Clinical Report: Efficacy of Silver Diamine Fluoride in Radiation-Induced Caries

Overview

This randomized pilot trial evaluated whether professionally applied 38% silver diamine fluoride (SDF) reduced radiation-induced caries (RIC) in patients undergoing head and neck radiotherapy. Participants received SDF or placebo before radiotherapy and at 1 and 3 months afterward, with caries outcomes assessed over 6 months.

Background

RIC is a destructive and persistent complication of head and neck radiotherapy that can progress rapidly and result in extensive tooth destruction and early tooth loss. Conventional preventive strategies have shown limited and inconsistent effectiveness. SDF combines high-concentration fluoride with antimicrobial activity and may protect irradiated teeth from demineralization and structural deterioration.

Data Highlights

• Fifty-six patients were randomly assigned to SDF or placebo, and 36 completed at least 1 follow-up visit.

• Median caries increment was significantly lower with SDF at 1 month (0.0 vs 1.0), 3 months (1.0 vs 2.0), and 6 months (2.0 vs 3.0).

• At 1 month, 72.2% of SDF recipients developed no new caries compared with 23.5% of placebo recipients.

• At 3 months, 47.1% of SDF recipients developed no new caries compared with 5.9% of placebo recipients.

• Stimulated salivary flow declined significantly in both groups, with no between-group differences.

Key Findings

• Professionally applied 38% SDF significantly reduced RIC progression over 6 months compared with placebo.

• SDF provided caries protection despite substantial declines in salivary flow.

• Gingival inflammation and oral health–related quality of life did not differ significantly between groups.

• No adverse or unanticipated treatment-related effects were reported.

• Characteristic SDF-associated discoloration occurred but was not reported as a concern by participants.

• The findings should be interpreted cautiously because this was a small, single-center pilot trial with limited follow-up.

Clinical Implications

Because SDF is quick to apply, professionally delivered, and does not depend on daily patient adherence, it may be a practical addition to oral care protocols before and after head and neck radiotherapy. Its apparent protective effect despite hyposalivation may offer an advantage in patients for whom conventional fluoride-dependent strategies are less effective.

Conclusion

Within the limitations of this randomized pilot trial, professionally applied 38% SDF significantly reduced RIC progression over 6 months compared with placebo. The findings may not be generalizable beyond the study sample and should be interpreted cautiously.

Related Resources & Content

1. Noureldin AAK, Sones A, Mendoza L, Mancl L, Milgrom P. “Effectiveness of Silver Diamine Fluoride in Preventing Radiation-Induced Caries: A Pilot Study.” JADA. 2026. doi:10.1016/j.adaj.2026.05.008.

2. Moore C, McLister C, Cardwell C, O’Neill C, Donnelly M, McKenna G. “Dental Caries Following Radiotherapy for Head and Neck Cancer: A Systematic Review.” Oral Oncol. 2020;100:104484.

3. Pedroso CM, Migliorati CA, Epstein JB, et al. “Over 300 Radiation Caries Papers: Reflections From the Rearview Mirror.” Front Oral Health. 2022;3:961594. doi:10.3389/froh.2022.961594.

4. El Harram N, Sqalli S. “Radiation-Induced Dental Caries: A Narrative Review.” Cureus. 2025;17(1):e76810. doi:10.7759/cureus.76810.

5. Worthington HV, Lewis SR, Glenny AM, et al. “Topical Silver Diamine Fluoride (SDF) for Preventing and Managing Dental Caries in Children and Adults.” Cochrane Database Syst Rev. 2024;11(11):CD012718. doi:10.1002/14651858.CD012718.pub2.

6. Rosenblatt A, Stamford TC, Niederman R. “Silver Diamine Fluoride: A ‘Silver-Fluoride Bullet.’” J Dent Res. 2009;88(2):116-125.

7. de Souza BM, Silva MS, Braga AS, et al. “Protective Effect of Titanium Tetrafluoride and Silver Diamine Fluoride on Radiation-Induced Dentin Caries In Vitro.” Sci Rep. 2021;11(1):6083.

8. Zhao IS, Gao SS, Hiraishi N, et al. “Mechanisms of Silver Diamine Fluoride on Arresting Caries: A Literature Review.” Int Dent J. 2018;68(2):67-76. doi:10.1111/idj.12320.

9. Oliveira BH, Rajendra A, Veitz-Keenan A, Niederman R. “The Effect of Silver Diamine Fluoride in Preventing Caries in the Primary Dentition: A Systematic Review and Meta-Analysis.” Caries Res. 2019;53(1):24-32.

10. Zheng FM, Yan IG, Duangthip D, Gao SS, Lo ECM, Chu CH. “Silver Diamine Fluoride Therapy for Dental Care.” Jpn Dent Sci Rev. 2022;58:249-257. doi:10.1016/j.jdsr.2022.08.001.

11. ClinicalTrials.gov. Registration No. NCT05403125.