28 February 2023

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CariedAway school-based trial prevented 80% of cavities with non-invasive treatment

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In a study of nearly 3,000 schoolchildren, silver diamine fluoride — a liquid applied with a brush to the surface of teeth to prevent cavities or keep them from getting worse — was as effective against cavities as dental sealants, the standard treatment. A single dose of either of the two topical treatments administered in elementary schools prevented about 80% of cavities and 50% of cavities from worsening when children were examined two years later, according to a news release from NYU College of Dentistry.

The results published Feb. 9, 2023, in JAMA Network Open, offer an efficient and cost-effective approach to improving children's oral health through school-based care.

Context

Tooth decay is the most common chronic disease in children, and children from low-income families are twice as likely to have cavities as those from higher-income families. Without adequate and timely intervention, cavities can lead to serious infections, reduce children's quality of life and be associated with lower academic performance and school attendance. But taking children to the dentist twice a year can be difficult, especially when parents must take time off work.

To reduce barriers to going to the dentist, some basic dental services can be offered in schools, especially those serving children from low-income families. The Centers for Disease Control and Prevention recommends dental sealants and topical fluorides as part of a school-based caries prevention program. Similarly, the World Health Organization lists silver diamine fluoride (SDF) and glass ionomer cement as essential medicines for dental caries.

Researchers at NYU School of Dentistry received funding from the Patient-Centered Outcomes Research Institute (PCORI) to conduct the largest national study of cavity prevention at school. 

CariedAway is an ongoing cluster randomized, single-blind, pragmatic noninferiority clinical trial conducted in New York City primary schools between Feb. 1, 2019, and June 1, 2023, to evaluate the effectiveness of SDF with fluoride varnish in comparison with an established, active comparator of glass ionomer sealants and atraumatic restorative treatment with fluoride varnish for dental caries.

Research process

The study involved 2,998 preschool students through third graders from 47 schools in New York City. The schools — which serve a racially diverse group of students, most of whom come from low-income families — were randomly assigned to receive a simple or more complex treatment.

After visiting each school, the clinical research team — which included a supervising dentist, dental hygienists, registered nurses and auxiliaries — performed baseline tests to measure the presence of cavities. The clinicians then applied fluoride varnish and sealants or SDF, depending on whether the school had been assigned to receive the complex or simple treatment.

Initial visits took place in 2019 and early 2020 and were interrupted when the Covid-19 pandemic temporarily shut down New York City schools and halted all attention on schools. Two years later, the schools allowed the clinical research team to resume, and returned to each school for follow-up visits.

The researchers found that both simple and complex treatments were successful: a single caries prevention treatment prevented more than 80% of caries (81% for SDF and 82% for sealants) and stopped the progression of half of cavities (56% for SDF and 46% for sealants).

"Without prevention, tooth decay grows continuously if left untreated,” said Dr. Richard Niederman, DMD, professor in the Department of Epidemiology and Health Promotion at NYU School of Dentistry, co-principal investigator of CariedAway and senior author of the study. 

“A CariedAway caries prevention treatment, administered just before schools closed during the pandemic, was extraordinarily effective over the next two years,” he said in the news release. "I don't know of any other preventive dental intervention that has had such a large beneficial impact throughout the pandemic.”

This article, based on the NYU news release, also appeared on Odontologia33. 

Ryan Richard Ruff, Tamarinda Barry-Godín and Richard Niederman. “Effect of Silver Diamine Fluoride on Caries Arrest and Prevention: the CariedAway School-Based Randomized Clinical Trial.” JAMA Netw Open. 2023;6(2):e2255458. doi:10.1001/jamanetworkopen.2022.55458