Silver diamine fluoride: a caries "silver-fluoride bullet"

Nanomaterial-based synergistic strategies for combating dental caries: progress and perspectives

Dental caries, as the predominant global oral disease, remains a critical public health issue worldwide, particularly in socioeconomically disadvantaged communities. However, common caries prevention approaches (e.g., oral health education, mechanical plaque removal, and delivery of fluoride agents) are still insufficient for optimal caries management, and therefore, alternative regimens that can supplement existing strategies are highly warranted. Nanomaterials exhibit considerable potential in combating cariogenic pathogens and biofilms owing to their promising antimicrobial capacity, improved penetration into biofilms, targeted precision delivery, and versatile physicochemical properties. As unifunctional materials are limited in caries management, this review underscores the latest advancement in multifunctional anti-caries nanomaterials/nanomedicines. It highlights the cutting-edge materials developed or engineered to (i) incorporate diagnostic capabilities to prevent caries at an early stage, thus enhancing treatment efficiency, (ii) integrate mechanical "brushing" with anti-caries approaches to mechanochemically eradicate biofilms, (iii) exert antimicrobial/antibiofilm effects while preserving dental hard tissue. The current work also outlines future directions for optimizing nanosystems in the management of dental caries while emphasizing the need for innovative solutions to improve preventive and therapeutic efficacies.

The Protective Effects of Silver Fluoride Solution and Fluoride Varnish on Dental Erosion-An In Vivo Study

Objectives: Dental erosion has evolved into a common condition with growing concern in the dental community. The aim of this study was to explore the protective effects of two highly fluoridated products, silver fluoride solution (silver diamine fluoride-potassium iodide solution, SDF-KI) and fluoride varnish, on dental erosion in mouse. Methods: Two groups of ten young CD-1 mouse were given a cola drink ad libitum over a 6-week period. A prophylactic treatment with a silver fluoride solution (38% SDF 48,000 ppm F with a silver concentration of 253,900 ppm) and a fluoride varnish (NaF, 22,600 ppm F) were applied on the mandibular molars, performed under sedation twice a week during the whole experiment. Furthermore, two control groups of ten mice were included, a positive (cola drink) and a negative (distilled water) control. A terminal procedure was followed by dissection of mandibular molars and analysis of them using scanning electron microscopy (SEM). The first molars were transversely ground, further analyzed by SEM, and measured for tooth height and tooth tissue loss. Results: Analyses of mandibular molars treated with a fluoride varnish indicated a 5% decreased tooth tissue loss, compared to the molars which served as a positive control. The best effect was achieved with the application of silver fluoride solution, displaying a 35% decreased tooth tissue loss compared to the positive control group. Conclusions: Preventive treatment with a solution of silver fluoride solution exhibits greater protection against dental erosion compared to a traditional fluoride varnish. This study indicates that silver fluoride solution is an effective fluoride compound and is highly beneficial in a clinical setting with the aim of preventing dental erosion.

Silver Diamine Fluoride to Arrest Dentine Caries of Permanent Teeth in People with Intellectual Disability

BACKGROUND

This study aimed to compare the effectiveness of 38% silver diamine fluoride (SDF) with different application frequencies in arresting dentine caries of permanent teeth in people with intellectual disabilities (ID) and evaluated their treatment cooperation.

METHODS

Forty-six people with ID (aged 6-30 years) with at least one permanent dentine caries were assigned to two groups: Group 1 (N = 23, 51 teeth) received semiannual applications, while Group 2 (N = 23, 61 teeth) received once a week for 3 consecutive weeks, followed by one application semiannually. Caries activity and Frankl behaviour rating scales were assessed at baseline, 6, and 12 months. Chi-squared, Fisher's exact, and multilevel logistic regression analyses were performed.

RESULTS

At 6 months, the between-group difference in caries-arresting rate was not statistically significant (14.0%, 95% CI: -0.7%, 28.7%). At 12 months, unadjusted analysis showed significantly higher caries-arresting rates in Group 2 compared to Group 1 (difference: 18.9%, 95% CI: 2.5%,35.3%). However, multilevel logistic regression revealed no significant differences between groups at both time points. No subjects showed behaviour deterioration; behaviour improvement was observed in 37.5% of Group 1 and 57.1% of Group 2 at 12 months.

CONCLUSION

Overall, 38% SDF is effective in arresting dentine caries in people with ID without a significant difference in application frequency. Applying 38% SDF does not negatively impact behaviour in people with ID and may promote positive behavioural changes.

An updated look at the use of silver diamine fluoride in U.S. dental schools' predoctoral curriculum-a survey

This survey aimed to update Silver Diamine Fluoride (SDF) use/teaching in U.S. predoctoral dental education programs in comparison to a 2016 survey, considering the COVID-19 pandemic. An online survey via email was sent to all accredited U.S. predoctoral dental education programs (n = 68) in January 2022. A total of 39 schools (57% response rate) responded to the survey, and all 39 of them reported that SDF was now part of their curriculum, significantly different (p < 0.001) from 2016 (68% of schools). Significant changes (p < 0.001) were reported in the survey responses from 2016 to 2022, particularly in how SDF was being taught (97% teaching didactically and clinically vs. 48% in 2016), but were not necessarily a response to the COVID pandemic. Schools report teaching more indications for the use of SDF and using more specific protocols with more schools teaching arresting caries in permanent teeth (97% vs. 78% in 2016). Since 2016, the use and teaching of SDF have been increasingly adopted across U.S. dental schools, though there remains room for improvement in terms of consistent implementation, specific clinical protocols, and comprehensive training.

Tooth Discoloration from 2 Silver Fluorides Used in Adults with Special Needs: A Randomized Trial

BACKGROUND

Discoloration of carious lesions after application of silver diamine fluoride lowers patient acceptance and limits its wider use for caries arrest.

OBJECTIVE

To assess lesion and tooth color changes from 2 novel silver fluoride (AgF) products and its relationship to caries activity (clinical visuo-tactile scores) and bacterial load (using laser fluorescence with the DIAGNOdent).

METHODS

A split-mouth design was followed, with matched smooth surface carious lesions in the same arch in adults with special needs randomized for 1-min treatments with AgF/potassium iodide (KI) (Riva Star Aqua, SDI) and AgF/stannous fluoride (SnF2) (Caries Status Disclosing Solution; Whiteley). Standardized images taken at baseline, immediately postoperatively, and at 3-mo review were subjected to digital image analysis to calculate delta-E and to track changes in luminosity of carious lesions.

RESULTS

Twelve participants were recruited in the study. A total of 56 teeth (28 pairs) were included. Significantly greater changes were seen in treated lesions than in the adjacent noncarious natural tooth structure, both immediately after treatment and at the 3-mo review (P < 0.0001). Color change and caries activity were not affected by tooth type, tooth location, plaque status, salivary status, or special needs condition. AgF/SnF2 caused transitory darkening immediately on application, while AgF/KI caused the immediate formation of yellow deposits (silver iodide). Both products caused significant darkening of treated lesions at 3 mo (P = 0.0009; P = 0.0361), with no differences between them (P = 0.506). Responding lesions showed larger and more perceptible color changes immediately after either AgF application (P = 0.002; P = 0.024).

CONCLUSIONS

Both AgF products were highly effective for caries arrest in this patient population. Despite minor differences in the appearance of treated lesions at the time of application, both products lead to similar darkening of treated sites at 3 mo.

KNOWLEDGE TRANSFER STATEMENT

This study shows the usefulness of silver fluoride used in conjunction with potassium iodide or stannous fluoride for achieving caries arrest in smooth surface lesions in adults with special needs. Patients need to be informed that long-term staining of the lesion occurs with both, similar to silver diamine fluoride.

Effect of application of dental varnishes on the properties and chemical composition in irradiated teeth

AIMS

To analyze the protective properties of fluor dental varnishes in teeth subjected to radiotherapy.

METHODS AND RESULTS

Eighty teeth were irradiated with a single dose of 60 Gy. Samples were randomized, and the following groups were made: negative control (n = 16); irradiation control (n = 16); irradiation + Duraphat (n = 16); irradiation + Mi Varnish (n = 16); and irradiation + Rivastar (n = 16). Energy dispersive x-ray (EDX) analysis and Raman spectrometry were performed to analyze the elemental composition and enamel's chemical structure. The Mi Varnish group presented a lower value (p < .05) in the Ca/F ratio than the other groups. Duraphat group presents differences (p < .05) in the ratio 1070 cm1-960 cm-1 compared to all the other groups.

CONCLUSION

Based on these in vitro results, the different varnishes used showed a similar preventive effect on the lesions produced by radiotherapy, with none standing out over the others.

Remineralization and bacterial inhibition of early enamel caries surfaces by carboxymethyl chitosan lysozyme nanogels loaded with antibacterial drugs

OBJECTIVE

This study aimed to develop dual-functional CMC-LYZ-ACP nanogels. Three different antibacterial substances, tea polyphenols (TPs), silver nitrate (AgNO3), and chlorhexidine (CHX) are then combined to form three dual-functional CMC-LYZ-ACP nanogels for remineralization and antibacterial purposes.

METHODS

An in vitro model of Streptococcus mutans biofilm was established to analyze the inhibitory effect of the antibacterial-remineralizing dual-functional nanogels on the biofilm. And the nanogels were applied to the surface of demineralized enamel to assess their remineralization efficacy.

RESULTS

The three remineralization-antibacterial dual-functional CMC-LYZ-ACP nanogels exhibited stable particle sizes within 200 nm and were all negatively charged nanospherical structures. They demonstrated significant inhibitory effects against Streptococcus mutans and achieved good remineralization outcomes both in vitro and in vivo.

CONCLUSION

The incorporation of the three antibacterial agents (AgNO3, TPs, CHX) endowed the CMC-LYZ-ACP nanogels with excellent antibacterial properties, inhibiting the growth of plaque biofilms while maintaining their potent remineralization capabilities.

CLINICAL SIGNIFICANCE

Remineralizing demineralized enamel while inhibiting biofilm adhesion and formation of caries-inducing bacteria can block caries and provide new strategies for early enamel caries treatment.

Arresting Early Childhood Caries with Silver Diamine Fluoride Gel Among Preschool Children: Protocol for a Randomised Clinical Trial

Background: The World Health Organisation (WHO) included silver diamine fluoride (SDF) in the WHO Model List of Essential Medicines for the management of early childhood caries. SDF is typically available as a 38% aqueous solution, which is watery to apply. A 38% SDF gel has recently been developed, but its caries-arrest effectiveness remains unsubstantiated. The objective of this study is to determine whether the efficacy of a 38% SDF gel is non-inferior to a 38% SDF solution in arresting early childhood caries. Methods: This is a 30-month, randomised, active-controlled, parallel-group non-inferiority pragmatic clinical trial with two arms. The hypothesis is that the 38% SDF gel is not worse than the 38% SDF solution by a non-inferiority margin of 10% caries-arrest rate when applied semi-annually to preschool children. This trial will recruit 630 3-year-old kindergarten children through block randomisation to receive either an application of SDF gel or SDF solution on cavitated carious lesions in their primary teeth every 6 months. The primary outcome is the proportion of soft (active) carious tooth surfaces that turn hard (arrested) at the 30-month follow-up. The same calibrated dentist will conduct 6-monthly dental examinations in the kindergartens to assess the status of carious lesions over 30 months. The examiner, the children, and parents will be blinded to treatments. The parents will be surveyed on their child's oral health-related behaviours and socioeconomic background to allow adjustment for effect modification. Results: If the anticipated results are obtained, clinicians can use the 38% SDF gel as an alternative of the 38% SDF solution in arresting early childhood caries. Conclusions: As SDF gel is cost-effective, non-invasive, and non-aerosol-generating, it can be widely recommended for caries control. Trial registration: ClinicalTrials.gov NCT06241261. Registered on 7 February 2024.

