Peter Milgrom1, Jeremy A Horst2, Sharity Ludwig3, Marilynn Rothen4, Benjamin W Chaffee5, Svetlana Lyalina6, Katherine S Pollard7, Joseph L DeRisi8, Lloyd Mancl9. 1. Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475 USA. Electronic address: dfrc@uw.edu. 2. Department of Biochemistry, University of California San Francisco,1700 4th Street, QB3 Room 404, San Francisco, CA 94158 USA. 3. Advantage Dental Services, 442 SW Umatilla, Suite 200, Redmond, OR 97756 USA. 4. Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475 USA; Institute of Translational Health Sciences, Regional Clinical Dental Research Center, Box 357475, Seattle, WA 98195-7475 USA. 5. Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, CA, 94143 USA. 6. Department of Epidemiology & Biostatistics, University of California San Francisco,550 16th Street, 2nd Floor, San Francisco, CA 94158 USA. 7. Department of Epidemiology & Biostatistics, University of California San Francisco,550 16th Street, 2nd Floor, San Francisco, CA 94158 USA; Gladstone Institutes,1650 Owens Street, San Francisco, CA 94158 USA. 8. Department of Biochemistry, University of California San Francisco,1700 4th Street, QB3 Room 404, San Francisco, CA 94158 USA; Chan-Zuckerberg BioHub, 499 Illinois St, San Francisco, CA 94158 USA. 9. Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475 USA.
Abstract
OBJECTIVES: The Stopping Cavities Trial investigated effectiveness and safety of 38% silver diamine fluoride in arresting caries lesions. MATERIALS AND METHODS: The study was a double-blind randomized placebo-controlled superiority trial with 2 parallel groups. The sites were Oregon preschools. Sixty-six preschool children with ≥1 lesion were enrolled. Silver diamine fluoride (38%) or placebo (blue-tinted water), applied topically to the lesion. The primary endpoint was caries arrest (lesion inactivity, Nyvad criteria) 14-21days post intervention. Dental plaque was collected from all children, and microbial composition was assessed by RNA sequencing from 2 lesions and 1 unaffected surface before treatment and at follow-up for 3 children from each group. RESULTS AND CONCLUSION:Average proportion of arrested caries lesions in the silver diamine fluoride group was higher (0.72; 95% CI; 0.55, 0.84) than in the placebo group (0.05; 95% CI; 0.00, 0.16). Confirmatory analysis using generalized estimating equation log-linear regression, based on the number of arrested lesions and accounting for the number of treated surfaces and length of follow-up, indicates the risk of arrested caries was significantly higher in the treatment group (relative risk, 17.3; 95% CI: 4.3 to 69.4). No harms were observed. RNA sequencing analysis identified no consistent changes in relative abundance of caries-associated microbes, nor emergence of antibiotic or metal resistance gene expression. Topical 38% silver diamine fluoride is effective and safe in arresting cavities in preschool children. CLINICAL SIGNIFICANCE: The treatment is applicable to primary care practice and may reduce the burden of untreated tooth decay in the population.
RCT Entities:
OBJECTIVES: The Stopping Cavities Trial investigated effectiveness and safety of 38% silver diamine fluoride in arresting caries lesions. MATERIALS AND METHODS: The study was a double-blind randomized placebo-controlled superiority trial with 2 parallel groups. The sites were Oregon preschools. Sixty-six preschool children with ≥1 lesion were enrolled. Silver diamine fluoride (38%) or placebo (blue-tinted water), applied topically to the lesion. The primary endpoint was caries arrest (lesion inactivity, Nyvad criteria) 14-21days post intervention. Dental plaque was collected from all children, and microbial composition was assessed by RNA sequencing from 2 lesions and 1 unaffected surface before treatment and at follow-up for 3 children from each group. RESULTS AND CONCLUSION: Average proportion of arrested caries lesions in the silver diamine fluoride group was higher (0.72; 95% CI; 0.55, 0.84) than in the placebo group (0.05; 95% CI; 0.00, 0.16). Confirmatory analysis using generalized estimating equation log-linear regression, based on the number of arrested lesions and accounting for the number of treated surfaces and length of follow-up, indicates the risk of arrested caries was significantly higher in the treatment group (relative risk, 17.3; 95% CI: 4.3 to 69.4). No harms were observed. RNA sequencing analysis identified no consistent changes in relative abundance of caries-associated microbes, nor emergence of antibiotic or metal resistance gene expression. Topical 38% silver diamine fluoride is effective and safe in arresting cavities in preschool children. CLINICAL SIGNIFICANCE: The treatment is applicable to primary care practice and may reduce the burden of untreated tooth decay in the population.
Authors: Elsa Vasquez; Graciela Zegarra; Edgar Chirinos; Jorge L Castillo; Donald R Taves; Gene E Watson; Russell Dills; Lloyd L Mancl; Peter Milgrom Journal: BMC Oral Health Date: 2012-12-31 Impact factor: 2.757
Authors: Thuy Doan; Michael R Wilson; Emily D Crawford; Eric D Chow; Lillian M Khan; Kristeene A Knopp; Brian D O'Donovan; Dongxiang Xia; Jill K Hacker; Jay M Stewart; John A Gonzales; Nisha R Acharya; Joseph L DeRisi Journal: Genome Med Date: 2016-08-25 Impact factor: 11.117