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. 2025 Jun 23;17(6):e86611.
doi: 10.7759/cureus.86611. eCollection 2025 Jun.

Comparative Evaluation of the Cariostatic and Antibacterial Efficacy of Nano Silver Fluoride With Silver Diamine Fluoride in Children With Special Health Care Needs: A Randomized Controlled Clinical Trial

Anija C K  1 , Nupur Ninawe  1 , Shivani Sawant  1 , Rashmi A Dongarwar  1 , Anuradha V Khade  2 , Hemraj Badhe  3
Affiliations

Comparative Evaluation of the Cariostatic and Antibacterial Efficacy of Nano Silver Fluoride With Silver Diamine Fluoride in Children With Special Health Care Needs: A Randomized Controlled Clinical Trial

Anija C K et al. Cureus. .

Abstract

Introduction Dental caries remains a significant public health concern, particularly among children with special health care needs, who are at increased risk due to challenges in oral hygiene maintenance and limited access to dental care. Silver diamine fluoride (SDF) is widely used to arrest caries but is associated with undesirable black staining. Nano silver fluoride (NSF) has been introduced as a potential alternative, offering effective caries management without aesthetic drawbacks. Hence, this randomized controlled clinical trial aimed to evaluate and compare the cariostatic and antibacterial efficacy of NSF and SDF in children with special health care needs (CSHCN) aged 4-12 years. Methods Forty-two children with mild to moderate intellectual disability (IQ 40-70) and 3-4 active carious lesions were randomized into two groups: Group 1 received SDF and Group 2 received NSF. Saliva samples were collected at baseline and after one month to assess Streptococcus mutans and Lactobacillus counts. Clinical evaluation of caries arrest was performed at one, three, and six months. Results Both SDF and NSF significantly reduced the number of active carious lesions and salivary bacterial counts within groups (p < 0.001), with no statistically significant difference between groups at any interval (p > 0.05). NSF demonstrated comparable efficacy to SDF in both primary and permanent teeth. Notably, NSF did not cause black staining, offering a more aesthetic option, especially for anterior teeth. Conclusion NSF is an effective, safe, and visually favorable alternative to SDF for caries management in CSHCN.

Keywords: antibacterial efficacy; caries arrest; cariostatic effect; nano silver fluoride; nsf; sdf; silver diamine fluoride; special children.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, Government Dental College and Hospital, Nagpur issued approval GDCHN/SS/PG/Ethic.Com. (Meet/09/14/2023). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Intellectual property info: Copyright. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Clinical photographs before and after the application of SDF
(a) Preoperative photograph with caries wrt 51, 52, 61, 62; (b) 1-month follow-up showing arrested caries wrt 51, 52, 61, 62; (c) 3-month follow-up showing arrested caries wrt 51, 52, 61, 62; (d) 6-month follow-up showing arrested caries wrt 51, 52, 61, 62 SDF: silver diamine fluoride
Figure 2
Figure 2. Clinical photographs before and after the application of NSF
(a) Preoperative photograph with caries wrt 84; (b) 1-month follow-up showing arrested caries wrt 84; (c) 3-month follow-up showing arrested caries wrt 84; (d) 6-month follow-up showing arrested caries wrt 84 NSF: nano silver fluoride
Figure 3
Figure 3. Microbiological evaluation for Streptococcus mutans and Lactobacilli in group 1 (SDF)
(a) Mutans streptococci before the application of SDF; (b) Lactobacilli before the application of SDF; (c) Streptococcus mutans one month after the application of SDF; (d) Lactobacilli one month after the application of SDF SDF: silver diamine fluoride
Figure 4
Figure 4. Microbiological evaluation for Streptococcus mutans and Lactobacilli in Group 2 (NSF)
(a) Streptococcus mutans before the application of NSF; (b) Lactobacilli before the application of NSF; (c) Streptococcus mutans one month after the application of NSF; (d) Lactobacilli one month after the application of NSF NSF: nano silver fluoride
Figure 5
Figure 5. CONSORT flow diagram of the study
CONSORT: Consolidated Standards of Reporting Trials
See this image and copyright information in PMC

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