Preventing Caries with Silver Diamine Fluoride

NCT ID: NCT04399369

Last Updated: 2024-09-25

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 688 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2020-10-22
• Study Completion Date: 2023-10-11

Brief Summary

Background: Early childhood caries (tooth decay, ECC) affected 55% 5-year-old Hong Kong children, and 70% of these children had gross destruction of the upper anterior teeth with negative long-term impacts on health and quality of life. The existing standard of care for prevention of ECC, topical application of 5% sodium fluoride (NaF) varnish, is inadequate. In Hong Kong and other parts of the world, 38% silver diamine fluoride (SDF) solution, applied topically to cavities, is used to arrest ECC. Work published by our research group suggests it likely also has a preventive effect of ECC. Moreover, SDF has been shown to be preventive in tooth decay in permanent teeth. Nevertheless, no pivotal clinical trial has been performed to support a change in usual practice.

Aim: This is a Phase II single-centre randomized, double-blind, active-controlled, parallel-group pragmatic trial with two arms to assess the effectiveness of 38% SDF and 5% NaF in preventing new caries lesions in primary anterior teeth. Methods: 688 three-year-old kindergarten children who are healthy will be recruited, stratified by school, and block randomized to receive either 38% SDF (treatment group) or 5% NaF (standard treatment group) therapy on primary upper anterior teeth. This sample size is sufficient for a superiority trial with power at 90%, allowing for a 15% dropout rate. The primary outcome is the number of sound tooth surfaces that become cavitated caries per child at 12-month follow-up. The secondary outcome is the number of carious tooth surfaces developed after baseline that become arrested at 12-month for each child. Dental examinations for the status of caries (active or arrested) will be conducted by the same calibrated examiner. The examiner, children and children's parents will be blind to treatment allocation. Parents will be surveyed to study the children's oral health-related behaviours and socioeconomic backgrounds, which will allow the adjustment for effect modification. Possible results and implications: If the results are as anticipated, it will help change the standard of care for caries prevention. If adopted in Hong Kong, SDF therapy will prevent 20,800 (13% of the 160,000) kindergarten children from having caries developed in their anterior teeth, thus reduce significantly the burden of ECC of the children and related stress of their family. Moreover, the results will be widely available and increase adoption of SDF in other countries to reduce the global burden of ECC among children.

Conditions

Dental Caries

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: TRIPLE

Study Groups

SDF

38% silver diamine fluoride solution

Group Type: EXPERIMENTAL

SDF

Intervention Type: DEVICE

38% silver diamine fluoride solution

NaF

5% sodium fluoride varnish

Group Type: ACTIVE_COMPARATOR

NaF

Intervention Type: DEVICE

5% sodium fluoride varnish

Interventions

SDF

38% silver diamine fluoride solution

Intervention Type: DEVICE

NaF

5% sodium fluoride varnish

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• generally healthy, with parental consents

Exclusion Criteria

• uncooperative and difficult to manage, have major systemic diseases such as porphyria, or are on long-term medication such as anti-epileptic drugs.

• Minimum Eligible Age: 3 Years
• Maximum Eligible Age: 4 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

The University of Hong Kong

OTHER

Sponsor Role: lead

Responsible Party

Chun Hung Chu

Clinical Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Local kindergartens

Hong Kong, , Hong Kong

Countries

Hong Kong

References

Zheng FM, Yan IG, Duangthip D, Lo ECM, Gao SS, Chu CH. Caries Prevention Using Silver Diamine Fluoride: A 12-Month Clinical Trial. Int Dent J. 2023 Oct;73(5):667-673. doi: 10.1016/j.identj.2022.12.005. Epub 2023 Jan 20.

Reference Type: DERIVED

PMID: 36682908 (View on PubMed)

Gao SS, Zheng FM, Chen KJ, Duangthip D, Lo ECM, Chu CH. Comparing two fluoride therapies for caries management in young children: study protocol for a randomised clinical trial. Trials. 2021 Aug 4;22(1):519. doi: 10.1186/s13063-021-05496-y.

Reference Type: DERIVED

PMID: 34348775 (View on PubMed)

Other Identifiers

20200520

Identifier Type: -

Identifier Source: org_study_id