What if treating a child's cavity took just a few seconds, without drilling, injections or anaesthesia?
A major clinical trial suggests that a simple liquid called silver diamine fluoride (SDF) could help make that possible.
The Phase III clinical trial, led by researchers at the University of Michigan in the United States and published in the journal JAMA Pediatrics, involved 830 children aged 12 to 71 months with severely early childhood tooth decay.
The findings strengthen evidence for a quick, non-invasive approach to managing tooth decay, potentially reducing the need for more complicated dental procedures.
SDF is applied directly to a cavity using a small, sponge-tipped applicator.
Unlike a traditional filling, which removes decayed material and restores the tooth, SDF helps stop existing decay from progressing.
Silver helps combat bacteria associated with tooth decay, while fluoride strengthens tooth minerals and helps protect against further damage.
The randomised, blinded, placebo-controlled trial compared 38% SDF with a placebo solution.
Researchers assessed the children at baseline, and at three, six and eight months after.
The treatment was applied at the start of the study and again at six months.
The primary endpoint was the proportion of cavities that had stopped progressing six months after the initial application.
At six months, SDF stopped 54% of cavities, compared with 22.5% in the placebo group.
At eight months, following the second application, the corresponding rates were 50.2% and 17.4% respectively.
At the three-month assessment, decay had stopped in 57.5% of cavities treated with SDF, compared with 18.8% in the placebo group.
The differences were statistically significant at all three assessments.
"This is a very effective and safe treatment, even in children as young as one," said study lead investigator Prof Dr Margherita Fontana.
The study found no significant difference in the reported tooth pain between the treatment and placebo groups.
Treatment-related adverse events were also similar, affecting 22.9% of participants in the SDF group and 22.2% in the placebo group.
However, the treatment does not rebuild damaged tooth structure, and some cavities may still require fillings or other dental procedures.
Untreated cavities can cause toothaches, infections, difficulty eating and sleeping, and missed school days.
For some young children, conventional dental treatment can also be difficult because of fear, anxiety or the need to remain still during a procedure.
SDF offers an alternative for suitable cavities because it can be applied quickly without drilling or sedation.
Researchers also see potential benefits for older adults, people with disabilities and patients who have difficulty accessing conventional dental care.
There is one important drawback: SDF permanently turns the decayed portion of a treated tooth dark, often black.
This discolouration may be particularly noticeable on front teeth, making appearance an important consideration for families.
SDF has been used in dentistry for decades.
In the US, the FDA cleared it for treating tooth sensitivity in 2014, and dentists have also used it off-label to manage cavities.
The new trial adds evidence that could support an application seeking US FDA approval specifically for stopping tooth decay.
The study received more than US$12mil (RM48.7mil) in funding from The National Institute of Dental and Craniofacial Research, part of the US National Institutes of Health.
Researchers believe wider adoption could eventually help more children receive treatment earlier, including through paediatric healthcare settings.
However, broader use will depend on regulatory decisions and how providers incorporate the treatment into care.
Not always.
SDF aims to stop decay, not restore a damaged tooth.
Some patients may need repeated applications, filings or other treatment, depending on the severity of the cavity.
For some children, it could help keep a cavity under control until a baby tooth falls out naturally.
For others, it may offer a temporary or longer-term option when conventional treatment is difficult.
The findings suggest that a treatment taking only seconds to apply could become a useful tool in cavity management.
The key is knowing when it is appropriate and ensuring that stopping decay is part of ongoing dental care, rather than a replacement for it. – dpa
