School-based cavity treatments help stop tooth decay in children

Two topical treatments applied to kids' cavities can stop the majority of them from progressing for years, according to a study led by NYU College of Dentistry and published in JAMA Network Open.

Treating more than 10,000 cavities in New York City elementary school students, the researchers found that both atraumatic restorations (ART) and silver diamine fluoride (SDF) kept most dental decay from worsening, supporting the use of non-surgical approaches for managing cavities.

Children miss an estimated 34 million hours of school each year due to emergency dental care. Bringing cavity prevention programs to schools can improve kids' oral health and stave off many issues that drive the need for urgent treatment, including extractions due to pain, abscess, or risk of infection.

In school-based dental programs, health professionals often use sealants-thin, protective coatings applied to the surface of children's back teeth-to safeguard against tooth decay. But few programs address existing cavities. ART can be used to stop the progression of cavities by removing tooth decay with hand instruments and applying the same protective material as sealants. SDF has also emerged as a promising tool for cavity prevention and treatment; originally approved by the FDA for treating tooth sensitivity, the liquid is brushed onto teeth to kill decay-causing bacteria and remineralize teeth to prevent further decay.

To compare the use of SDF and ART, researchers at NYU College of Dentistry led a large clinical trial in New York City elementary schools as part of their CariedAway cavity prevention program. At twice-yearly school visits, health professionals examined children's teeth and applied either ART or SDF followed by fluoride varnish to any existing cavities, depending on which treatment the school was randomly assigned to receive.

In a previous analysis of the CariedAway study, NYU researchers reported that a single treatment of either ART or SDF kept approximately 50 percent of cavities from worsening over two years.

Their latest analysis, published in JAMA Network Open, focused on more than 1,600 children ages 5 to 13 who had cavities on one or more teeth. SDF or ART were applied to the children's teeth-including more than 10,000 cavities-during biannual school visits. The students were followed for up to four years to see if their tooth decay worsened or stayed the same.

This study is our most robust analysis of these different cavity prevention techniques, as we focused on decay on each tooth surface and measured it up to four years."

Ryan Richard Ruff, PhD, MPH, associate professor of epidemiology & health promotion at NYU College of Dentistry and principal investigator of CariedAway

The researchers found that SDF and ART had similar results when applied to cavities: SDF kept 62 percent of decayed surfaces from worsening over four years, while ART controlled 55 percent.

"Offering ART or SDF in schools can help avoid the need for more invasive dental treatment and improve access to preventive care," said Tamarinda J. Barry Godín, DDS, MPH, a research scientist at NYU College of Dentistry and CariedAway project director.

Additional study authors include Aditi Ashish Gawande and Qianhui Xu of NYU. The research was funded by the Patient-Centered Outcomes Research Institute (PCS-1609-36824).