Is silver diamine fluoride effective in reducing dentin hypersensitivity? A systematic review

Background. The purpose of this systematic review was to assess the clinical efficacy (sensitivity reduction) and safety (gum damage) of silver diamine fluoride (SDF) as a tooth desensitizer for adults. Methods. The search strategy was developed and adapted from 12 databases. Two independent reviewers selected the studies in consensus with a third reviewer. Randomized clinical trials with adult volunteers affected by dentin hypersensitivity (DH), and receiving treatment with SDF were included. Studies with volunteers testing tooth whitening products, using some type of desensitizer, or taking analgesic or anti-inflammatory medication were excluded. The risk of bias was assessed according to the RoB 2 tool, and confidence in cumulative evidence, according to GRADE. Results. Only 3 articles were included. The average pain assessed using the visual analog scale was lower in the SDF groups than in the short-term control groups (24h to 7 days) (P=0.0134 and P=0.0015) of the two studies. The third study evaluated a combination of SDF and a CO2 laser, compared to using only SDF, and found no statistical difference between the two (P=0.74). Inflammation and gingival staining were also evaluated in two of the three studies. No adverse effects were reported. All the included studies had a high risk of bias, and the certainty of the evidence was very low. Conclusion. SDF can be used as a safe and effective tooth desensitizer in adults, with good results, as was achieved in a short-term follow-up. However, more studies with longer evaluation periods are required.