Evaluation of the Effectiveness of Silver Diamine Fluoride in Arresting Caries in Primary Teeth

Background

Silver diamine fluoride (SDF) has been identified as a noninvasive way to stop dental caries from becoming worse, particularly in baby teeth.

Materials and Methods

A hundred kids between the ages of 3 and 6 who have at least one carious lesion in their primary teeth participated in a randomized controlled experiment. One of the two groups-the experimental group (n = 50), which got a 38% SDF therapy, or the control group (n = 50), which received a placebo-was randomly allocated to the subjects. Over the course of a year, the carious lesions received biannual applications of the SDF. The main result was the stoppage of caries, ascertained by monitoring the change of an active lesion to an inactive one using standardized digital radiographs and clinical evaluations.

Results

Only 35% of the carious lesions in the control group showed evidence of arrest after a year, compared to 87% of lesions in the experimental group (P < 0.001). It was shown that there would be one carious lesion arrested for every 2.5 patients with SDF if the number required to treat (NNT) was 2.5. During the research, no notable side effects were noted.

Conclusion

The remarkable efficacy of SDF in halting dental caries in primary teeth highlights its significance in the treatment of young dental patients.

The anti-caries effects of copper tetraamine fluoride on enamel: An in vitro study

OBJECTIVE

To investigate the antibacterial, remineralising, and discolouring effects of copper tetraamine fluoride (CTF) on artificial enamel caries.

METHOD

Human enamel blocks with artificial caries were treated with CTF, silver diamine fluoride (SDF, positive control) and water (negative control) before being challenged with Streptococcus mutans. The morphology, viability, and growth kinetics of biofilm were evaluated using scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), and colony-forming unit (CFU) counting. The lesion depths, mineral loss, micro-hardness, and crystal characteristics were assessed using micro-computed tomography, Knoop Hardness Tester, and X-ray diffraction (XRD), respectively. The discolouring property was assessed by spectrophotometry.

RESULTS

SEM showed that bacteria completely covered the enamel surface treated with water, but not the enamel surface treated with CTF and SDF. CLSM showed dead-to-live ratio of biofilm treated with CTF, SDF and water were 0.8 ± 0.1, 0.9 ± 0.2 and 0.5 ± 0.1 (p < 0.001, CTF, SDF>Water). Log10 CFU values of biofilm treated with CTF, SDF and water were 7.7 ± 0.2, 7.7 ± 0.1 and 8.1 ± 0.1 (p < 0.001, CTF, SDFWater). XRD revealed well-crystallised hydroxyapatite in enamel treated with CTF and SDF, but not water. Spectrophotometry showed ΔE values of the CTF, SDF and water groups were 5 ± 3, 54 ± 6 and 6 ± 2 (p < 0.001, CTF, water

CONCLUSION

CTF inhibited Streptococcus mutans biofilm and remineralised artificial enamel caries without discolouration.

CLINICAL SIGNIFICANCE

If CTF is successfully translated into clinical use, it can be a simple agent for clinicians to arrest enamel caries.

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Key Words

• Antibacterial
• Caries
• Enamel
• Fluoride
• Remineralization

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MESH Headings

• Dental Enamel/drug effects
• Humans
• Biofilms/drug effects
• Streptococcus mutans/drug effects
• Dental Caries/microbiology
• Microscopy, Electron, Scanning
• X-Ray Microtomography
• Hardness
• Cariostatic Agents/pharmacology
• X-Ray Diffraction
• Silver Compounds/pharmacology
• Fluorides, Topical/pharmacology
• Quaternary Ammonium Compounds/pharmacology
• Anti-Bacterial Agents/pharmacology
• Microscopy, Confocal
• Tooth Remineralization/methods
• Materials Testing
• Water/chemistry

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Grants Collapse

Affiliation(s)

Veena Wenqing Xu Faculty of Dentistry, University of Hong Kong, Hong Kong, China
Iris Xiaoxue Yin Faculty of Dentistry, University of Hong Kong, Hong Kong, China
John Yun Niu Faculty of Dentistry, University of Hong Kong, Hong Kong, China
Ollie Yiru Yu Faculty of Dentistry, University of Hong Kong, Hong Kong, China
Mohammed Zahedul Islam Nizami Faculty of Dentistry, University of Hong Kong, Hong Kong, China; Department of Mineralized Tissue Biology and Bioengineering, The ADA Forsyth Institute, Cambridge, MA, USA.
Chun Hung Chu Faculty of Dentistry, University of Hong Kong, Hong Kong, China.

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Effect of Zinc on improving silver diamine fluoride-derived tooth discoloration in vitro

BACKGROUND

Silver Diamine Fluoride (SDF) is effective for arresting dental caries, presenting a valuable non-invasive treatment option in dentistry. Despite its therapeutic advantages, a significant drawback is the tooth discoloration that follows its application, which can affect patient acceptance. Addressing this aesthetic concern without diminishing the treatment's efficacy remains challenging in dental practice. This study explores strategies to improve the aesthetic outcomes of SDF treatments.

METHODS

This in vitro study assessed the efficacy of Zinc in reducing SDF-induced discoloration on dentin blocks and examined its impact on the physical properties of dentin, including hardness and roughness. Dentin blocks were pre-treated with various concentrations of Zinc, followed by SDF application. Color changes were analyzed using Image J software, and cytotoxicity was evaluated using the CytoTox-ONE™ Homogeneous Membrane Integrity Assay. Dentin surface characteristics, including micro-hardness and roughness, were assessed using scanning electron microscopy.

RESULTS

The study results revealed a dose-dependent efficacy of Zinc in reducing discoloration caused by SDF on dentin, with higher Zinc concentrations showing better improvement in color outcomes. The application of a 20 M Zinc solution prior to SDF treatment significantly reduced discoloration compared to SDF alone, measured on day 14. Additionally, no significant changes in the hardness or roughness of etched dentin were observed in Zinc + SDF group compared to the SDF alone group. Zinc treatments demonstrated a desirable outcome on mucosal cytotoxicity, comparable to that of the negative control.

CONCLUSION

Zinc significantly reduced SDF-induced tooth discoloration in a dose-dependent manner without affecting the etched dentin's micro-hardness and roughness, potentially improving patient acceptance, especially in visible areas of the mouth. Further research is warranted to validate the effectiveness of this zinc-enhanced treatment protocol in vivo.

CLINICAL SIGNIFICANCE

Zinc-enhanced SDF treatments could enhance patient acceptance, especially in visible areas of the mouth, offering an improved option for caries management.

Effect of Zinc on Improving Silver Diamine Fluoride-derived Tooth Discoloration in Vitro

Background Silver Diamine Fluoride (SDF) is effective for arresting dental caries, presenting a valuable non-invasive treatment option in dentistry. Despite its therapeutic advantages, a significant drawback is the tooth discoloration that follows its application, which can affect patient acceptance. Addressing this aesthetic concern without diminishing the treatment's efficacy remains challenging in dental practice. This study explores strategies to improve the aesthetic outcomes of SDF treatments. Methods This in vitro study assessed the efficacy of Zinc in reducing SDF-induced discoloration on dentin blocks and examined its impact on the physical properties of dentin, including hardness and roughness. Dentin blocks were pre-treated with various concentrations of Zinc, followed by SDF application. Color changes were analyzed using Image J software, and cytotoxicity was evaluated using the CytoTox-ONE™ Homogeneous Membrane Integrity Assay. Dentin surface characteristics, including micro-hardness and roughness, were assessed using scanning electron microscopy. Results The study results revealed a dose-dependent efficacy of Zinc in reducing discoloration caused by SDF on dentin, with higher Zinc concentrations showing better improvement in color outcomes. The application of a 20M Zinc solution prior to SDF treatment significantly reduced discoloration compared to SDF alone, measured on day 14. Additionally, no significant changes in the hardness or roughness of etched dentin were observed in Zinc + SDF group compared to the SDF alone group. Zinc treatments demonstrated a desirable outcome on mucosal cytotoxicity, comparable to that of the negative control. Conclusion Zinc significantly reduced SDF-induced tooth discoloration in a dose-dependent manner without affecting the etched dentin's micro-hardness and roughness, potentially improving patient acceptance, especially in visible areas of the mouth. Further research is warranted to validate the effectiveness of this zinc-enhanced treatment protocol in vivo . Clinical Significance: Zinc-enhanced SDF treatments could enhance patient acceptance, especially in visible areas of the mouth, offering an improved option for caries management.

Topical silver diamine fluoride (SDF) for preventing and managing dental caries in children and adults

BACKGROUND

Dental caries is the world's most prevalent disease. Untreated caries can cause pain and negatively impact psychosocial health, functioning, and nutrition. It is important to identify cost-effective, easy-to-use agents, which can prevent or arrest caries. This review evaluates silver diamine fluoride (SDF).

OBJECTIVES

To assess the effects of silver diamine fluoride for preventing and managing caries in primary and permanent teeth (coronal and root caries) compared to any other intervention including placebo or no treatment.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, Cochrane Oral Health's Trial Register and two clinical trials registers in June 2023.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), with parallel-group or split-mouth design, in children and adults (with or without carious lesions) that compared SDF with placebo or no treatment; different frequencies, concentrations or duration of SDF; or any other intervention.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane, and GRADE to assess the certainty of the evidence. We collected data for primary caries prevention (change in caries increment), arrest of carious lesions, secondary prevention of caries (lesions do not progress from initial classification), adverse effects, dental pain or sensitivity, and aesthetics at the end of study follow-up.

