Is silver diamine fluoride more effective than sodium fluoride varnish at preventing caries in upper anterior primary teeth?

A COMMENTARY ON: Zheng F M, Yan I G, Duangthip D, Lo E C M, Gao S S, Chu C H. Randomized clinical trial on caries prevention of silver diamine fluoride. J Dent Res 2025; https://doi.org/10.1177/00220345251363837 . DESIGN: This randomised controlled trial sought to compare the effectiveness of silver diamine fluoride (SDF) to sodium fluoride varnish (NaF) for the prevention of caries in anterior primary teeth for young children. The inclusion criteria were children aged 3-4 years of age. Children were excluded if they had co-operative challenges or were on long-term medications. Children with active caries were included, lesions were considered active if they were soft on probing. The setting was kindergartens in Hong Kong. The children received either 38% SDF or 5% NaF applied to their six upper anterior primary teeth at six-monthly intervals. The primary outcome measure was the mean number of new carious surfaces per child at 30 months follow-up. Intention-to-treat analysis was used with the Mann-Whitney U test applied for the analysis of the primary outcome. RESULTS: Overall, 730 children were randomised, 621 (85%) were followed up and analysed at the 30 months end point for the presence of new carious surfaces (dmfs). Not all children seen at baseline were analysed, however of those that were their caries experience was similar with a mean dmfs of 0.47 ± 1.35 for the SDF group and 0.48 ± 1.53 for the NaF group. At 30 months, there were less new lesions for those in the SDF group (0.35 ± 1.09), than the NaF group (0.54 ± 1.50) (p = 0.048). CONCLUSIONS: The authors concluded that SDF was more effective than NaF in preventing new carious surfaces at 30 months for anterior caries in primary teeth of young children.