Caries preventive efficacy of silver diamine fluoride (SDF) and ART sealants in a school-based daily fluoride tooth brushing program in the Philippines

INTERVENTION: Intervention 1: Single application of 38% Silver Diamine Fluoride (SDF) solution (Saforide, Bee Brand Medical, Japan) on occlusal surfaces of first permanent molars. Molars were isolated with cotton rolls. Cotton pellets were used to dry the occlusal surface. SDF was applied on the occlusal surface by rubbing for one minute with a Vivabrush (Ivoclar Vivadent GmbH, Liechtenstein). Next, tannic acid (strong black tea) was applied to precipitate the SDF. Excess was removed with a dry cotton pellet. A layer of vaseline was applied to cover the SDF. Children were asked not to eat for one hour after treatment. Additional to the application of SDF solution, some of the children were participating in a daily toothbrushing with fluoride toothpaste over an 18‐months period. Intervention 2: Single application of atraumatic restaurative treatment sealant on the occlusal surface of first permanent molars. Children in the sealant group received ART glass‐ionomer cement sealants on sound occlusal surfaces of all erupted permanent first molars. The treatment was provided according to the ART sealant application procedure. A high‐viscosity material (Ketac Molar Easymix, 3M ESPE, Germany) was used strictly according to the manufacturer’s instructions. Some of the children participated in a program with daily toothbrushing with fluoride toothpaste over an 18‐months period. Intervention 3: In two schools, which served as control group, no therapy only examination was conducted. CONDITION: K02.0 ‐ Caries limited to enamel PRIMARY OUTCOME: The most important criteria is the prevention of the onset of caries by the single application of SDF or ART sealant.; ; A baseline was conducted by 8 trained and calibrated examiners in all participating schools (including control schools). Another examination took place after 18 months.; The examinations were performed outside in the school yard with sunlight as a direct light source. The children were placed in a supine position on a long classroom bench, with their heads on a pillow on the lap of the examiner, who sat behind them. Teeth were examined after drying with cotton rolls and the occlusal surface of the permanent first molars were additionally dried with cotton pellets. Examination was performed with the use of a ball‐end (CPI) probe and a plane mirror. Surfaces of the permanent first molars were recorded as sound unless caries was scored when: 1) the CPI probe could enter a cavity or 2) if the probe could not enter a small discontinuity in the enamel but a greyish appearance of the enamel was seen as a sign of undermining caries in the dentine. INCLUSION CRITERIA: Students of the participating primary schools