MAIN RESULTS

We included 29 RCTs (13,036 participants; 12,020 children, 1016 older adults). We summarise outcome data for the five most clinically relevant comparisons. All studies included high risks of bias, and some findings were imprecise (e.g. because of small sample sizes). SDF versus placebo or no treatment (14 studies; 2695 children, 905 older adults) Compared to placebo or no treatment, SDF may help prevent new caries in the primary dentition (1 study, 373 participants), or on the coronal surfaces of permanent dentition (1 study, 373 participants) but the evidence is very uncertain. SDF likely prevents new root caries (mean difference (MD) -0.79 surfaces, 95% confidence interval (CI) -1.40 to -0.17; 3 studies, 439 participants; moderate-certainty evidence). SDF may help arrest caries in the primary dentition (MD 0.86 surfaces, 95% CI 0.39 to 1.33; 2 studies, 841 participants; low-certainty evidence) and the permanent dentition (coronal: 1 study, 373 participants; root: 1 study, 158 participants) but the evidence is very uncertain. The evidence is very uncertain for secondary prevention of caries (primary dentition: 1 study, 128 participants; permanent dentition (coronal): 1 study, 663 participants), for adverse effects (5 studies, 1299 participants), and aesthetics (1 study, 43 participants). Different approaches to SDF application (5 studies, 1808 children) Studies compared different frequencies or intervals of application, different concentrations of SDF, and different durations of treatment. Some studies included multiple comparisons of different approaches. Because of the different approaches, we could not combine findings from these studies. Due to very low-certainty evidence, we were unsure whether any approach to SDF application was better than another for caries arrest (4 studies, including 8 comparisons of different approaches, 1360 participants); secondary prevention of caries (1 study, 203 participants), or led to differences in adverse effects (3 studies, 1121 children) or aesthetics (1 study, 119 children). SDF versus fluoride varnish (8 studies, 2868 children, 223 older adults) Compared to flouride varnish, SDF may result in little or no difference to the prevention of new caries in the primary dentition (MD 0.00, 95% CI -0.26 to 0.26; 1 study, 434 participants; low-certainty evidence). The evidence is very uncertain for this outcome measure in the permanent dentition (coronal: 1 study, 237 participants; root: 1 study, 100 participants; very low-certainty evidence). Due to very low-certainty evidence, we were unsure whether or not there were any differences between flouride varnish (applied weekly for three applications) and SDF for caries arrest and secondary prevention of caries in the primary dentition (1 study, 309 participants). Similarly, we were unsure of adverse effects (3 studies, 980 children), dental pain or sensitivity (1 study, 62 children), or aesthetics (1 study, 263 children). SDF versus sealants and resin infiltration (2 studies, 343 children) Very low-certainty evidence in this comparison meant we were unsure if either treatment was better than the other for primary prevention of caries in permanent dentition (coronal: 1 study, 242 participants), or adverse effects (2 studies, 336 participants). SDF versus atraumatic restorative treatment (ART) with glass ionomer cement (GIC) or GI material (4 studies, 610 children) Very low-certainty evidence in this comparison meant we were unsure if either treatment was better than the other at arresting caries in the primary dentition (1 study, 143 participants). We were also unsure whether there were any differences between treatments in adverse effects (3 studies, 482 participants), dental pain or sensitivity (1 study, 234 participants), or aesthetics (2 studies, 248 participants).

AUTHORS' CONCLUSIONS

In the primary dentition, evidence remains uncertain whether SDF prevents new caries or progression of existing caries compared to placebo or no treatment, but it may offer benefit over placebo or no treatment in caries arrest. Compared to placebo or no treatment, SDF probably also helps prevent new root caries. However, the evidence is uncertain for other caries outcome measures in this dentition and in all caries outcomes for coronal surfaces of permanent dentition. Compared to flouride varnish, SDF may offer little or no benefit in preventing new caries in the primary dentition, but the evidence is very uncertain for other caries outcome measures in the primary dentition and for preventing new caries in the permanent dentition. We were unable to establish whether one SDF treatment approach was better than another, or how SDF compared to other treatments, because of very low-certainty evidence. The impact of SDF staining of teeth was poorly reported and the evidence for adverse effects is very uncertain. Additional well-conducted studies are needed. These should measure the impact of staining and be analysed to take account of clustering issues within participants.

Evaluation of dental cements derived from mixtures of highly reactive ionomer glasses and bottle glass: Cement manipulation, mechanical, fluoride ion releasing, radiopaque and setting properties

OBJECTIVES

To evaluate the mechanical properties, fluoride release, radiopacity, and setting characteristics of dental cements derived from highly reactive ionomer glasses and bottle glass mixtures.

METHODS

Two highly reactive glass series, LG99 and LG117, were synthesized, milled, sieved, and characterized using XRD and laser particle size analysis. These glasses were mixed with predetermined ratios of ground bottle glass, poly(acrylic acid), and aqueous tartaric acid to form glass ionomer cements. The cements' working time (WT), setting time (ST), fluoride release, radiopacity, compressive strength (CS), and elastic modulus (EM) were evaluated. Mean differences in CS were analyzed using multivariate ANOVA with Tukey's post hoc test at p = 0.05.

RESULTS

The WT and ST for both groups ranged from 1.5 to 2.5 min. LG99 series cements showed significantly higher CS (∼65 MPa) and EM (∼2 GPa) than LG117 series (p < 0.05). Both series showed similar fluoride release profiles, peaking at 1.2 mmol/L at 28 days. Radiopacity for LG99 ranged from 0.97 to 1.34, while LG117 ranged from 0.60 to 0.95. Solid state 27Al magic-angle spinning-nuclear magnetic resonance (MAS NMR) confirmed the presence of Al(IV) and Al(VI), indicating setting completion by one day for both series. Bottle glass showed a chemical shift at 55.8 ppm, overlapping with LG99's Al(IV) signal. The 19F MAS NMR spectra revealed Al-F and F-Sr(n) species in all glasses, with LG117 forming CaF2 after one day in deionized water.

CONCLUSION

Mixtures of highly reactive ionomer glass and bottle glass produced cements with satisfactory properties for dental applications. Further research is needed to optimize their formulation and properties.

An In-vitro Evaluation of Tooth Discoloration and Shear Bond Strength of Glass Ionomer Cement Bonded to Tooth Surface Pretreated with Silver Diamine Fluoride and Glutathione Biomolecule

BACKGROUND

Silver diamine fluoride (SDF) is employed in caries prevention and treatment; however, tooth discoloration post treatment is a significant disadvantage, which can be reduced using glutathione (GSH), a water soluble tripeptide.

AIM

To evaluate and compare the effect of glutathione biomolecule (GSH) and potassium iodide (KI) along with SDF on tooth discoloration and shear bond strength of glass ionomer cement (GIC) on the tooth surface.

METHODS

Artificial caries were created on 48 extracted unblemished premolars and divided into four groups (SDF, SDF + KI, SDF + GSH, and Water). The solutions were applied according to the manufacturer's instructions, and the samples were incubated for 24 hours. The color assessment was recorded on days 1, 7, and 14 by using a spectrophotometer. Following the color assessment, all the treated samples were bonded with GIC. The shear bond strength was evaluated using a universal testing machine.

RESULTS

Mixing SDF with GSH initially reduced tooth discoloration. Although there was an increase in the discoloration after 2 weeks, it was still less when compared to the SDF group. The application of GSH and KI post SDF application had no significant difference in the shear bond strength of GIC on the tooth surface.

CONCLUSIONS

The use of GSH along with SDF helps in reducing the discoloration without compromising the shear bond strength.

Survival of Silver Diamine Fluoride Varnish Treated Teeth among Children with Single/Multiple Applications: A Split-mouth Randomized Clinical Trial

Introduction

Utilizing 38% silver diamine fluoride (SDF) has been demonstrated in clinical trials to prevent and halt early childhood caries (ECC). Based on a research evaluation, it has been found that 38% SDF can effectively prevent new tooth decay and stop existing tooth decay in children's primary teeth.

Objective

This study aimed to assess the survival of teeth treated with repeated applications of 38% SDF in children with ECC and to compare the outcomes between single and multiple applications.

Materials and methods

A split-mouth, double-blind, active-control, parallel-arm randomized controlled trial was conducted following Consolidated Standards of Reporting Trials (CONSORT) guidelines. Children aged 4-5 years with bilateral ECC were recruited from a primary government school in Maharashtra, India. Treatment involved applying 38% SDF to carious lesions, with lesions randomized into two groups: single application and double application. Follow-ups were conducted at 6 and 12 months to assess lesion progression, depth, and survival.

Results

Eighty-four primary carious teeth from 42 female participants were included. Lesions were predominantly occlusal or proximal, with varying sizes and depths. After 12 months, 12 lesions failed in group I (single application) and 3 in group II (double application). The intergroup comparison of mean levels at 12 months showed a statistically significant difference (p = 0.01). Intragroup comparisons showed an increase in lesion depth and level from baseline to 6 months, with a subsequent rise from 6 to 12 months in group I. The mean survival rate of teeth after SDF application at the end of 12 months was around 94% for group II, while for group I it further decreased from 70 to 58%.

Conclusion

Repeated applications of 38% SDF showed improved survival rates of teeth in children with ECC compared to single applications. Double application of SDF demonstrated superior efficacy in maintaining tooth survival over 12 months.

How to cite this article

Kharat PB, Rajpurohit L, Mathur A, et al. Survival of Silver Diamine Fluoride Varnish Treated Teeth among Children with Single/Multiple Applications: A Split-mouth Randomized Clinical Trial. Int J Clin Pediatr Dent 2024;17(11):1211-1218.

Effect of Surface Treatments on Shear-bond Strength of Glass Ionomer Cements to Silver Diamine Fluoride-treated Simulated Carious Dentin

OBJECTIVES

This study investigated the effect of different surface treatments on the shear bond strength (SBS) and failure modes of self-cured (SC) and light-cured (LC) high-viscosity glass ionomer cements (HVGICs) to silver diamine fluoride (SDF)-treated simulated carious dentin (SCD).

METHODS AND MATERIALS

Extracted human premolars were sectioned and pH cycled for 10 days to simulate carious dentin. The demineralized specimens were treated with 38% SDF (Riva Star) for 2 minutes, washed, stored in deionized distilled water at 37°C for 2 weeks, and subjected to the following surface treatments (n=14): T1 - no treatment (control); T2 - 10 seconds polyacrylic acid (PAA); T3 - 5 seconds phosphoric acid (PPA); T4 - 5 seconds PPA plus universal adhesive (Zipbond); and T5 - 5 seconds PPA plus resin-modified GIC adhesive (Riva bond LC). SC (Riva Self-cure HV) and LC (Riva Light-cure HV) HVGICs were applied to the conditioned specimens and stored in artificial saliva at 37°C for 1 week. SBS and failure modes were subsequently determined. Statistical analyses were performed using Kruskal-Wallis/post-hoc Mann-Whitney U and Chi-square tests (α=0.05).

RESULTS

The highest SBS was observed when SC and LC were restored with T2 and T5, respectively. Significant differences in SBS were as follows: SC - T2, T1 > T5, T3; LC - T5, T4, T3 > T2. SC generally exhibited adhesive failures, while LC presented both adhesive and mixed failures.

CONCLUSION

The preferred method for preparing SDF-treated carious dentin before restoration application is PAA for SC and PPA plus RMGIC adhesive for LC HVGICs.

"Evaluation of Silver Diamine Fluoride Modified Atraumatic Restorative Treatment (SMART) on hypomineralized first permanent molar"- a randomized controlled clinical study

BACKGROUND

Restoring first permanent molars affected with molar incisor hypomineralization (MIH) is challenging. Focusing on improving the quality of life for children affected by MIH, at least until the complete eruption of first permanent molars to receive full coverage, to decrease the hypersensitivity and to be able to perform proper oral hygiene measures, the purpose of this study was to compare silver modified atraumatic restorative technique (SMART) versus the conventional restoration and fluoride varnish application on moderate to severe hypomineralized molars. The comparison considered the restoration survival, hypersensitivity, and digital surface area changes after one year follow up.

