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Managing root caries with silver diamine fluoride, sodium fluoride and direct restorations: A cost-effectiveness analysis
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Date
2025-09-13
Authors
Hu, Shijia
Hong, Catherine Hsu Ling
Gao, Xiaoli
Wee, Hwee-Lin
Wang, Yi
Lai, Bien Wen Pui
Ho, Shenna Yu-En
Allen, Patrick Finbarr
Tan, Sharon Hui Xuan
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier Ltd.
Published Version
Abstract
Objective: To assess the cost-effectiveness of silver diamine fluoride (SDF) relative to sodium fluoride (NaF) and traditional resin-modified glass ionomer cements (RMGIC) restorations for the management of root caries in older adults aged 60 and above. Methods: A Markov model design was chosen and two models were constructed: 1) Clinic-based model - with access to dental facility that allows for placement of traditional restorations, 2) Community-based model - without access to dental facility due to mobility, lack of executive function, or financial barriers. Modelling was done over a 10-year time horizon with a cycle length of one year. Data on transition probabilities and relative risks were obtained from published literature for the base case. Outcomes of interest were incremental cost per incremental caries-controlled year and incremental cost per incremental extraction-free year. Probabilistic sensitivity analyses were conducted to account for uncertainty in the base case. Results: In the clinic-based model, both SDF and NaF were dominated by traditional RMGIC restorations, which had lower cost, and higher number of caries-controlled and extraction-free years, with a 90% probability of being cost-effective. In the community-based model, NaF was dominated by SDF, which incurred lower cost and resulted in a higher number of caries-controlled and extraction-free years, with almost 100% probability of being cost-effective. Conclusions: Traditional RMGIC restoration was the most cost-effective option for managing root caries when full dental facility is available. In situations where treatment is provided in a community setting, SDF was more cost-effective than NaF. CLINICAL SIGNIFICANCE: Based on limited clinical studies and within the Singapore oral health system, traditional RMGIC restoration was most cost-effective in clinical settings for managing root caries, while SDF was most cost-effective in community settings.
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Keywords
Cost-effectiveness analysis , Fluoride , Geriatric dentistry , Root caries , Silver diamine fluoride
Citation
Hu, S., Hong, C. H. L., Gao, X., Wee, H. L., Wang, Y., Lai, B. W. P., Ho, S. Y. E., Allen, P. F. and Tan, S. H. X. (2025) 'Managing root caries with silver diamine fluoride, sodium fluoride and direct restorations: A cost-effectiveness analysis', Journal of Dentistry, 162, p.106093 (7pp). https://doi.org/10.1016/j.jdent.2025.106093