Silver Diamine Fluoride Solution Research Articles

Preventive dental erosion with silver diamine fluoride: An in vitro study

ObjectivesTo evaluate the erosion preventive effect of 38 % silver diamine fluoride (SDF) solution in enamel and dentin of human permanent teeth. MethodsNinety enamel and ninety dentin blocks were prepared from permanent molars and allocated into three groups. Gp-SDF received a one-off application of 38 % SDF solution. Gp-SNF received a one-off application of a solution containing 800 ppm stannous chloride and 500 ppm fluoride. Gp-DW received a one-off application of deionized water. The blocks were submitted to acid challenge at pH 3.2, 2 min, 5 times/day for 7 days. All blocks were immersed in human saliva between cycles for one hour. The crystal characteristics, percentage of surface microhardness loss (%SMHL), surface loss, and elemental analysis and surface morphology were examined by X-ray diffraction (XRD), microhardness test, non-contact profilometry, and energy-dispersive X-ray spectroscopy (EDS) and scanning electron microscopy (SEM), respectively. Data of%SMHL and surface loss were analyzed by one-way ANOVA. ResultsXRD spectra revealed that fluorapatite and silver compounds formed in Gp-SDF, while fluorapatite and stannous compounds formed in Gp-SNF. Gp-DW presented only hydroxyapatite. The median (interquartile range) of%SMHL in Gp-SDF, Gp-SNF and Gp-DW were 27.86(3.66), 43.41(2.45), and 46.40(3.54) in enamel (p< 0.001), and 14.21(1.57), 27.99(1.95), and 33.18(1.73) in dentin, respectively (p < 0.001). The mean (standard deviation, μm) of surface loss of Gp-SDF, Gp-SNF, and Gp-DW were 2.81(0.59), 4.28(0.67), and 4.63(0.64) in enamel (p < 0.001) and 4.13(0.69), 6.04(0.61), and 7.72(0.66) in dentin, respectively (p < 0.001). SEM images exhibited less enamel corruption and more dentinal tubular occlusion in Gp-SDF compared to Gp-SNF and Gp-DW. EDS analysis showed silver was detected in Gp-SDF while stannous was detected in the dentin block of Gp-SNF. Conclusion38 % SDF yielded superior results in protecting enamel and dentin blocks from dental erosion compared to SNF and DW. Clinical significanceTopical application of 38 % SDF is effective in preventing dental erosion in human enamel and dentin.

Noninferiority of Silver Diamine Fluoride vs Sealants for Reducing Dental Caries Prevalence and Incidence

Dental caries is the world's most prevalent noncommunicable disease and a source of health inequity; school dental sealant programs are a common preventive measure. Silver diamine fluoride (SDF) may provide an alternative therapy to prevent and control caries if shown to be noninferior to sealant treatment. To determine whether school-based application of SDF is noninferior to dental sealants and atraumatic restorative treatment (ART) in the prevalence of dental caries. The Silver Diamine Fluoride Versus Therapeutic Sealants for the Arrest and Prevention of Dental Caries in Low-Income Minority Children (CariedAway) study was a pragmatic noninferiority cluster-randomized clinical trial conducted from February 2018 to June 2023 to compare silver diamine fluoride vs therapeutic sealants for the arrest and prevention of dental caries. Children at primary schools in New York, New York, with at least 50% of the student population reporting as Black or Hispanic and at least 80% receiving free or reduced lunch were included. This population was selected as they are at the highest risk of caries in New York. Students were randomized to receive either SDF or sealant with ART; those aged 5 to 13 years were included in the analysis. Treatment was provided at every visit based on need, and the number of visits varied by child. Schools with preexisting oral health programs were excluded, as were children who did not speak English. Of 17 741 students assessed for eligibility, 7418 were randomized, and 4100 completed follow-up and were included in the final analysis. Participants were randomized at the school level to receive either a 38% concentration SDF solution or glass ionomer sealants and ART. Each participant also received fluoride varnish. Primary study outcomes were the prevalence and incidence of dental caries. A total of 7418 children (mean [SD] age, 7.58 [1.90] years; 4006 [54.0%] female; 125 [1.7%] Asian, 1246 [16.8%] Black, 3648 [49.2%] Hispanic, 153 [2.1%] White, 114 [1.5%] multiple races or ethnicities, 90 [1.2%] other [unspecified], 2042 [27.5%] unreported) were enrolled and randomized to receive either SDF (n = 3739) or sealants with ART (n = 3679). After initial treatment, 4100 participants (55.0%) completed at least 1 follow-up observation. The overall baseline prevalence of dental caries was approximately 27.2% (95% CI, 25.7-28.6). The odds of decay prevalence decreased longitudinally (odds ratio [OR], 0.79; 95% CI, 0.75-0.83) and SDF was noninferior compared to sealants and ART (OR, 0.94; 95% CI, 0.80-1.11). The crude incidence of dental caries in children treated with SDF was 10.2 per 1000 tooth-years vs 9.8 per 1000 tooth-years in children treated with sealants and ART (rate ratio, 1.05; 95% CI, 0.97-1.12). In this school-based pragmatic randomized clinical trial, application of SDF resulted in nearly identical caries incidence compared to dental sealants and ART and was noninferior in the longitudinal prevalence of caries. These findings suggest that SDF may provide an effective alternative for use in school caries prevention. ClinicalTrials.gov Identifier: NCT03442309.

