Abstract
BACKGROUND: Dental caries remains a widespread global health challenge, prompting the exploration of alternative fluoride agents. This systematic review evaluates the efficacy of nano-silver fluoride (NSF), silver diamine fluoride (SDF), titanium tetrafluoride (TiF4), and sodium fluoride varnish (NaF) in caries prevention and arrest. METHODS: A systematic search of PubMed, Scopus, and Web of Science was conducted to identify studies published between 2010 and 2024. Inclusion criteria focused on randomized controlled trials, clinical studies, and in vitro investigations comparing alternative fluoride agents. Data on caries arrest rates, enamel remineralization, biofilm inhibition, and adverse effects were extracted and analyzed. RESULTS: NSF demonstrated superior enamel microhardness and reduced microleakage without staining. SDF showed high caries arrest rates (95-98%) but caused black staining of treated lesions. TiF4 effectively increased acid resistance and reduced biofilm activity, outperforming NaF in specific applications. NaF, while cost-effective and widely accessible, was less effective for advanced caries compared to SDF and NSF. CONCLUSION: Alternative fluoride agents, such as NSF and TiF4, offer promising results in caries prevention and management, addressing limitations of traditional fluoride treatments. Further clinical trials are needed to validate these findings for broader implementation.