Silver Diamine Fluoride Versus Sodium Fluoride Varnish for Arresting Early Childhood Caries

Introduction: Early childhood caries is the most prevalent chronic disease of childhood, and minimally invasive fluoride agents are increasingly used to arrest cavitated lesions without the need for sedation or general anesthesia. Methods: This systematic review followed the PRISMA 2020 statement and searched PubMed, OpenAlex and Crossref for comparative studies published between 2015 and 2023 that compared 38% silver diamine fluoride with 5% sodium fluoride varnish for arresting carious lesions in children with early childhood caries. Risk of bias was assessed with RoB 2 and ROBINS-I, and the results were synthesized narratively. Results: Five studies with 609 children were included, comprising four randomized trials and one prospective comparative study. For cavitated dentine lesions, silver diamine fluoride arrested more lesions than fluoride varnish, with arrest rates of 60.3% versus 50.0% in advanced lesions in one trial and 86.7% versus 13.3% in another, and lower failure rates at 12 months in two further trials. For enamel lesions the two agents were comparable, with 18-month arrest rates of 59.1% and 58.8%. Conclusions: Silver diamine fluoride appears superior to sodium fluoride varnish for arresting cavitated dentine lesions, whereas the two agents perform comparably on enamel lesions. The evidence is limited by the small number of studies and heterogeneous outcome definitions.