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

ObjectivesThis 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. Methods96 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). ResultsOnly 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. ConclusionIndependent 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 significanceThis study may clarify and support clinicians regarding the longevity of resin-based restoration in caries-affected dentine treated with silver diamine fluoride.

Topical Effect of Silver Diamine Fluoride in Preventing and Arresting Root Caries in Elderly Patients.

Aim of the study: The purpose of the present investigation was to see how efficient silver diamine fluoride (SDF) solution treatment to prevent dental root caries.&#x0D; Materials and method: This research was done at Iraq's geriatric facilities. Forty seniors with active caries lesions were fortuitously assigned into two groups: Group 1 (placebo control)—doubles Twice-Annual treatment with soda water; Group 2—Doubles Twice-Annual treatment with silver diamine fluoride solution.&#x0D; Results: After 18 months, the arrest rates of root caries were 28 percent in group1 (control) and 88 percent group 2 silver diamine fluoride solutions (x2 test, p &lt; 0.05). There was a considerable relation (dependent) between silver diamine fluoride and stopping root surface dental caries Chi=7.08, df=2, P&lt;0.05, which means that silver diamine fluoride was efficient in stopping dental caries while there was no relation (independent) between placebo dye and arresting caries, Chi=1.33 df=2 P&gt;0.05.&#x0D; Conclusions: Silver diamine fluoride solution was helpful in avoiding root caries in elderly people who do not have access to fluoridated water.

Efficacy of Silver Diamine Fluoride in Arresting Dental Caries in Primary Teeth in Patient Visiting Tertiary Hospital of Kathmandu

IntroductionCarious lesions can both be prevented and arrested using fluoride-based materials. This study was done to evaluate and compare the efficacy of silver diamine fluoride in arresting dental caries at different frequencies of applications. MethodsThis experimental study was conducted among ten preschool children of 3-5 years old with seventy-four active carious lesions taking teeth as a sample unit. Children were randomly allocated into two intervention groups: Group 1— application of 38% silver diamine fluoride solution atthree consecutive weeks and Group 2— three applications of 38% silver diamine fluoride solution at monthly interval. The time taken of caries arrest was recorded. Data were collected and entered in Microsoft Excel sheet and analysis was done in Statistical Package for the Social Sciences (SPSS) version 16. ResultsThe mean time taken for caries arrest for Group II (57.20 days) was found to be statistically longer than Group I (21.54 days) (p-value &lt; 0.001). As the mean time taken for caries arrest for Group I was shorter, the weekly application was found to have higher efficacy than the monthly application. ConclusionsEfficacy of Silver Diamine Fluoride was found to be more in Group I (weekly application) compared to Group II (monthly application).

