Three-Year Clinical Performance of Silver Diamine Fluoride (SDF) versus Glass Ionomer Cement in Arresting Carious Lesions in Primary Molars: A Community-Based Cohort Study

Winata Putri (Department of Pediatrics, CMHC Research Center, Palembang, Indonesia)
Sophia Lucille Rodriguez (Department of Pediatrics, Trinidad General Hospital, Mexico City, Mexico)
Sarah Armalia (Department of Natural Sciences, Barelang Study Center, Tanjung Pinang, Indonesia)
Alexander Mulya (Department of Oral Health and Dentistry, Emerald Medical Center, Jakarta, Indonesia)

Crown: Journal of Dentistry and Health Research
Vol. 3 No. 1 (2025): Crown: Journal of Dentistry and Health Research

Introduction: Early Childhood Caries (ECC) is a significant global health problem. Minimally invasive treatments like Silver Diamine Fluoride (SDF) and Glass Ionomer Cement (GIC) are crucial, but long-term comparative effectiveness data from real-world community settings are scarce. This study aimed to compare the three-year clinical performance of 38% SDF versus high-viscosity GIC in arresting active carious lesions in the primary molars of preschool children. Methods: This study was designed as a three-year, prospective, non-randomized, community-based cohort study in an underserved urban population in South Sumatra, Indonesia. A total of 450 children aged 3-5 years with at least one active cavitated carious lesion (ICDAS 5/6) in a primary molar were enrolled. Following parental consent and choice, lesions were treated with either a single application of 38% SDF or a high-viscosity GIC restoration using the Atraumatic Restorative Treatment (ART) technique. Calibrated examiners assessed the lesions for caries arrest at 6, 12, 24, and 36 months using standardized visual-tactile criteria. The primary outcome was the proportion of arrested lesions. Survival analysis was performed using Kaplan-Meier curves and a Cox proportional hazards model. Results: A total of 620 lesions (309 SDF, 311 GIC) were treated and followed. At the 36-month follow-up, the caries arrest rate in the SDF group was 81.2%, which was significantly higher than the 64.8% arrest rate observed in the GIC group (χ² = 24.5, p < 0.001). The Kaplan-Meier survival analysis demonstrated a significantly higher probability of lesions remaining in an arrested state in the SDF group over the three-year period (log-rank test, p < 0.001). The Cox regression model identified the treatment modality as the primary predictor of failure, with GIC having a hazard ratio of 2.15 (95% CI: 1.55-2.98) compared to SDF. Conclusion: Within the parameters of this community-based cohort study, a single application of 38% SDF was significantly more effective in arresting active carious lesions in primary molars over a three-year period than high-viscosity GIC applied via the ART technique. These findings support the prioritization of SDF in public health programs for managing ECC.