Comparative Evaluation of the Cariostatic and Antibacterial Efficacy of Nano Silver Fluoride With Silver Diamine Fluoride in Children With Special Health Care Needs: A Randomized Controlled Clinical Trial.

Introduction Dental caries remains a significant public health concern, particularly among children with special health care needs, who are at increased risk due to challenges in oral hygiene maintenance and limited access to dental care. Silver diamine fluoride (SDF) is widely used to arrest caries but is associated with undesirable black staining. Nano silver fluoride (NSF) has been introduced as a potential alternative, offering effective caries management without aesthetic drawbacks. Hence, this randomized controlled clinical trial aimed to evaluate and compare the cariostatic and antibacterial efficacy of NSF and SDF in children with special health care needs (CSHCN) aged 4-12 years. Methods Forty-two children with mild to moderate intellectual disability (IQ 40-70) and 3-4 active carious lesions were randomized into two groups: Group 1 received SDF and Group 2 received NSF. Saliva samples were collected at baseline and after one month to assess Streptococcus mutans and Lactobacillus counts. Clinical evaluation of caries arrest was performed at one, three, and six months. Results Both SDF and NSF significantly reduced the number of active carious lesions and salivary bacterial counts within groups (p < 0.001), with no statistically significant difference between groups at any interval (p > 0.05). NSF demonstrated comparable efficacy to SDF in both primary and permanent teeth. Notably, NSF did not cause black staining, offering a more aesthetic option, especially for anterior teeth. Conclusion NSF is an effective, safe, and visually favorable alternative to SDF for caries management in CSHCN.