Treating hypersensitivity in older adults with silver diamine fluoride: A randomised clinical trial

ObjectiveThis study aimed to evaluate the desensitizing effect of topically applied 38% silver diamine fluoride (SDF) solution on the exposed root surface of hypersensitive teeth in older adults. MethodThis double-blind randomised clinical trial recruited healthy older adults with dentine hypersensitivity. A trained examiner tested the most hypersensitive tooth root surface with a blast of compressed cold air from a three-in-one syringe. The participants gave a sensitivity score (SS) in visual analogue scale from 0 (no pain) to 10 (agonizing) at the baseline visit. Then, they received 38% SDF or 5% potassium nitrate solution (control) as intervention on the root surface. After the intervention, they received a compressed cold air test and reported the SS again. The compressed cold air test followed by intervention was repeated at 4- and 8-week follow ups. The primary outcome was the reduction in SS at 8-week follow-up with reference to the SS at baseline before intervention. Shapiro–Wilk and Mann–Whitney U tests were performed for data analysis following a normality test of SS. ResultsThis trial recruited 148 participants, and 139 (94%) participants completed the trial. The median percentage reductions in SS in the SDF and potassium nitrate groups were 60% and 50%, respectively (p < 0.001). ConclusionAccording to the results, 38% SDF solution reduced hypersensitivity on the exposed root surface of older adults. In addition, 38% SDF was more effective than 5% potassium nitrate solution to reduce hypersensitivity on the exposed root surface of older adults. Clinical significanceDentin hypersensitivity is common amongst older adults and negatively affects their quality of life. To date, there is no gold standard professionally applied desensitizing therapy in treating hypersensitivity. Evidence from this clinical trial could aid clinical practice and improve oral health in older adults. Trial registrationThis study was registered at ClinicalTrials.gov (NCT05392868).

The Caries-Arrest Effectiveness of Silver Diamine Fluoride Treatment with Different Post-Treatment Instructions in Preschool Children: A Study Protocol for a Randomized Controlled Trial.

In this 12-month randomized active-controlled clinical trial, we compare two post-treatment instructions for silver diamine fluoride (SDF) therapy in arresting dentine caries. The trial will include at least 254 kindergarten children with active dentine caries. The children will be randomized into two groups and receive a 38% SDF solution applied topically to their carious lesions. Children in Group A will rinse immediately, whereas those in Group B will refrain from rinsing, eating, and drinking for 30 min. One trained examiner will perform the dental examination at baseline and every six months. The primary outcome measurement will be the proportion of caries lesions that become arrested at the 12-month examination. Potential confounding factors and parents' satisfaction with SDF therapy at baseline and after 12 months will be collected using parental questionnaires. This trial will provide evidence-based information for clinical practitioners to give post-treatment instructions for SDF therapy. This study is registered at ClinicalTrial.gov (USA) (registration number: NCT05655286).

Stability of Silver and Fluoride Contents in Silver Diamine Fluoride Solutions

ObjectiveThis 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. MethodsAlkalinity 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. ResultsFor 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. ConclusionsThe 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.

Clinical Assessment of SDF Effect in Arresting Dental Caries in Deciduous Teeth.

Current research was done to evaluate the effectiveness of 38% silver diamine fluoride (SDF) on carious lesions in deciduous teeth. The study included kids who had at least one carious lesion in accordance to the International Caries Detection and Assessment System II. A 38% SDF (FAgamin, Tedequim Company, Córdoba, Argentina) solution was applied directly to the lesion on the deciduous teeth as per the manufacturer's instructions. A follow-up evaluation was performed after one, three, and six months. Clinical results were used to assess the efficacy of SDF. The obtained data were statistically evaluated. When it came to halting dental caries in primary teeth, 38% SDF was 92% effective. In conclusion, 38% SDF can be used to effectively stop caries in primary teeth.