METHODS

Twenty-eight children were selected (20 girls and 8 boys) with at least 2 MIH molars with the same defect severity. The study comprised 2 groups; MOD group (moderate hypomineralized molar severity) and SEV group (Severe hypomineralized molar severity) (n = 28 tooth). Each group was further subdivided into 2 subgroups according to the technique of restoration: SMART subgroup and CONV subgroup (high viscosity glass ionomer restoration and fluoride varnish application) (each = 14 tooth). Evaluation was done in terms of the restoration survival (6 months and 12 months), hypersensitivity at 1 weak, 6 months and 12 months and occlusal surface area changes at 12 months). Professional Fluoride varnish application and home prophylaxis using MI paste were the protocol for each child patient.

RESULTS

There was no significant difference between the 4 subgroups, regarding tooth restoration integrity at 6-months vs. 12-months. However, a statistically significant difference in tooth restoration integrity between the 4 subgroups at 12-months (P = .049). Also, the hypersensitivity score, there was a statistically significant difference between the 4-time intervals (P < .001) and a statistically significant difference in surface area changes between the 4 subgroups.

CONCLUSIONS

Selective removal of carious tissue and SMART restoration, combined with dental home and professional preventive measures every 3 months maintained the integrity of restorations in severely and moderately affected permanent molars up to 1 year.

TRIAL REGISTRATION

The study protocol was retrospectively registered on Clinical Trials (NCT05931822-05/ 07/2023).

Combination of Silver Diamine Fluoride and Hall Technique for Caries Management in Primary Molars: A Randomized Controlled Trial

Aims and background

Combination of different noninvasive caries arresting approaches may improve the effectiveness and success rate of individual procedures for caries management. The purpose of this study was to evaluate clinical and radiographic success rate of a combination of 38% silver diamine fluoride (SDF) application and Hall technique (HT) for the management of dentinal caries in primary molars and compare it with conventional stainless steel crown (SSC) restoration.

Materials and methods

Children aged 4-8 years, having carious primary molars with the International Caries Detection and Assessment System (ICDAS) score of 5 or 6, were randomly assigned to treatment group A or B. Treatment group A (n = 25) received 38% SDF application and Hall crown, while group B (n = 25) received conventional SSC restoration. Follow-up was done at 1 month, 3, 6, 12, 24, and 30 months intervals.

Results

There was one case of major failure in group A (93.5% successful) while no case of major failure in group B (100% successful) and the difference was not statistically significant (p > 0.05). For minor failure (loss of SSC), the success rate was 91.3% in group B and 84.2% in group A, wherein the difference was not statistically significant (p > 0.05).

Conclusion

Conservative management of dentinal carious lesions with SDF and HT showed a similar success rate as compared to conventional operative procedures.

Clinical significance

This protocol can help reduce the clinical chair time and the need for deep sedation/general anesthesia in young children suffering from deep carious lesions with reversible pulpitis.

Trial registration number

CTRI/2020/07/026877, Clinical Trial Registry-India.

How to cite this article

Mittal M, Chopra R, Kumar A, et al. Combination of Silver Diamine Fluoride and Hall Technique for Caries Management in Primary Molars: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2024;17(10):1114-1120.

Preventing proximal enamel caries in neighboring tooth with glass ionomer cement restoration and silver diamine fluoride pretreatment

OBJECTIVE

To investigate caries preventive effects of 38 % silver diamine fluoride (SDF) pretreatment on neighboring tooth proximal to glass ionomer cement (GIC), including conventional GIC (CGIC) and resin-modified GIC (RMGIC) restorations in an in vitro model.

METHODS

HUMAN TOOTH BLOCKS WERE RESTORED WITH: SDF+CGIC (Group 1), CGIC (Group 2), SDF+RMGIC (Group 3) or RMGIC (Group 4). Enamel specimen simulating proximal surface of neighboring tooth was placed in proximity to the restorations. The specimen underwent cariogenic challenge with cross-kingdom biofilm of Streptococcus mutans, Lacticaseibacillus casei and Candida albicans. After cariogenic challenge, the biofilm's growth kinetics, viability, and morphology were evaluated by propidium monoazide-quantitative polymerase chain reaction (PMA-qPCR), confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM), respectively. The enamel lesion depth, surface morphology and crystal characteristics were determined by micro-computed tomography (micro-CT), SEM and X-ray diffraction (XRD), respectively.

RESULTS

PMA-qPCR demonstrated lower microbial growth in Group 1 and 3 compared with Group 2 and 4 (p < 0.05). CLSM showed the dead-to-live ratio in Groups 1-4 were 1.15±0.12, 0.53±0.13, 1.10±0.24 and 0.63±0.10, respectively (Group 1,3 > 2,4, p < 0.05). SEM revealed Groups 1 and 3 had scattered biofilm whereas Group 2 and 4 had confluent biofilm. Micro-CT showed the enamel lesion depths (µm) were 98±9, 126±7, 103±6 and 128±7 for Group 1 to 4, respectively (Group 1,3 < 2,4, p < 0.05). SEM revealed oriented and ordered enamel prismatic patterns in Group 1 and 3, not in Group 2 and 4. XRD showed the reflections of hydroxyapatite in Groups 1 and 3 were sharper than Groups 2 and 4.

CONCLUSION

SDF pretreatment enhances the preventive effect of GIC on proximal enamel surface on neighboring tooth through inhibiting cariogenic biofilm, reducing enamel demineralization and promoting enamel remineralization.

CLINICAL SIGNIFICANCE

SDF pretreatment of GIC restorations can help prevent caries on neighboring teeth, particular for patients with high caries risk.

An open-label, parallel-group, randomized clinical trial of different silver diamine fluoride application intervals to arrest dental caries

BACKGROUND

Silver diamine fluoride (SDF) is an antimicrobial agent and alternative treatment option that can be used to arrest dental decay. While there is optimism with SDF with regard to caries management, there is no true consensus on the number and frequency of applications for children. The purpose of this study was to examine the effectiveness of 38% SDF to arrest early childhood caries (ECC) at three different application regimen intervals.

METHODS

Children with teeth that met International Caries Detection and Assessment System codes 5 or 6 criteria were recruited from community dental clinics into an open-label, parallel-group, randomized clinical trial from October 2019 to June 2021. Participants were randomized to one of three groups using sealed envelopes that were prepared with one of three regimens inside: visits one month, four months, or six months apart. Participants received applications of 38% SDF, along with 5% sodium fluoride varnish (NaFV), at the first two visits to treat cavitated carious lesions. Lesions were followed and arrest rates were calculated. Lesions were considered arrested if they were hard on probing and black in colour. Statistics included descriptive and bivariate analyses (Kruskal one-way analysis of variance and Pearson's Chi-squared test). A p-value of ≤ 0.05 was considered significant.

RESULTS

Eighty-four children participated in the study (49 males and 35 females, mean age: 44.4 ± 14.2 months). Treatment groups were well matched with 28 participants per group. A total of 374 teeth and 505 lesions were followed. Posterior lesions represented only 40.6% of affected surfaces. Almost all SDF treated lesions were arrested for the one-month (192/196, 98%) and four-month (159/166, 95.8%) interval groups at the final visit. The six-month group experienced the lowest arrest rates; only 72% (103/143) of lesions were arrested (p < 0.001). The duration of application intervals was inversely associated with improvements in arrest rates for all lesions.

CONCLUSIONS

Two applications of 38% SDF and 5% NaFV in one-month and four-month intervals were comparable and very effective in arresting ECC. Applications six months apart were less effective and could be considered inferior treatment.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04054635 (first registered 13/08/2019).

Ion release of the glass ionomer restoration with silver diamine fluoride dentin pretreatment

OBJECTIVE

To assess the fluoride and silver ion release of glass ionomer cement (GIC) restorations, including conventional GIC (CGIC) and resin-modified GIC (RMGIC) restorations, with 38 % silver diamine fluoride (SDF) solution dentin pretreatment.

METHODS

Eighty dentin blocks were allocated into 4 groups and restored with SDF+CGIC, CGIC, SDF+RMGIC and RMGIC, respectively. Each block was stored in deionized water at 37 °C for 2 years. Fluoride and silver ion concentration in storage solution was measured using ion-selective electrode and inductively coupled plasma-optical emission spectrometry for up to 2 years. The cross-sectional surfaces of restored dentin blocks were assessed by X-Ray diffraction analysis (XRD), scanning electron microscope (SEM) with energy-dispersive X-ray spectroscopy (EDS) after 1 week and 2 years, respectively.

RESULTS

The mean ± standard deviation (SD) of accumulative fluoride releasing in SDF+CGIC, CGIC, SDF+RMGIC and RMGIC for 2 years were 0.13±0.005 mg, 0.09±0.006 mg, 0.15±0.008 mg and 0.05±0.003 mg, respectively (Groups SDF+RMGIC > SDF+CGIC > CGIC >RMGIC, p < 0.05). The mean ± SD of accumulative silver releasing in SDF+CGIC, CGIC, SDF+RMGIC and RMGIC for 2 years were 0.03±0.009 mg, 0.00±0.00 mg, 0.01±0.003 mg, and 0.00±0.00 mg, respectively (Groups SDF+CGIC > SDF+RMGIC > CGIC&RMGIC, p < 0.05). Groups SDF+CGIC and SDF+RMGIC showed sustainably higher fluoride and silver releasing compared to Groups CGIC and RMGIC (p < 0.05). XRD analysis indicated the fluorapatite and silver chloride were observed only in Groups SDF+CGIC and SDF+RMGIC, but not in Groups CGIC and RMGIC. SEM images of the cross-sectional view of the dentin blocks showed silver crystals within dentinal tubules 1 week and 2-year in Groups with SDF pretreatment.

CONCLUSION

The 38 % SDF dentin pretreatment sustainably increased the fluoride and silver release of GIC and RMGIC restorations for up to 2 years.

The use of silver diamine fluoride to prevent/treat enamel carious lesions: a narrative review

This comprehensive literature review examines the use of silver diamine fluoride (SDF) for the prevention and treatment of enamel carious lesions. SDF has been approved by different international drug associations as a caries-preventing agent to be used on deep carious lesions (dentin). However, SDF can cause staining of exposed tooth structures. Furthermore, the effect of SDF on the bond of adhesives to the tooth structure is still being determined. This review explores various studies on the use of SDF to treat enamel carious lesions, highlighting its effectiveness and preventive action. The literature suggests that SDF inhibits bacterial growth, promotes remineralization, and does not negatively affect adhesive retentions. Potassium iodide (KI) or glutathione (GSH) can reduce staining and discoloration. However, the reviewed studies have limitations. Further research, including well-designed clinical trials, is necessary to validate the findings and evaluate the long-term implications of SDF treatment. Conclusion: Despite the above-mentioned limitations, SDF shows potential as a therapy for enamel caries prevention, remineralization, and use as an adjuvant to other dental treatments, warranting further investigation and the refinement of application methods.

Remineralizing effect of NSF on artificial enamel caries

INTRODUCTION

Nanotechnology offers new approaches and endless opportunities for remineralizing tooth decay without being toxic or causing allergies. This study aimed to determine the effect of nanosilver fluoride (NSF) on the remineralization potential of enamel caries-like lesions compared to 5% sodium fluoride varnish in permanent teeth.

