Effectiveness of Silver Diamine Fluoride on Streptococcus mutans and Lactobacillus: A Systematic Review

Abstract

Objective: This systematic review evaluated the efficacy of silver diamine fluoride (SDF) at various concentrations, follow-up intervals, and in combination with other agents in reducing Streptococcus mutans (S. mutans) and Lactobacillus, as well as comparing its effectiveness with other antimicrobial agents.Material and Methods: A systematic search was conducted in Scopus, Web of Science, Cochrane Library, PubMed, and Google Scholar for studies published up to 31 December 2023. Eligible studies included both in vitro and clinical studies evaluating the effects of SDF on S. mutans and Lactobacillus. Extracted data included SDF concentration, follow-up interval, and antibacterial outcomes. The risk of bias was assessed using the appropriate tools, according to the study design. Results: Twenty-four studies met the inclusion criteria. In vitro studies consistently demonstrated the strong antibacterial effects of SDF, with increased efficacy at higher concentrations. Clinical studies reported significant reductions in S. mutans and Lactobacillus for up to six months post-treatment. When compared to other agents, SDF showed comparable or superior antibacterial efficacy. Most studies showed a moderate to high risk of bias. Conclusion: SDF demonstrated significant antibacterial activity against S. mutans and Lactobacillus in both laboratory and clinical studies. Its efficacy is influenced by factors such as concentration, follow-up interval, and combination with other agents. Despite methodological variability limiting the certainty of evidence, the current findings support SDF as an effective antibacterial agent against cariogenic bacteria. Further well-designed and standardised clinical trials with longer follow-up periods are needed to strengthen the evidence base and validate its comparative effectiveness in caries management.