Caries Prevention Using Silver Diamine Fluoride: A 12-Month Clinical Trial

ObjectiveThis clinical trial aimed to compare the caries-preventive effect of annual application of 38% silver diamine fluoride solution (SDF) with 5% sodium fluoride varnish (FV) to the anterior primary teeth of children. The hypothesis was that SDF was superior to FV at 1 year. Secondary objectives were to determine the child's cooperation and the parent's satisfaction and assess adverse effects. MethodWe recruited 688 3- to 4-year-old children and randomly allocated them to receive SDF or FV (positive control) on their 6 upper anterior teeth. Tooth-surface status was recorded using the decayed, missing, and filled surfaces index. A trained observer rated the child's cooperation as “totally cooperative” or “not totally cooperative.” We used a questionnaire to determine the parent's satisfaction as “satisfied,” “neutral,” or “dissatisfied.” Adverse effects (yes/no) were evaluated 1 day and about 1 year after treatment. ResultsOf the children, 434 (SDF, n = 209; FV, n = 225) completed the trial. The mean new decayed tooth surfaces developed for SDF and FV groups were 0.4 ± 1.5 and 0.4 ± 1.3, respectively (P = .65). Child's cooperation for SDF and FV therapy was 71% (244/344) and 70% (241/344), respectively (P = .89). Parent's satisfaction for SDF and FV therapy was 71% (148/209) and 69% (155/225), respectively (P = .29). Adverse effects were found neither at 1 day nor at about 1 year after treatment for either treatment arm. ConclusionsSDF is not superior to FV for caries prevention in primary upper anterior teeth at 1-year follow-up. Child's cooperation and parent's satisfaction were similarly high with SDF and FV therapy at 1-year follow-up. Neither short-term nor long-term adverse effects were observed. This study is registered at ClinicalTrials.gov (NCT04399369).

Effectiveness of 38% Silver Diamine Fluoride in Reducing Dentine Hypersensitivity on Exposed Root Surface in Older Chinese Adults: Study Protocol for a Randomised Double-Blind Study

Background: Dentine hypersensitivity on an exposed root surface induces pain, affects daily oral hygiene practice, limits dietary choices and negatively affects quality of life. Silver diamine fluoride is marketed in the United States as a desensitising agent, but well-designed clinical trials are limited. This study evaluates the anti-hypersensitivity effect of silver diamine fluoride on hypersensitive teeth due to an exposed root surface in older Chinese adults. Methods/design: We will conduct a randomised double-blind clinical trial with a sample size of at least 148 Chinese older adults aged 65 or above who have dentine hypersensitivity due to an exposed root surface. We will collect written consent before the study. A trained examiner will examine the participants’ teeth with a blast of compressed air from a 3-in-1 syringe. Those adults who report a self-perceived sensitivity score (SS) (0 to 10) of 8 or more on at least one tooth with an exposed root surface will be recruited. The recruited older adults will be randomly allocated into two groups using a block randomisation of six. Group 1 participants will receive the application of 38% silver diamine fluoride solution every 4 weeks. Group 2 participants will receive the application of 5% potassium nitrate solution every 4 weeks. Dietary advice, oral hygiene instruction and fluoride toothpaste at 1450 ppm will be provided to participants in both groups. The same trained examiner will perform follow-up examinations for the participants and determine the dentine hypersensitivity in SS of the most hypersensitive tooth (with the highest pre-treatment SS) immediately after the intervention and at 4-week and 8-week intervals. Discussion: There is no consensus on the standard of care for a professionally applied desensitising agent in older adults. This trial will provide evidence for clinicians to devise an effective dental care plan for older adults with dentine hypersensitivity. Trial registration: NCT05392868 Registered on 22 May 2022.

CHANGES IN PARENTAL SATISFACTION AND ORAL HEALTH-RELATED QUALITY OF LIFE OF PRESCHOOL CHILDREN AFTER RECEIVING ATRAUMATIC RESTORATIVE TREATMENT WITH OR WITHOUT PRIOR SILVER DIAMINE FLUORIDE APPLICATION.

To investigate the short-term and long-term changes in parental satisfaction and oral health-related quality of life (OHRQoL) of preschool children after receiving atraumatic restorative treatment (ART) with or without prior silver diamine fluoride (SDF) application. In a randomized controlled trial, preschool children with cavitated dentine caries lesions in their primary teeth were randomly assigned into two groups to receive either application of SDF solution or placebo (tonic water) on the caries lesions 10 weeks before receiving ART restorations. The information on parental satisfaction and OHRQoL of the children were collected through self-completed questionnaires at baseline, the 6-month and the 24-month follow-up. A five-point scale, from 1 (very dissatisfied) to 5 (very satisfied), was used by parents to indicate their satisfaction with their child's dental conditions. A higher parental satisfaction score indicates that parents were more satisfied with their child's dental condition. In addition, the Chinese version of Early Childhood Oral Health Impact Scale (ECOHIS) was adopted to assess the children's OHRQoL, and a higher ECOHIS score indicates greater negative impacts of oral health on the child's OHRQoL. A total of 194 children participated in this study, with 101 and 93 children receiving SDF and placebo application before ART restorations, respectively. After placement of ART restorations, at 6-month and 24-month follow-up, parental satisfaction scores with their child's dental health status were significantly higher compared with those at baseline (P <.001) indicating the parents were more satisfied at follow-ups. Regarding OHRQoL, no statistically significant changes were found in the child impact section (CIS), family impact section (FIS) and total ECOHIS scores in both study groups at the 6-month follow-up. In contrast, at the 24-month follow-up, the CIS (P = .025) and total ECOHIS scores (P = .015) of the children in the control group were significantly higher than those at baseline (greater negative impacts), but not the FIS score. In this study, after one-off placement of ART restorations irrespective of prior SDF application, short-term and long-term parental satisfaction with their child's dental health status was improved, but not the children's OHRQoL.