METHODS

Fifteen teeth (molars and premolars) were gathered, cleaned, and polished using a scaler. After sectioning the teeth mesiodistally and removing the roots, the thirty specimens were subjected to a demineralized solution to induce early enamel lesions and then assigned randomly into two equal groups. The test materials were applied, and then all the specimens were subjected to a pH cycling model for 30 days. DIAGNOdent and surface roughness were investigated, and an evaluation of the enamel Ca and P weight% for Ca/P ratio calculation was done using SEM-EDX to analyze the specimens at the end of the study. The data were analyzed using an independent t-test.

RESULTS

The mean values for the DIAGNOdent measurements for NSF and NaF at baseline and after demineralization were not significantly different (p > 0.05). After treatment, NaF varnish showed a significantly higher mean DIAGNOdent measurement (11.8 ± 5.80) than NSF (4.7 ± 1.6). The mean surface roughness of the NaF group (1.64 ± 0.39) was much higher than NSF's mean surface roughness (1.07 ± 0.21). Specimens treated with NSF had statistically significant smoother surfaces (p < 0.001). The NSF group had a higher mean Ca/P ratio (2.9 ± 0.35) than NaF (2.2 ± 0.11). This difference was statistically significant (p = 0.012).

CONCLUSION

The study reveals that nano silver fluoride is a more effective treatment than sodium fluoride varnish in enhancing teeth's clinical characteristics, particularly in terms of mineral content and surface roughness, suggesting it could be an improved strategy to prevent dental caries and maintain enamel integrity.

Partial in-vitro dispersal of S. mutans UA159 biofilms by silver-(I)cyanoximate compounds

Silver(I) cyanoximate compounds have antibacterial activity against the oral pathogen Streptococcus mutans, a resident of oral plaque biofilm. As oral biofilm strategies focus on the inhibition of attachment or physical removal of the existing microbes, we were interested in exploring the ability of six different silver(I) cyanoximate compounds to target and disperse a pre-existing biofilm. Here we report that these compounds were only able to partially disperse S. mutans biofilms as the compounds were more effective at inhibiting biofilm formation. None of the six compounds were able to outperform silver nitrate, a commonly used antibacterial in dentistry.

Perspectives of patients, dental professionals, and stakeholders on the use of silver diamine fluoride for the management of dental caries: A qualitative systematic review

OBJECTIVES

This qualitative systematic review and meta-aggregation aimed to synthesise evidence regarding perceptions of patients, practitioners, and stakeholders on the use of Silver Diamine Fluoride (SDF) for the management of dental caries.

DATA

This review was reported in alignment with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and is registered with PROSPERO (CRD42023390301) and the Joanna Briggs Systematic Reviews register.

SOURCES

References were retrieved from PubMed, Web of Science, Scopus, and EMBASE using a pre-established search strategy.

STUDY SELECTION

Qualitative and mixed-methods studies examining perspectives of patients, practitioners, and/or stakeholders on the use of SDF were included. The initial search identified 650 articles eligible for inclusion, out of which 14 articles were included in the review. Reviewers synthesised findings and generated 11 distinct categories grouped into three synthesised findings: 1) Clinical use; 2) Staining; 3) Facilitators and barriers.

CONCLUSIONS

Practitioners and patients viewed SDF as a therapeutic option with multiple benefits. While aesthetic concerns may be a barrier to some groups, the acceptance of the treatment was influenced by other factors, such as trusting professional advice.

CLINICAL SIGNIFICANCE

Patient education is key for increased SDF acceptance. This systematic review can assist clinicians in addressing concerns regarding SDF therapy. Findings have the potential to inform policy decisions that address oral health inequities through patient-centred health care models.

The effect of silver diammine fluoride on In Vitro Enamel caries lesion remineralization and staining as a function of lesion baseline mineral distribution

OBJECTIVES

to investigate whether baseline mineral distribution modulates the ability of silver diammine fluoride (SDF) to remineralize and stain enamel caries lesions.

METHODS

This laboratory study followed a 3 [treatment: SDF/fluoride varnish (FV)/deionized water (DIW)] ×3 [lesion protocol: methylcellulose (MeC)/hydroxyethylcellulose (HEC)/Carbopol 907 (C907)] factorial design. Lesions were created in bovine enamel specimens (n = 20). Treatments were applied and lesions remineralized in artificial saliva. Digital transverse microradiography (TMR-D) was used to analyze lesions. Lesion color was monitored spectrophotometrically. The effects of lesion protocol and treatment on changes in lesion depth (ΔLD), mineral loss (ΔΔZ), maximum mineral density at the surface zone (ΔSZmax), and color changes related to remineralization (ΔL*remin) were analyzed using two-way ANOVA.

RESULTS

The treatment×lesion protocol interaction was significant for ΔΔZ (p < 0.01) and ΔL*remin (p < 0.01), however not for ΔLD (p = 0.23) or ΔSZmax (p = 0.91). There were no differences in ΔΔZ between treatments in HEC and C907 lesions. However, DIW resulted in more remineralization than both SDF (p < 0.01) and FV (p = 0.01) in MeC lesions. Considering changes from lesion baseline after remineralization in MeC lesions, SDF treatment resulted in the highest mineral gain in the surface zone. However, DIW revealed the highest mineral gain after remineralization in the lesion body. SDF stained lesions with the intensity increasing after remineralization in C907 lesions, whereas staining decreased in MeC and HEC lesions.

CONCLUSION

High fluoride treatments can interfere with continuous remineralization of caries lesions due to partial arrest. Baseline lesion mineral distribution affects SDF's ability to enhance remineralization and the staining caused by SDF.

CLINICAL SIGNIFICANCE

SDF is being used to arrest active caries lesions extending into dentin and to treat dentin hypersensitivity. This study shed light on SDF's effect on an isolated process in dental caries only, remineralization. It achieved this by examining enamel caries lesions with differing mineral distributions and assessing their staining properties.

Effect of Curing Light with Different Intensities on the Penetration of Silver and Fluoride Ions and Dentin Hardness in Primary Carious Molars Following Silver Diamine Fluoride Application: A Comparative Microscopic Ex Vivo Study

Background

A paradigm shift from surgical to medical approach for caries management has popularized silver diamine fluoride (SDF) as a preventive and interim caries arrest medicament. Few studies conducted have explored the effect of curing light on SDF's microbial property, its penetration, and effect on dentin. However, there is a research gap regarding the effect of different intensities of curing light on SDF performance.

Aim

To determine the effect of different curing light intensities on SDF penetration depth and dentin hardness in carious lesions of primary molars.

Materials and methods

Silver diamine fluoride was applied on 30 extracted carious primary molars. Teeth were randomly allocated into three groups-(1) control group, no light curing after application of SDF; (2) light curing of SDF with low intensity (1000 mW/cm2); and (3) light curing of SDF with high intensity (2500 mW/cm2). A scanning electron microscopy (SEM) with energy dispersive X-ray (EDX) analysis was performed to check ion penetration after 1 week, and a Vickers hardness test was used to assess dentin hardness of both infected and affected dentin layers at 1-week and 1-month intervals. Based on the distribution of data, parametric and nonparametric tests were applied. Statistical Package for the Social Sciences (SPSS) version 26 was used for statistical analysis. The level of significance was set at 5%.

Results

Silver diamine fluoride penetrated beyond the carious lesion in all three groups. The mean silver ion precipitation in infected dentin in group III (16.90 ± 0.68) was maximum, whereas it was found to be minimum in group II (7.31 ± 0.63). The mean fluoride ion precipitation in affected dentin in group III (4.06 ± 0.41) was highest and least in group II (3.09 ± 0.58). A considerable increase in mean dentin hardness of infected dentin was observed in all three groups (214.00 ± 89.06, 218.00 ± 75.17, 231.00 ± 98.86, respectively; p < 0.001) after 1 month.

Conclusion

Applying SDF to carious lesions using a high-intensity dental curing light induced more silver ion precipitation in infected dentin and increased its hardness.

How to cite this article

Bhatt R, Patel M, Thakkar A, et al. Effect of Curing Light with Different Intensities on the Penetration of Silver and Fluoride Ions and Dentin Hardness in Primary Carious Molars Following Silver Diamine Fluoride Application: A Comparative Microscopic Ex Vivo Study. Int J Clin Pediatr Dent 2024;17(7):766-772.

The Efficacy of Silver Diamine Fluoride as a Caries Preventive Agent on Permanent Teeth: A Scoping Review

Dental caries is a chronic condition that affects people of all ages and has a high prevalence in Indonesia. Applying silver diamine fluoride (SDF) as a topical fluoridation agent is one of the approaches to prevent bacterial interactions that lead to the development of carious lesions. This study aims to determine the efficacy of SDF as a caries preventive agent on permanent teeth. Article searches were conducted using the keywords "silver diamine fluoride" AND "permanent tooth OR permanent teeth" AND "caries OR dental caries" AND "remineralize" through digital databases including PubMed, Cochrane Library, Science Direct, and Google Scholar. Articles with randomized controlled trial or nonrandomized controlled trial designs, articles written in Indonesian or English, publications published within the last 5 years (2016-2021), and aligned with the PCC (population, concept, and context) framework were included. Articles that were not accessible in full text or in a paid format, those that were of the meta-analysis or systematic review study type, and those that did not evaluate the use of SDF as a caries preventive agent were excluded from consideration. This scoping review refers to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensions for Scoping Reviews (PRISMA-ScR) guidelines. A total of 8 articles were reviewed, encompassing various locations, designs, and samples, which demonstrated the use of SDF resulted in a high percentage of fluoride release with a high degree of remineralization efficacy. The deposition of crystals or minerals into fissures and crevices caused by demineralization indicated a reduction in lesion depth and influenced the microhardness of enamel. SDF can stimulate the rehardening of tooth structures rich in calcium and phosphate. The solution of SDF has the potential to serve as an alternative substance for preventing caries in permanent teeth because it enhances mineral precipitation and mineral density, promotes the remineralization of hydroxyapatite in enamel by increasing fluoride, and increases tooth structure resistance to acid attack.

Enhancement of mineral density and mechanical properties in root caries treated with silver diammine fluoride and glass ionomer cement, with emphasis on silver ion distribution

OBJECTIVES

This study aimed to measure the distribution of silver ion (Ag+), mineral recovery, and nanohardness in carious lesions and comprehensively evaluate the degree of dentin restoration.

METHODS

Sixty human teeth with root caries were randomly assigned to the control, silver diammine fluoride (SDF) [Safo], and SDF+Glass ionomer cement (GIC) treatment [Safo+Fuji] groups. Micro-computed tomography (micro-CT) was performed at five time points for each sample before/after treatment to evaluate mineral density within and around carious lesions. Three months following treatment, 12 samples were selected for synchrotron radiation X-ray fluorescence analysis to evaluate Ag+ distribution, while 15 samples were selected for nanoindentation. Data were analyzed using Dunnett's T3 test for micro-CT and Wilcoxon rank sum test with Bonferroni correction (p = 0.017) for nanoindentation. The correlation between hardness and mineral change was analyzed using the Spearman rank correlation coefficient.

RESULTS

The Safo and Safo+Fuji groups showed significantly higher mineral recovery rates than did the control group (p < 0.001). In the Safo group, Ag+ accumulated in the deeper layers rather than the superficial layer of caries. In the Safo+Fuji group, Ag+ was found evenly distributed throughout caries, with only a few Ag+ detected in the GIC layer. Hardness in the Safo+Fuji group was significantly higher compared with the Safo group at depths in the range of 10-50 µm.

