Background:Dental caries remains one of the most prevalent chronic diseases worldwide, affecting both primary and
permanent dentitions. Silver diamine fluoride (SDF) has emerged as a non-invasive, cost-effective, and efficient agent
for caries arrest and prevention.
Objective: To systematically review and synthesize current evidence on the clinical efficacy, safety, and practical
applications of SDF in both pediatric and adult populations.
Materials and Methods:A systematic review was conducted following PRISMA guidelines. Electronic databases
including PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched up to October
2025. Inclusion criteria encompassed randomized controlled trials, clinical studies, systematic reviews, and in-vitro
studies evaluating SDF in humans. Data extraction included study characteristics, population, SDF concentration,
outcomes, and adverse effects. Quality assessment was performed using the Cochrane Risk of Bias tool, ROBINS-I,
and AMSTAR 2. Quantitative synthesis was performed on 18 studies using meta-analysis to evaluate caries arrest
efficacy.
Results:Thirty studies were included in qualitative synthesis, with 18 qualifying for meta-analysis. SDF demonstrated
consistent caries-arresting efficacy across primary and permanent teeth, with odds ratios ranging from 2.80 to 3.80 for caries arrest compared to controls. Biannual application and use in pediatric populations yielded particularly high
success rates. Laboratory and adjunctive studies confirmed chemical stability, antimicrobial properties, and minimal
adverse effects, with tooth discoloration being the main esthetic concern, mitigated by potassium iodide or glutathione.
Risk of bias assessment showed 18 studies with low risk, 8 with some concerns, and 4 with high risk.
Conclusion:SDF is a highly effective, safe, and non-invasive intervention for the prevention and arrest of dental
caries. Its ease of application, low cost, and suitability for high-risk populations make it a valuable tool in both clinical
and community dental settings.
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