Drill-free treatment permanently stops tooth decay in schoolchildren

Ryan Ruff and colleagues at New York University conducted a large clinical trial and found that conservative methods - silver diamine fluoride application and atraumatic restorative treatment - are about equally effective and permanently halt the progression of superficial caries in children. The cluster-randomized CariedAway trials enrolled 1,668 children aged 5 to 13 years at the time of inclusion (mean 6.8 years; 52.8 percent were girls). They all had at least one superficial carious tooth defect. Based at 48 school sites, 861 of them had silver diamine fluoride applied to their teeth; the remaining 806 received atraumatic restorative treatment (cleaning the defect with hand instruments without drilling and sealing with cementum). The results are published in the journal JAMA Network Open.

The follow-up period for the participants was up to four years. During this time, recurrences of superficial carious defects occurred in 38.3 and 45.5 percent of cases after application of diamine silver fluoride and atraumatic restorative treatment, respectively (risk difference statistically insignificant). A significant difference was observed in the proportion of participants who had at least one relapse (45.5 versus 53.3 percent), but not in the risk of recurrence. The results support conservative secondary prevention of dental caries in schools.