CONCLUSION

In the presence of GICs, SDF exhibited high remineralization capacity when diffusing throughout carious lesions over time. Combined treatment with SDF and GIC could strengthen root dentin even in the presence of caries.

CLINICAL SIGNIFICANCE

We found that combination treatment with SDF and GIC could increase mineral density in caries and improve the hardness of the tooth structure compared with fluoride-based agents alone. These findings might pave the way for future clinical trials to determine the therapeutic potential of nanotechnology-based restorative materials.

Effectiveness of nanosilver fluoride and silver diamine fluoride in arresting early childhood caries: a randomized controlled clinical trial

BACKGROUND

One of the most prevalent health problems affecting children worldwide is untreated caries in primary teeth. Agents to arrest caries are used to manage untreated decay in children in disadvantaged communities. Nano Silver Fluoride (NSF) overcomes the staining problems of Silver Diamine Fluoride (SDF). This study compared the clinical cariostatic effect of NSF to 38% SDF for arresting caries lesions.

METHODS

The study included 360 children younger than 4 years, with at least one active lesion, ICDAS score ≥ 3, recruited from nurseries in a rural area in Alexandria, Egypt, in 2022. They were randomly assigned to receive a single application of NSF at baseline, or two applications of SDF at baseline and after 6 months. The arrest of active carious lesions was assessed after 6 and 12 months using ICDAS criteria, and parents' satisfaction with child appearance was also assessed. Chi-Square test was used to compare the groups and multi-level multiple logistic regression was used to assess the effect of the intervention on caries arrest at lesion level and binary logistic regression was used to assess the effect at patient level.

RESULTS

1853 active lesions were included in children whose mean (SD) age was 42.3 (8.2) months. The arrest rate was significantly higher in the NSF than the SDF group at lesion level (78.4% and 65.0% at 6 months and 71.3% and 56.3% at 12 months, p < 0.001). In regression analysis, NSF had significantly higher odds of caries arrest than SDF at lesion level (at 6 months, AOR = 2.57, 95% CI: 1.55, 4.26 and at 12 month, AOR = 3.27, 95% CI: 1.89, 5.67). Parents of children receiving NSF had significantly greater satisfaction with their children's dental appearance than those receiving SDF: (97.2% and 76.1%, respectively, p < 0.001).

CONCLUSION

NSF demonstrated greater effectiveness in arresting caries in preschool children without inducing black staining of teeth and with greater parental satisfaction than SDF. NSF can be an alternative to SDF in arresting caries especially in underprivileged communities.

TRIAL REGISTRATION

The trial was registered in the clinicaltrials.gov registry (#NCT05255913)-16/02/2022.

Explorations of the chemical constitution and aqueous solution status of caries-arresting silver(I)-diammine fluoride and silver(I)-fluoride products using high-resolution 19F NMR analysis. Spectroscopic and SEM investigations of their interactions with human saliva: evidence for the in vivo salivary-catalysed autoconstruction of Ag/AgCl-based nanoparticles (IV-SCAN)-part I

Introduction

Silver(I)-diammine fluoride (SDF) and silver(I)-fluoride (SF) complexes have been successfully employed for the arrest of dental caries for many years. However, to date there are very few studies available reporting on the molecular structural compositional and solution status of these agents [typically applied as highly-concentrated 38% (w/v) solutions]. Here, we explored the solution status and chemical constitution of commercially-available SDF and SF products, and secondly investigated the multicomponent interplay of these products with biomolecules present in intact human whole-mouth salivary supernatants (WMSSs) in vitro.

Methods

High-resolution 19F NMR analysis was employed to explore SDF and SF product solutions, and to determine WMSS fluoride (F-) concentrations, whereas ammonia (NH3) release form SDF was tracked by 1H NMR spectroscopy. SEM and thin-film FTIR-ATR analyses were employed to explore the atomic and molecular compositions of sequentially-generated AgCl deposits and chromophoric Ag/AgCl nanoparticles (CSNPs); the time-dependent generation of the latter was followed spectrophotometrically.

Results

19F NMR spectra of aqueous SF solutions contained a very broad F- signal (Δv1/2 70 Hz), demonstrating that much of its solvated F- content was rapidly exchanging with Ag(I) on the NMR timescale, but those of SDF had a much sharper resonance, similar to that of "free" F- (4 Hz). Moreover, further NMR results revealed that a popular SDF product contained high molar excesses of both F- and NH3. Treatment of WMSSs with SDF and SF generated an off-white precipitate, which slowly developed into CSNPs at 23°C; SEM demonstrated high contents of both silver and chloride in this material (ca.1:1 atomic content ratio). FTIR-ATR analysis found that the CSNPs formed contained a range of salivary biomolecules, which appear to encapsulate the Ag/AgCl core (significant thiocyanate contents were also found). In conclusion, NMR results acquired demonstrated that SF, but not SDF, product solutions feature rapidly-exchanging F - between its "free" and Ag(I)-bound forms, and that SDF contains large excesses of both F- and its NH3 ligands. Characterised AgCl deposits and CSNPs were sequentially produced from the interactions of these complexes with WMSS biomolecules.

Discussion

In view of their well-known microbicidal and cariostatic properties, the observed autobioconstruction of CSNPs involving salivary catalysis is of much therapeutic significance.

The Use of Potassium Iodide in Pediatric Dentistry Does Not Change the Retention of Glass Ionomer Cement on a Dentin Treated with Silver Fluoride: In Vitro Results

In pediatric and operative dentistry, caries treatment benefits from a therapeutic option based on the use of silver fluoride (AgF) associated with potassium iodide (KI) to avoid dark colorations on dental tissues. The objective of this in vitro study is to evaluate the retention of glass ionomer cement (GIC) on a dentin when treated with AgF and KI. Twenty-two healthy human permanent molars and eight human primary teeth, all free of any decay, were cut to obtain occlusal flat dentinal surfaces and were then treated with AgF for a duration of 60 s. For half of the teeth, a drop of KI was applied for a duration of 30 s. All samples were covered with a plot of GIC and their resistance to shear bond strength was measured. The fracture resistance in both permanent and primary teeth does not show any statistically significant differences whether KI was applied or not. For permanent teeth, the resistance is slightly higher in the group treated with KI than in the group treated with AgF alone. To our knowledge, these data are the first to describe the possible application of KI both on primary and permanent teeth. In any case, further studies are needed to investigate the bond strength between dentin and GIC on a wider range of samples.

Knowledge, Attitudes, and Practices towards Silver Diamine Fluoride among Dentists in Vietnam

Silver diamine fluoride (SDF) is a topical solution used for managing dental caries. The mixed-methods study consists of a quantitative study (questionnaire survey) and a qualitative study (in-depth interview) to explore the knowledge, attitudes, and practices towards SDF among dentists in Vietnam. A descriptive approach and a thematic approach were performed to analyze data, respectively. The questionnaire survey invited 436 licensed dentists registered for the national annual dental meeting and 226 dentists participated (response rate: 52%). Among them, 174 (77%, 174/226) dentists knew SDF, and 69 (40%, 69/174) dentists used SDF for caries management. Most of them considered SDF therapy as non-invasive (84%, 146/174) and simple (80%, 140/174). However, most of them expressed concern that SDF could discolor the tooth (74%, 128/174). Their most preferred teeth for SDF therapy were primary posterior teeth (92%, 160/174). The in-depth interview consulted 16 dentists to reach data saturation. They learned about SDF from outside curriculum resources as an effective anti-caries agent. They understood the advantages (simple, non-invasive, timesaving) and disadvantages (tooth discoloring, ammonia odor) of SDF. They used SDF to arrest caries in uncooperative children in the clinic and people living in rural areas in outreach services. Most dentists in Vietnam are supportive of SDF therapy, and they know its advantages and disadvantages for caries management. The results addressed the aim of the study to investigate Vietnamese dentists' perspectives towards SDF.

Professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries: Systematic review

OBJECTIVES

This systematic review aimed to review the safety and effectiveness of professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries (LMICs).

METHODS

Randomized controlled trials conducted in LMICs, in which professionally applied fluorides were compared with placebo/no treatment/health education only or usual care with a minimum one-year follow-up period, were included. Any topically applied fluoride agents such as sodium fluoride (NaF), acidulated phosphate fluoride, silver diamine fluoride (SDF), and nano silver fluoride (NSF) were included. Five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) were searched in May 2022. Meta-analysis was conducted using a random effect model.

RESULTS

This review included 33 studies for qualitative synthesis, encompassing 16,375 children aged between 1.5 and 14 years. Nevertheless, the meta-analysis focused on only 17 studies, involving 4067 children. Fourteen papers assessed potential adverse events, none of which was reported as major adverse events. SDF and NSF were identified as effective in arresting caries on primary teeth (p < 0.05) compared with a placebo or no treatment. Fluoride varnish and gel were identified as effective in reducing new caries development on primary teeth (p < 0.05) but not on permanent teeth (p > 0.05). The certainty of the generated evidence obtained is low.

CONCLUSION

The review provides valuable insights into the use of professionally applied fluorides in LMICs and contributes to recommendations for their use. However, the limited rigorous evidence suggests the need for further research to strengthen these findings and draw more robust conclusions.

Using sequential applications of a novel silver diamine fluoride gel and sodium fluoride varnish to arrest severe early childhood caries lesions: A clinical trial with single group assignment

BACKGROUND

Silver diamine fluoride (SDF) gel was developed to overcome the clinical limitations of liquids with children. The authors conducted a clinical trial to determine caries lesion arrest in primary teeth at 1-year follow-up when 38% SDF gel and 2.5% sodium fluoride varnish were applied sequentially at the same appointment. Parent satisfaction was assessed.

METHODS

The study design was an open-label prospective, clinical trial with single group assignment. Participants were 237 children aged 3 through 4 years at enrollment and from 5 centros educativos iniciales (preschools). Eligible children had 1 or more d3 (cavitation into dentin) active caries lesions. Teeth with active caries lesions (cavitation confined to enamel [d2] or d3) were treated by applying 1 or 2 drops of viscous 38% SDF gel (Advantage Silver Dental Arrest Gel, Elevate Oral Care, LLC) dabbing the excess with cotton. Treated teeth were covered with 2.5% sodium fluoride varnish (Fluorimax, Elevate Oral Care, LLC) to mask the taste. Treatment was repeated at 5 months postexamination. The primary outcome was caries lesion (d2-d3) arrest at 1 year.

RESULTS

Two hundred nineteen children were available at the 1-year follow-up. There was a median of 21 (interquartile range [IQR], 13-34) active carious surfaces (d2-d3) at baseline. Median arrested carious surfaces was 92.6% (IQR, 81.1%-100.0%; 95% CI, 86.8% to 95.2%). When parents were asked whether they were bothered by the color change of teeth, the median response on a 10-point scale in which 1 equaled not bothered at all and 10 equaled very bothered was 1.0 (IQR, 1.0-2.0).

CONCLUSIONS

Two applications of 38% SDF gel and 2.5% sodium fluoride varnish arrested greater than 90% of carious surfaces at 1 year and with high levels of parental satisfaction.

PRACTICAL IMPLICATIONS

Combined treatment was highly efficacious in a population with many caries lesions. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT05395065.

