Effectiveness of Silver Diamine Fluoride and Fluoride Varnish in Arresting Caries Lesions in Permanent Molars: A Randomized Controlled Trial

This study aimed to compare the efficacy of 38% silver diamine fluoride (SDF) and 5% fluoride varnish (FV) in arresting caries lesions in first permanent molars, considering their eruption status as a secondary clinical factor. A randomized, controlled, blinded clinical trial was conducted with 165 children (6–12 years). A total of 660 first permanent molars were assessed; 139 teeth with ICDAS scores 1 or 2 were included for analysis. Participants were assigned via cluster randomization (school-level) to G1 (38% SDF + KI) or G2 (5% FV). Follow-up assessments were conducted after six months to evaluate caries arrest using ICDAS criteria. After six months, 88.1% of teeth in the SDF group (G1) reached an ICDAS score of 0, compared to 65.6% in the FV group (G2) (p < 0.001). The stage of molar eruption did not significantly influence the outcomes in either group (p = 0.99). Both treatments significantly reduced ICDAS scores from baseline (p < 0.001), but SDF demonstrated superior effectiveness. 38% SDF is more effective than 5% fluoride varnish in arresting early-stage occlusal caries lesions in first permanent molars, regardless of the eruption stage. SDF offers a highly effective, non-invasive, single-session alternative for managing early caries in permanent molars. Its efficacy is maintained even in partially erupted teeth, making it a practical tool for public health programs and pediatric clinical practice.