SILVER DIAMINE FLUORIDE - A REVIEW

Despite the fact that the prevalence and severity of dental caries in children has decreased in recent decades, children from low socioeconomic backgrounds continue to endure the consequences of dental caries in many developed and developing nations. The antibacterial action of silver compounds has been demonstrated through the use of silver compounds for the prevention and treatment of various infections for over a century. Though silver diamine fluoride (SDF) was used to prevent dental cavities in Japan throughout the 1970s, it was little known in the rest of the globe. A 38 percent (44,800 ppm fluoride) SDF solution is now widely used in several countries to prevent cavities and relieve hypersensitivity in primary and permanent teeth. SDF application to prevent dental cavities is a non-invasive, rapid, and uncomplicated technique. According to reports from published studies, SDF application did not cause serious pulpal damage. It does, however, have some disadvantages, such as black darkening of carious teeth and an unpleasant metallic taste. However, due to its low cost and ease of usage, SDF appears to be a good therapeutic agent for use in community dental health projects.

Fluoride Delivered via a Topical Application of 38% SDF and 5% NaF

ObjectivesThe objectives of this study were to compare the amount of fluoride delivered via a topical application of 38% silver diamine fluoride (SDF) solution and 5% sodium fluoride (NaF) varnish as well as to determine the amount of 38% SDF solution delivered using various micro-applicators. MethodsThe weights of 38% SDF (Saforide) and 5% NaF (Duraphat) applied to the occlusal surface of an extracted human upper first premolar with a regular-size (2.50-mm tip diameter) micro-applicator were measured using an electronic-analytical balance. Afterwards, the weight of 38% SDF applied to a premolar using the micro-applicators of 5 common brands (Premium Plus, 3M, Dentsply, Elevate Oral Care, and SDI) were studied. The tip diameter of each micro-applicator was measured under a microscope. The weights of the delivered fluoride and silver were also calculated. ResultsThe mean weights of the fluoride delivered via the SDF solution and NaF varnish were 0.25 ± 0.07 mg and 0.49 ± 0.08 mg, respectively (P < .001). In addition, the tip diameters of the micro-applicators ranged from 1.89 ± 0.03 mm to 2.76 ± 0.02 mm. The mean weights of the fluoride delivered per application of 38% SDF using different applicators ranged from 0.13 ± 0.06 mg to 0.30 ± 0.09 mg, whereas the mean weights of the silver ranged from 0.76 ± 0.32 mg to 1.68 ± 0.50 mg. The weights of the delivered 38% SDF solution varied with the brand and with the tip diameters of the dental micro-applicators (P < .001). ConclusionsThe fluoride of the 38% SDF solution delivered topically was significantly less than that of 5% NaF varnish. Moreover, the amount of SDF solution delivered depends on the brand and size of the micro-applicators.