Comparisons of ammonia- and water-based silver-containing solutions on dentin bonding and enzymatic activity: 1-yr evaluation

OBJECTIVE

To evaluate the effects of an ammonia-based and a water-based silver-containing solutions on bonding performance and matrix-metalloproteinases (MMPs) activity of a universal adhesive to dentin after 1 year of artificial aging.

METHODS

Mid-coronal dentin surfaces of 60 sound human molars were exposed and the following groups were formed according to the surface pre-treatment and etching mode of the universal adhesive (Zipbond Universal, SDI) (n = 10): G1) Zipbond in the self-etch mode (ZSE); G2) Riva Star (SDI) applied before ZSE; G3) Riva Star Aqua (SDI) applied before ZSE; G4) Zipbond in the etch-and-rinse mode (ZER); G5) Riva Star applied before ZER; G6) Riva Star Aqua applied before ZER. The specimens were sectioned and subjected to microtensile bond strength (µTBS) test at baseline (T0) and after 12 months (T12) of artificial storage. Scanning electron microscope (SEM) and energy dispersive spectroscopy analysis (EDS) were also conducted. Three additional molars per group were processed for the in situ zymography analysis at T0 and T12. Data were statistically analyzed (p < 0.05).

RESULTS

Dentin pre-treatments and aging decreased bonding values, regardless of the etching mode (p < 0.05). No differences in µTBS were observed between the two silver-containing solutions, both at T0 and T12. Riva Star Aqua and etching significantly increased the MMPs activity, independent of the storage period (p < 0.05).

SIGNIFICANCE

Dentin surface pre-treatment with silver-containing solutions negatively affects the bonding performances of resin composite restorations placed with a universal adhesive. However, the ammonia-based product Riva Star might show better stability in the long term, due to lower activation of MMPs.

Silver Diamine Fluoride as a Medicament for the Indirect Pulp Therapy in Primary Teeth: A Review of the Literature

Silver diamine fluoride (SDF) has been demonstrated to be effective in arresting caries lesions and, recently, clinical trials have assessed the effectiveness of SDF as a medicament for indirect pulp therapy (IPT) in primary teeth. This review aims to summarize the literature related to the use of SDF and find out if SDF can be used as an effective material for IPT. A literature search was undertaken on electronic databases including PubMed, MEDLINE, ScienceDirect, and Google Scholar, which elicited 50 studies employing different materials in the IPT of primary molars; however, of them, only four clinical trials used SDF as indirect pulp capping (IPC) material. SDF has the potential to be a useful material for IPT in primary teeth. It is a handy choice for pediatric dentists due to its minimum invasiveness, ease of application, and ability to stop the progression of caries. However, more studies are needed to determine whether SDF can be used routinely for IPT and whether it can even replace the currently available materials, as well as to fully realize its potential and establish criteria for its ideal application in IPT procedures.

Optimized 3D printed zirconia-reinforced leucite with antibacterial coating for dental applications

OBJECTIVES

This study aims to produce by robocasting leucite/zirconia pieces with suitable mechanical and tribological performance, convenient aesthetics, and antibacterial properties to be used in dental crown replacement.

METHODS

Leucite pastes reinforced with 12.5%, 25%, and 37.5% wt. ZrO2 nanoparticles were prepared and used to print samples that after sintering were characterized in terms of density, shrinkage, morphology, porosity, mechanical and tribological properties and translucency. A coating of silver diamine fluoride (SDF) and potassium iodide (KI) was applied over the most promising material. The material's antibacterial activity and cytotoxicity were assessed.

RESULTS

It was found that the increase of ZrO2 reinforcement up to 25% enhanced both microhardness and fracture toughness of the sintered composite. However, for a superior content of ZrO2, the increase of the porosity negatively affected the mechanical behaviour of the composite. Moreover, the composite with 25% ZrO2 exhibited neglectable wear in chewing simulator tests and induced the lowest wear on the antagonist dental cusps. Although this composite exhibited lower translucency than human teeth, it was three times higher than the ZrO2 glazed material. Coating this composite material with SDF+KI conferred antibacterial properties without inducing cytotoxicity.

SIGNIFICANCE

Robocasting of leucite reinforced with 25% ZrO2 led to best results. The obtained material revealed superior optical properties and tribomechanical behaviour compared to glazed ZrO2 (that is a common option in dental practice). Moreover, the application of SDF+KI coating impaired S. aureus proliferation, which anticipates its potential benefit for preventing pathogenic bacterial complications associated with prosthetic crown placement.

Effect of Silver Diamine Fluoride on Bonding Performance and Ultra-morphological Characteristics to Sound Dentin

OBJECTIVES

This study aimed to evaluate microtensile bond strength (µTBS) and ultra-morphological characteristic changes in sound dentin resulting from silver diamine fluoride (SDF) when using adhesives.

METHODS

Ninety-six extracted human third molars were divided into the SDF-contaminated dentin group and the sound dentin group. In the SDF-contaminated dentin group, 38% SDF was agitated for 1 min, left undisturbed for 2 min, and rinsed with distilled water for 30 s. Then, each group was further subdivided into six subgroups (n = 8 / group) according to application modes: self-etch mode (SE) and etch-and-rinse mode (ER) followed by three adhesives: (1) Scothbond Universal Plus Adhesive (SUP); (2) G2-Bond Universal Adhesive (G2B); and (3) Clearfil Mega Bond 2 (MB2). All specimens were restored with resin composite and were stored in distilled water for 24 h before μTBS testing. Data from the μTBS test were analyzed using Three-way ANOVA and Duncan test (p < 0.05). The morphology of fractured surface and adhesive-dentin interfaces were evaluated by SEM, TEM, and STEM. Further elemental analysis was done by EDX.

RESULTS

All SDF-contaminated dentin groups demonstrated significantly lower μTBS than sound dentin groups. All ER groups had higher μTBS than SE groups, except for G2B in the sound dentin group. STEM/EDX revealed an SDF-dentin-reacted layer in the SDF-contaminated dentin group.

SIGNIFICANCE

SDF had an adverse effect on adhesives. Additionally, ER mode is preferable when bonded to SDF-contaminated dentin. A calcium and fluoride-contained layer was observed in all SDF-contaminated dentin.

Effect of silver diamine fluoride on the longevity of the bonding properties to caries-affected dentine

OBJECTIVES

This study aimed to evaluate the adhesive properties in dentine after the application of silver diamine fluoride (SDF) on carious dentine lesions immediately and after 2 years of water storage.

METHODS

96 human molars used were subjected to artificial dentine caries production, and then randomly divided into 12 experimental groups according to 1. application of an SDF solution (carious dentine lesion without SDF treatment [control], with 12 % silver diamine fluoride [SDF 12 %] or 38 % silver diamine fluoride [SDF 38 %]); 2. Universal adhesives (Clearfil Universal Bond Quick [CUQ] and Single Bond Universal [SBU]); 3. adhesive strategy (etch-and-rinse [ER] and self-etch [SE]). After restoration, the specimens were sectioned and submitted to the microtensile bond strength test (μTBS) and energy-dispersive X-ray spectrometry analysis (SEM/EDX). All tests were performed immediately and after 2 years of water storage. Data from the μTBS were analyzed using four-way ANOVA and Tukey's test (α = 0.05).

RESULTS

Only the interaction of factors 'SDF' vs 'time' was significant (p = 0.03). After 2 years of storage, the groups where SDF was applied showed higher μTBS values compared to the control group. No significant decrease in μTBS values was observed for SBU when comparing immediate and 2-year results, but a significant reduction in μTBS values was observed after 2 years for CUQ.

CONCLUSION

Independent of the adhesive strategy, the use of SDF may be a promising alternative to maintain the bonding of universal adhesives to carious dentinal lesions.

CLINICAL SIGNIFICANCE

This study may clarify and support clinicians regarding the longevity of resin-based restoration in caries-affected dentine treated with silver diamine fluoride.

Laser fluorescence assessment of dental caries arrest with two silver fluoride agents in patients with special needs- a preliminary report

PURPOSE

While silver diamine fluoride has been used extensively for caries arrest and desensitising, silver fluoride (AgF) at neutral pH may also have value as a minimally invasive dental caries treatment. This study explored the effectiveness of two AgF products (AgF/KI and AgF/SnF2) when used in adult patients with special needs (SN) who had high caries risk and salivary gland hypofunction.

METHODS

This split-mouth clinical study, over two appointments 3-months apart, compared the impact of a single application of AgF/KI (Riva Star Aqua, SDI) and AgF/SnF2 (Creighton Dental CSDS, Whiteley) on matched carious lesions in the same arch, by clinical visual-tactile (cVT) assessment of caries status and laser fluorescence (LF, DIAGNOdent) evaluation of bacterial load in the lesions, using repeated measures analysis.

RESULTS

Twelve participants were recruited in the study. A total of 56 teeth (28 pairs) were included. Both AgF products gave a significant decrease in caries activity as measured by cVT (P < 0.0001) and LF (P = 0.0027). There were no statistically significant differences between the two AgF treatments, with response rates for improvements in active lesions of 92% in the AgF/KI arm, and 96% in the AgF/SnF2 arm. There was no effect of tooth type, lesion type, arch type, plaque metabolism and plaque area at the site level on outcomes, nor was there a clustering effect of sites in a patient level analysis. Overall, LF was superior to cVT for detecting lesions that still progressed despite treatment (P = 0.0027).

CONCLUSION

A single application of AgF/KI or AgF/SnF2 has high predictability (over 90%) for achieving arrest in active caries lesions in adult patients with SN and high caries risk. Clinical assessment should use visual-tactile examination combined with LF readings to detect lesions that are still progressing and that require additional treatments. Future studies should compare these AgF modalities with SDF and explore factors such as time between applications and the need for repeated applications.

TRIAL REGISTRATION

The study was registered with the Australian Clinical Trials Registry (ACTRN12621001139864p) on 23/08/2021.

Remineralization and inactivation of carious lesions treated with silver fluoride in Brazilian children with special healthcare needs

Introduction

Providing conventional, restorative dental care to children with special healthcare needs (CSHCN) often requires sedation using general anesthesia. Saliva consistency, diet, and oral hygiene practice are different for CSHCN, and limited evidence is available on the efficacy of silver fluoride (SF) for the management of carious lesions for this vulnerable population.

Methods

Parents of CSHCN were educated about silver fluoride as a treatment option for caries. In total, 550 carious lesions from 100 participants were identified and scored according to the Nyvad Caries criteria. A total of 100 lesions with Nyvad scores 1, 2, and 3 were treated with a single application of silver fluoride and observed postoperatively at 1, 3, and 6 weeks.

Result

The results indicate statistically significant (p < 0.05) differences in lesion remineralization over the 6-week follow-up period. At the 6-week follow-up, more than 85% of all lesions were remineralized across all children, regardless of condition or original Nyvad score of 1, 2, or 3.

Conclusion

A single application of silver fluoride has demonstrated effectiveness in remineralization and inactivation of carious lesions over 6 weeks among Brazilian CSHCN. Silver fluoride should be considered an option for the management of carious lesions among CSHCN. Further studies are recommended, including larger sample sizes, longer follow-up times, a second application of SF, and different special needs conditions.

