Stopping tooth decay

A new systematic review examined a dental technique, SDF-ART (or SMART technique), which combines two treatments: Silver Diamine Fluoride (SDF) and Atraumatic Restorative Treatment (ART). It aimed to determine how well SDF-ART stops or slows down tooth decay in both children and adults.

Silver Diamine Fluoride is a liquid that helps stop tooth decay and strengthen the tooth. Atraumatic Restorative Treatment is a simple, drill-free way to fill cavities. The idea behind SDF-ART is to apply Silver Diamine Fluoride to a cavity and then cover it with a filling (like Glass Ionomer Cement or GIC) to stop decay, help the tooth heal, and hide the black discoloration that Silver Diamine Fluoride can cause.

The systematic review’s findings showed no significant difference in how well SDF-ART stopped decay compared to ART alone at both 12-month and 24-month check-ups. SDF-ART does not appear to be superior at arresting decay than ART by itself.

It should be noted that the systematic review found limited research on the effectiveness of the SDF-ART technique. Also, most studies focused on primary (baby) teeth.

Therefore, more robust clinical trials with larger groups of participants and longer follow-up times, especially in permanent teeth and adult populations, are necessary to draw more definitive conclusions.

Even if SDF-ART is not clinically proven to be superior in stopping decay, the SMART technique has practical benefits: it generally requires less total treatment time and is more economical than ART alone.

These practical advantages make SDF-ART a patient-friendly and cost-effective alternative treatment option, especially for children, adults facing physical or behavioural challenges, and those in underserved communities who might have limited access to dental care.

The systematic review is available in the July 2025 issue of JBI Evidence Synthesis: Effectiveness of silver diamine fluoride application with atraumatic restorative treatment in arresting the progression of dental caries in children and adults.