Ion Concentration of Silver Diamine Fluoride Solutions

ObjectiveThe aim of this work was to determine the free fluoride and silver ion concentrations and the alkalinity of 4 commercially available 38% silver diamine fluoride (SDF) solutions. MethodsFour common brands of 38% SDF solutions, namely Saforide, Advantage Arrest, e-SDF, and Topamine, were selected. Three bottles of each brand of SDF solution from the same lot were assessed. Measurements of the silver and fluoride content and alkalinity were performed directly when a bottle was opened. Each measurement was repeated to recheck its reliability. The free fluoride ion concentrations were measured using a calibrated ion-selective electrode. The free silver ion concentrations were measured using optical emission spectrometry. The alkalinity of the SDF solution was determined with a pH electrode. ResultsThe mean concentrations of fluoride ions of the Saforide, Advantage Arrest, e-SDF, and Topamine were 43,233 ppm, 44,333 ppm, 51,370 ppm, and 54,400 ppm, respectively; their percentage differences from the expected value (44,800 ppm) were 3.5%, 2.4%, 14.7%, and 21.4%, respectively. The mean concentrations of silver ions of the Saforide, Advantage Arrest, e-SDF, and Topamine were 258,841 ppm, 260,016 ppm, 336,149 ppm, and 319,966 ppm, respectively; their percentage differences from the expected value (253,900 ppm) were 3.2%, 5.8%, 32.4%, and 25.9%, respectively. The 4 products had pH values of 9.2, 9.1, 9.2, and 9.0, respectively. ConclusionsThis study showed differences between the claimed and measured fluoride and silver ion concentrations in 4 common 38% SDF products, which were alkaline with a pH value of 9.

Effect of application time of 38% silver diamine fluoride solution on arresting early childhood caries in preschool children: a randomised double-blinded controlled trial protocol

BackgroundTo study the caries lesion activity response to topical 38% silver diamine fluoride (SDF) therapy with increasing treatment application time.Methods/designThe design is a stratified-randomised, double-blind, active-controlled, parallel-group clinical trial with nine treatment arms. The trial will involve recruiting at least 414 3- to 5-year-old kindergarten children with caries, who will receive approximately 0.004 mL of 38% SDF (the typical amount applied per the manufacturer’s instructions) to treat each caries lesion. The children will be stratified by caries status, randomised by blocks, and allocated to nine groups of SDF application times: 3, 5, 10, 15, 30, 45, 60, 120, and 180 s. The outcome measure is caries lesion activity (active/arrest) at the tooth-surface level at 6 months post-initial treatment. A calibrated dentist will conduct the blinded clinical examinations at baseline and at the 6-month follow-up. In addition, the parents will be surveyed to examine the effects of the moderating variables, such as oral hygiene, on caries lesion activity. The hypothesis is that a monotonically increasing trend can be found between the SDF application time and the proportion of caries lesions that are arrested. The Cochran-Armitage test for trends in proportions, corrected for clustering within children, will be used to determine the relationship between the exposure to SDF (the SDF application time) and the response (proportion of lesions arrested) in children, taking into consideration the effect of the moderating variables as well as the nesting of multiple caries lesions within an individual child. An EC 80 analysis (an 80% maximal concentration) will be used to determine the exposure (the SDF application time) for 80% caries lesion arrest. Bootstrap methods will be used for clustered data and will be resampled by clustering to determine the 95% confidence interval.DiscussionThis study will help with determining the optimal application time for SDF treatment. It will provide an evidence-based protocol for the use of SDF to arrest tooth decay in the primary teeth of young children. The results will inform an evidence-based SDF protocol to arrest caries, which affects 573 million children with tooth decay worldwide.Trial registrationClinicalTrials.gov NCT04655430. Registered on 7th December 2020.

Historical background and clinical implications of silver diamine fluoride in dentistry: A narrative review

Dental caries is a chronic, irreversible disease affecting preschool children worldwide. As the frequency of dental caries has steadily declined over the past few years, children from low socioeconomic backgrounds still have higher rates of dental caries, and still have a higher prevalence in developing countries. Though the role of fluoride in dental caries prevention has been scientifically proven, the antimicrobial effect of silver compounds to treat various infections has been postulated. However, 38% silver diamine fluoride (SDF) solution is currently used to arrest dental caries, and as an antihypersensitivity agent. The SDF solution is available in dark, amber-colored bottles and is simple, non-invasive, and easy to use by trained dentists or specialists. Although it has the disadvantage of causing black discoloration and an unpleasant metallic taste after application, studies in the literature show that it can help prevent dental caries, hypersensitivity, root caries, and remineralization. This article explains in depth the SDF: its historical background, clinical application, and efficacy in different fields of dentistry.

