Prevention of Dental Caries by Silver Diamine Fluoride.
Prevention of Dental Caries by Silver Diamine Fluoride.
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二胺氟化银预防龋齿。
DOI：
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
M. Heima
中科院分区：
文献类型：
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作者：
J. Horst;M. Heima
由于美国最近的监管批准，使用氟化二胺银（SDF）治疗龋齿引起了相当大的关注。政策、演示和出版物的主要焦点一直是阻止龋齿病变（龋洞），因为该材料具有非侵入性地实现这一难以捉摸的临床重要目标的独特能力。然而，SDF在预防方面也被证明是有效的，即降低新龋齿病变的发生率。对9项儿童临床试验的分析表明，与对照组相比，SDF预防了61%的新病变。为了防止一个新的龋齿病变，临床医生需要用SDF治疗4个乳牙（1名患者）或12.1个恒磨牙（3名患者）。预防效果似乎是即时的，并随着时间的推移保持在相同的分数。直接比较SDF每年应用一次与替代治疗表明，SDF比其他局部氟化物更有效，每年放置两到四次，比牙科密封剂更具成本效益。牙釉质病变可能比牙本质空洞病变更敏感。对于有任何新龋齿病变风险的患者，每年在高风险表面（例如，永久第一磨牙的近中面，其中第二乳磨牙的远中面有龋齿）应用SDF似乎是预防龋齿的最具成本效益的方法。SDF是一种未充分利用的循证龋齿预防剂。
The use of silver diamine fluoride (SDF) for management of dental caries has gained considerable attention due to recent regulatory clearance in the United States. The primary focus of policies, presentations, and publications has been the arrest of caries lesions (cavities) because of the material's unique ability to non-invasively achieve this elusive and clinically important goal. However, SDF also has proven efficacy in prevention, ie, decreasing the incidence of new caries lesions. Analysis of nine clinical trials in children shows that SDF prevented 61% of new lesions compared to controls. To prevent one new caries lesion, clinicians need to treat four primary teeth (one patient) or 12.1 permanent molars (three patients) with SDF. The preventive effect appears to be immediate and maintains at the same fraction over time. Direct comparisons of SDF applied once per year with alternative treatments show that SDF is more effective than other topical fluorides placed two to four times per year and more cost-effective than dental sealants. Enamel lesions may be even more responsive than cavitated dentin lesions. Annual application of SDF to high-risk surfaces (eg, mesial surfaces of permanent first molars where the distal surface of the second primary molar is carious) in patients with any risk of new caries lesions appears to be the most cost-effective approach available to prevent dental caries. SDF is an underutilized evidence-based preventive agent for dental caries.