Effect of silver diamine fluoride and nano silver fluoride on oral health-related quality of life of children with early childhood caries: A randomized clinical trial

OBJECTIVES

Untreated caries in primary teeth is one of the most prevalent health problems in children worldwide. Silver diamine fluoride (SDF) non-invasively arrests caries but causes staining unlike Nano Silver Fluoride (NSF) which causes no stains. This study compared the effect of NSF and 38 % SDF on the oral health related quality of life (OHRQoL) of preschool children after 6 months.

METHODS

Children were included if they were younger than 4 years, with at least one active lesion, ICDAS score ≥3, attending nurseries in a rural area in Alexandria, Egypt. They were randomly assigned to receive NSF once at baseline, or SDF at baseline and after 6 months. The Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS) was used to assess the OHRQoL. The groups were compared using chi-square test and the effect of the intervention on OHRQoL was assessed using multiple linear regression.

RESULTS

360 children were included, mean (SD) age = 42.3 (8.2) months. After 6 months, NSF had significantly lower A-ECOHIS scores than SDF in bivariate analysis (p< 0.05) and in regression analysis (B= -5.02, p = 0.001) after adjusting for confounders. There were significant reductions in the A-ECOHIS total and domains' scores in both study groups, except for the social interaction domain in the SDF group.

CONCLUSION

After 6-month, both agents significantly improved children's OHRQoL although NSF had a significantly better impact on OHRQoL than SDF.

CLINICAL SIGNIFICANCE

Patient-reported outcomes support the inclusion of the two agents among the options for ECC management with better effect on quality of life after NSF.

TRIAL REGISTRATION

The trial was registered in the clinicaltrials.gov registry (#NCT05255913).

Effect of silver diamine fluoride on the microleakage of flowable resin composite and glass ionomer cement restorations to carious primary dentin: an-in vitro study

BACKGROUND

This study aimed to evaluate the effect of Silver Diamine Fluoride (SDF) on the microleakage of flowable resin composite (FRC) and resin-modified glass ionomer cement (GIC) restorations bound to carious primary dentin.

METHODS

Forty-four extracted carious primary molars were allocated into four groups as follows (n = 11 teeth/group): Group I, Flowable resin composite (FRCa): SDF38% treatment + FRC, Group II, Flowable resin composite (FRCb): FRC without SDF treatment, Group III, Resin-modified glass ionomer cement (GICa): SDF38% treatment + GIC, Group IV, Resin-modified glass ionomer cement (GICb): GIC without SDF treatment. Specimens were subjected to thermo cycling at 500 cycles between 5 to 55 °C (dwell time of 60 seconds) in baths before being immersed for 24 h in a 1% toluidine blue solution. Microleakage testing was conducted for each specimen in two areas; occlusal and gingival. Specimens were evaluated under stereomicroscope at 4x magnification. Results were analyzed using Kruskal-Wallis test followed by pairwise comparisons utilizing Dunn's post hoc test at p ≤ 0.05.

RESULTS

Insignificant differences between different groups (p = 0.49) were observed at the gingival walls area readings. The highest value was found in GICb (2.33 ± 0.52), while the lowest value was found in FRCa (1.71 ± 0.76). Insignificant differences between different groups (p = 0.982) were observed at the occlusal walls area readings. The highest value was found in FRCa (1.43 ± 0.98), while the lowest value was found in GICb (1.17 ± 1.33).

CONCLUSION

SDF does not adversely affect the microleakage of FRC and GIC restorations bound to carious primary dentin.

The Evolving Microbiome of Dental Caries

Dental caries is a significant oral and public health problem worldwide, especially in low-income populations. The risk of dental caries increases with frequent intake of dietary carbohydrates, including sugars, leading to increased acidity and disruption of the symbiotic diverse and complex microbial community of health. Excess acid production leads to a dysbiotic shift in the bacterial biofilm composition, demineralization of tooth structure, and cavities. Highly acidic and acid-tolerant species associated with caries include Streptococcus mutans, Lactobacillus, Actinomyces, Bifidobacterium, and Scardovia species. The differences in microbiotas depend on tooth site, extent of carious lesions, and rate of disease progression. Metagenomics and metatranscriptomics not only reveal the structure and genetic potential of the caries-associated microbiome, but, more importantly, capture the genetic makeup of the metabolically active microbiome in lesion sites. Due to its multifactorial nature, caries has been difficult to prevent. The use of topical fluoride has had a significant impact on reducing caries in clinical settings, but the approach is costly; the results are less sustainable for high-caries-risk individuals, especially children. Developing treatment regimens that specifically target S. mutans and other acidogenic bacteria, such as using nanoparticles, show promise in altering the cariogenic microbiome, thereby combatting the disease.

Stability of Silver and Fluoride Contents in Silver Diamine Fluoride Solutions

OBJECTIVE

This study aims to determine the stability, alkalinity, and fluoride and silver ion concentrations of 5 commercially available 38% silver diamine fluoride (SDF) solutions-namely Advantage Arrest, e-SDF, Riva Star, Saforide, and Topamine-in 180 days.

METHODS

Alkalinity was determined using a pH electrode. The fluoride and silver ion concentrations were obtained using a calibrated ion-selective electrode and optical emission spectrometer, respectively. Six bottles of each product were examined on days 0 (freshly opened), 30, 60, 90, and 180. The time taken for each freshly opened product to form a black silver precipitate under room light (500 lx) and 25 °C was also recorded.

RESULTS

For 180 days, Advantage Arrest, e-SDF, Riva Star, Saforide, and Topamine had the pH range of 9.8-9.8, 10.5-10.6, 13.0-13.1, 9.8-9.8, and 9.3-9.4; fluoride ion concentration range (nearest 1000 ppm) of 40.9%-42.4%, 46.7%-50.9%, 37.0%-39.0%, 37.0%-45.7%, and 47.7%-53.4%; silver ion concentration range (nearest 1000 ppm) of 283.4-307.0, 307.3-315.4, 418.6-435.7, 266.3-281.0, and 416.2-456.1 ppm; and precipitation time (nearest hour) of 17, 12, 6, 7, and 7 hours, respectively. The percentage change of fluoride and silver could be more than 5% after 60 days.

CONCLUSIONS

The alkalinity of the 5 SDF solutions remained stable after 180 days. In addition, their fluoride and silver concentrations decreased substantially after 60 days. The freshly opened SDF solutions did not precipitate within 5 hours under ambient room conditions. The alkalinity and fluoride and silver concentrations of the 38% SDF solutions could be less stable after 60 days; thereafter, the fluoride and silver concentrations decreased. Thus, the SDF solution should be used within 60 days after opening.

Parental acceptance of silver fluoride as a treatment option for carious lesions among South African children with special health care needs

Providing dental care for children with neurological special health care needs, including Down syndrome, Cerebral palsy and Autism spectrum disorders, is challenging. They often require repeat exposure to sedation or general anaesthesia for routine dental care. 51 parents of children with special needs completed a questionnaire regarding the acceptance of Silver Fluoride as a treatment option.

Background

Silver Diamine Fluoride has become popular as a minimally invasive treatment option for providing oral health care to young or uncooperative children. Silver Fluoride (SF) is a newer development with similar but improved properties. The aim was to determine the acceptance of SDF/SF as treatment option for Children with Special Health Care Needs (CSHCN), including Down Syndrome, Autism Spectrum Disorder and Cerebral Palsy.

Methods

51 Parents of CSHCN completed a questionnaire on the overall acceptance of SF; aesthetic concerns related to the location of application; the use of SDF as an alternative to general anesthesia; and the composition of SF.

Results

The use of SF on posterior teeth were more acceptable (70.59%) as opposed to its application to anterior teeth (50.98%). Parents generally agreed/ strongly agreed to the use of SF to reduce infection and pain (82%); to avoid treatment under GA (26.70%); and to avoid an injection (78%). 64% of parents indicated their agreement in using SF because it has a reduced cost when compared to a conventional restoration. Majority of parents were in agreement to use SF even if it contains Fluoride (84%) and Silver (78%).

Conclusion

The use of SF, as treatment option for caries, was well accepted by South African parents of CSHCN. Shared decision making should be applied when considering SF as treatment option for CSHCN.

Effect of a novel quaternary ammonium silane based cavity cleanser FiteBac 2% K21 QAS in comparison with other cavity disinfectants on the bond strength of resin-modified glass ionomer cement

Background

The application of cavity cleansers for cavity disinfection can be a crucial step in the longevity of restorations. The objective of the present study was to compare the effect of the application of a new quaternary ammonium silane (QAS)-based cavity cleanser (2% K21 QAS), with other commercially available cavity disinfectants on the bond strength of resin-modified glass ionomer cement (RMGIC).

Materials and Methods

The buccal surfaces of 40 extracted premolars were trimmed to obtain a flat dentinal surface and were randomly divided into four experimental groups depending on the cavity cleansers used before restoration. Group 1: 2% chlorhexidine (CHX), Group 2: QAS (FiteBac 2% K21 QAS), Group 3: silver diamine fluoride-potassium iodide (Riva Star, SDF-KI), and Group 4: 3% hydrogen peroxide (H2O2). Then, a predetermined dimension of RMGIC restoration was bonded to the treated dentin surfaces. Following this, each sample was tested for shear bond strength (SBS) using a universal testing machine at a crosshead speed of 0.5 mm/min.

Results

Among the experimental groups, SDF-KI has shown the highest mean SBS, followed by 2% K21 QAS, and 2% CHX, which have shown almost comparable results. The 3% H2O2 group has shown the lowest values.

Conclusion

According to the results of the present study, 2% K21 QAS has the potential to be used as an effective cavity cleanser before the placement of RMGIC restorations. Since its application does not affect the bond strength of restoration, it can be successfully used as an alternative to CHX and SDF-KI.

Estimation of fluoride ion concentration in urine after application of silver diamine fluoride in patients with severe early childhood caries

BACKGROUND

Despite the University of California San Francisco, the American Academy of Pediatric Dentistry (AAPD), and the Food and Drug Administration having approved the use of silver diamine fluoride (SDF) in arresting dentinal caries, literature available on its systemic absorption is limited.

AIM

This study aimed to assess any systemic absorption of fluoride ion following the topical application of SDF in young children.

MATERIALS AND METHODS

Children aged between 3 and 6 years who were diagnosed with severe early childhood caries and required rehabilitation were recruited for the study. Before the onset of treatment for the arrest and control of caries, a baseline urine sample as a control was collected from the patient. In accordance with the manufacturer's instructions and AAPD guidelines, SDF was topically applied on a minimum of five carious teeth, following which additional urine samples were collected after 2 h and after 24 h, respectively, of application of SDF. The urine samples were stored at -20°C, and the estimation of fluoride ion concentrations in urine was then ascertained using a fluoride ion selective electrode.

RESULTS

The results revealed that the fluoride concentration in urine before application of SDF was 0.66 mg/L ± 0.25 mg/L, and following 2 h of application, it was 1.13 mg/L ± 0.23. However, 24 h postapplication, the urinary fluoride concentration was reduced to 0.63 mg/L ± 0.20, which is close to the baseline value of the control sample.

CONCLUSION

There was no significant systemic absorption of fluoride following the application of SDF, and it could be adopted as an effective and safe agent in the armamentarium for managing caries in young children.