent research has uncovered an exciting breakthrough that could revolutionize cavity prevention. A study involving nearly 3,000 schoolchildren has revealed that silver diamine fluoride (SDF) is as effective as dental sealants in preventing cavities. The findings, published in JAMA Network Open, highlight the potential of SDF as a cost-effective solution for improving children’s oral health through school-based care.1

Addressing the Prevalence of Dental Caries

Dental caries remains the most prevalent chronic disease among children, impacting their quality of life and academic performance. Unfortunately, children from low-income families are disproportionately affected, facing twice the risk of caries compared to their higher-income counterparts. Regular dental visits are crucial, but they can be challenging for parents who need to take time off work or if there is a lack of access to care. Schools can play a pivotal role in addressing this barrier by offering basic dental services, particularly for children from low-income backgrounds.

According to the Centers for Disease Control and Prevention (CDC), the prevalence of dental caries among school-aged children ranges from 21.4% to 53.8%, with the percentage increasing with age. Of those, an estimated 13% are untreated, which can potentially cause pain and discomfort that lead to missed school days and nutritional deficiencies. Implementing strategies to prevent the development of dental caries and/or the arrest of caries progression has the potential to improve quality of life and academic performance.2

The Role of School-based Care

School-based caries prevention programs have gained recognition as effective interventions. The CDC recommends and supports school sealant programs, providing a feasible solution to improve oral health outcomes. In line with this, the CariedAway study, funded by the Patient-Centered Outcomes Research Institute (PCORI), sought to compare the effectiveness of two cavity prevention techniques: SDF combined with fluoride varnish versus traditional glass ionomer sealants with fluoride varnish.1

The CariedAway study involved 2,998 kindergarten through third-grade children across 47 New York City schools. These schools catered to a diverse population, predominantly comprising children from low-income families. Through a randomized trial, some schools received the simple treatment using SDF and fluoride varnish, while others received the more technique-specific treatment involving traditional sealants and fluoride varnish.1

A team of clinical researchers, including dental hygienists, dentists, registered nurses, and assistants, conducted baseline exams and applied the respective treatments. The study was initiated in 2019, briefly interrupted by the COVID-19 pandemic, and resumed two years later for follow-up visits.1

The study’s remarkable findings demonstrated that both the simple SDF application and more technique-specific treatments, dental sealants, were highly successful. A single preventive treatment with either SDF or sealants prevented over 80% of caries, with SDF scoring 81% and sealants 82%. Furthermore, the treatments halted the progression of approximately 50% of existing caries, with SDF at 56% and sealants at 46%.1

The outcomes of the CariedAway study present promising implications for dental hygienists and school-based oral health programs. While the limited availability of trained dental professionals poses a challenge for sealant programs, SDF provides an attractive alternative. Unlike sealants requiring a dental professional for application, SDF can be administered by nurses already present in many schools. Additionally, the application of SDF could be a time saver and allow for more access to care among school-aged children. This feature broadens the scope of oral health care and enhances access to preventive interventions.


The groundbreaking research on SDF’s efficacy in preventing cavities has sparked excitement among dental hygienists and professionals working in school-based oral health programs. With its simplicity, cost-effectiveness, and potential for expansion, SDF offers a game-changing solution to improve children’s oral health. By leveraging these findings and incorporating SDF into their practice, dental hygienists can contribute to children’s overall well-being and academic success, especially those with a lack of access to care.

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  1. Ruff, R.R., Barry-Godín, T., Niederman, R. Effect of Silver Diamine Fluoride on Caries Arrest and Prevention. JAMA Network Open. 2023; 6(2): e2255458 DOI: 10.1001/jamanetworkopen.2022.55458
  2. Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015-2016. (2018, April). Centers for Disease Control and Prevention.