Effectiveness of Silver Diamine Fluoride for Arresting and Preventing Root Caries in Older Adults: A Systematic Review and Meta-Analysis

Purpose: Amidst increasing gingival recession, xerostomia, and poor access to restorative care, root caries has emerged as an important concern in older adults. Silver diamine fluoride (SDF) is the most applied minimally invasive approach for the arrest and prevention of caries, but there is still debate over its efficacy on teeth among geriatric individuals. This review aimed to examine the effectiveness of SDF in arresting and preventing root caries in adults aged ≥55 years compared to a placebo, no treatment, or other topical agents.
Methods: A systematic review and meta-analysis were carried out according to PRISMA 2020 guidelines and a previously registered protocol (PROSPERO CRD420251231424). A literature search in PubMed, Embase, Web of Science, and Scopus from the database inception until November 2025 was carried out. The search included studies that examined SDF for the arrest or prevention of root caries in older adults; therefore, randomized controlled trials, quasi-experimental studies, and cohort studies were considered. Study selection, data extraction, and risk of bias assessment were conducted independently by two reviewers, using RoB 2.0 and the Newcastle-Ottawa Scale. Random-effects models were used to determine the standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CI). I² was used to quantify heterogeneity, and Doi plots and the LFK index were used to assess publication bias.
Results: A total of eleven studies met the inclusion criteria (n=1,958 participants). The pooled SMD did not show any statistically significant difference between SDF and placebo for arresting root caries (SMD –0.02; 95% CI –0.15 to 0.11; I²=98.9%). Similarly, pooled dichotomous data showed no significant association between SDF and caries arrest (OR 0.60; 95% CI 0.26–1.41; I²=91.9%). Substantial heterogeneity and asymmetry in the Doi plot suggested methodological differences and potential publication bias.
Conclusion: Available evidence does not show consistent benefit of SDF over placebo or other preventive agents in arresting root caries among older adults. Considerable heterogeneity, methodological limitations, and small-study effects restrict the certainty of current findings. Well-designed multicentre randomized trials with standardized protocols, defined application intervals, and ≥24-month follow-up are required to clearly establish SDF effectiveness in geriatric populations.

Keywords: Silver diamine fluoride, root caries, older adults, geriatric dentistry, caries arrest.