Silver diamine fluoride for managing carious lesions: A literature review

Though the prevalence and the severity of dental caries is decreased in past few years, still children from low socioeconomical status in many industrialized or developing countries are still suffering from ill-effects of dental caries. The antimicrobial effect of silver compounds has been proven by the 100-year-old application of silver compounds. Silver diamine fluoride (SDF) has been used to arrest dental caries during 1970s in Japan, but it was not exposed much to other parts of the world. Today in many countries a 38% (44,800 ppm fluoride) SDF solution is commonly used to arrest caries and also to reduce hypersensitivity in primary and permanent teeth. Application of SDF to arrest dental caries is non-invasive procedure and is quick and simple to use. Reports of available studies showed that there is no severe pulpal damage after SDF application. However, it has some drawbacks like black discoloration of the carious teeth and an unpleasant metallic taste. But, low cost of SDF and its simplicity in application suggest that it is an appropriate agent for use in community dental health programme. Thus, SDF appears to meet the criteria of both the WHO Millennium Goals and the US Institute of Medicine’s criteria for 21st century medical care, that is, it is a safe, effective, efficient, and equitable caries preventive agent.

Impact of Silver Diamine Fluoride on Oral Health Related Quality of Life (Ohrqol)-A Literature Review

Introduction: Silver diamine fluoride (SDF) has emerged as an effective agent for arresting and preventing caries. It offers an immediate inhibition of caries process thereby reducing pain and suffering in those who lack access to quick restorative /prosthetic rehabilitation. It may impact oral health related quality of life (OHRQoL).&#x0D; Aim: This literature review is aimed at reviewing the SDF versus other standard care therapies and exploring their impact on OHRQoL.&#x0D; Methodology: Literature was searched by two independent reviewers to recognise the English language papers in the four most commonly used databases: Medline, PubMed, Embase, and Scopus. Search included 11 randomised controlled trials that used SDF as an intervention either alone or with comparative agent/treatment for caries arrest and studies that considered oral health-related quality of life as an associating factor.&#x0D; Results: Two studies used application of SDF solution or placebo as intervention, few adopted use of comparator agent or/and alternative treatment and some adopted single sample pre-post designs with isolated SDF use. Different versions of Early Childhood Oral Health Impact Scale (ECOHIS) was used by most studies for assessment of oral health-related quality of life. While two studies (Ruff et al, Hiremath et al) used the Child Oral Health Impact Profile (COHIP).&#x0D; Conclusion: SDF application may increase the quality of life of children as perceived by their parents and SDF staining is not a concern for both of them.

Quantitative Analysis and Effect of SDF, APF, NaF on Demineralized Human Primary Enamel Using SEM, XRD, and FTIR.

IntroductionTopical fluoride therapy has proven benefits in the prevention of demineralization. Tooth enamel has shown a great potential for remineralization with an application of topical fluorides if administered at an appropriate time. In an effort to find an effective remineralizing agent, a novel fluoride agent silver diamine fluoride (SDF) has emerged as a potent caries arresting as well as caries preventing agent.Aim and objectiveThe present study was aimed at determining the primary tooth enamel resistance to demineralization after topical application of three fluoride agents SDF, APF, and NaF.Materials and methodsEnamel specimens were prepared from 40 caries-free primary molars. These specimens were randomly allocated into three groups of 10 specimens each and they were treated by different topical fluorides namely: Group I–SDF, group II–Acidulated phosphate fluoride (APF), group III–Sodium fluoride. Three enamel specimens from each group were placed on custom-made acrylic blocks with 5 × 5 mm of an exposed window for scanning electron microscope (SEM) evaluation and rest of the specimens were ground into a fine powder for X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR) analysis. The tooth blocks and treated samples were subjected to the demineralization process for 168 hours. They were then qualitatively assessed to evaluate their resistance to demineralization using SEM, XRD, and FTIR.Results and conclusionMorphologically, the enamel of all groups specimens was mostly smooth with some groves and microporosities. Chemically, the Ca/P molar ratios of all groups were similar with slight variations. Structurally, the crystalline phases found in enamel by powder XRD were hydroxyapatite and carbonate apatite; and there was a higher amount of incorporated type B carbonate than type A carbonate as evidenced by FTIR. The study concludes that topical application of a 38% SDF solution can inhibit demineralization of enamel.How to cite this articleJabin Z, Nasim I, Vishnu Priya V, et al. Quantitative Analysis and Effect of SDF, APF, NaF on Demineralized Human Primary Enamel Using SEM, XRD, and FTIR. Int J Clin Pediatr Dent 2021;14(4):537–541.