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Silver diamine fluoride - an overview of the literature and current clinical techniques

Abstract

Dental caries continues to affect the British population, despite advances in prevention and management options. There are many treatment and preventive treatment strategies to address dental caries. Silver diamine fluoride (SDF) is a colourless alkaline solution containing silver and fluoride, which forms a complex with ammonia and has proven to be effective in management of dental caries. Additional dental benefits of SDF continue to be explored and discussed in the literature. SDF is a relatively new material which can be used to reduce and crystallise dental caries in a simple non-invasive treatment modality without the use of local anaesthetic. It can thus be well tolerated by children as a treatment technique and can be quickly applied to the isolated tooth without the need for extensive excavation. Currently, SDF is classified in the UK as a desensitising agent; however, it may be reclassified as a caries treatment agent at some stage and thus provide an effective non-invasive treatment for children's tooth decay. This would prevent the multiple admissions for dental extraction under general anaesthetic, as a simpler approach can be provided. This article will evaluate and review the literature behind SDF and provide details on its use and clinical application.

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References

  1. Royal College of Surgeons. The state of children's oral health in England. 2015. Available online at https://www.rcseng.ac.uk/library-and-publications/rcs-publications/docs/report-childrens-oral-health/ (accessed April 2020).

  2. Public Health England. Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention. 3rd ed. 2014. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf (accessed May 2019).

  3. Rosenblatt A, Stamford T C, Niederman R. Silver diamine fluoride: a caries "silver-fluoride bullet". J Dent Res 2009; 88: 116-125.

  4. Chu C H, Lo E C. Promoting caries arrest in children with silver diamine fluoride: a review. Oral Health Prev Dent 2008; 6: 315-321.

  5. Melaiye A, Youngs W J. Silver and its application as an antimicrobial agent. Expert Opin Ther Pat 2005; 15: 125-130.

  6. Barillo D J, Marx D E. Silver in medicine: A brief history BC 335 to present. Burns 2014; DOI: 10.1016/j.burns.2014.09.009.

  7. Lansdown A B. Silver in health care: antimicrobial effects and safety in use. In Hipler U C, Elsner P (eds) Biofunctional Textiles and the Skin. pp 17-34. Basel: Karger Publishers, 2006.

  8. Klasen H J. A historical review of the use of silver in the treatment of burns. II. Renewed interest for silver. Burns 2000; 26: 131-138.

  9. Stebbins E A. What value has argenti nitras as a therapeutic agent in dentistry? Int Dent J 1891; 12: 661-670.

  10. Howe P R. A method of sterilizing and at the same time impregnating with a metal affected dentinal tissue. Dent Cosmos 1917; 59: 891-904.

  11. Peng J Y, Botelho M G, Matinlinna J P. Silver compounds used in dentistry for caries management: a review. J Dent 2012; 40: 531-541.

  12. Nishino M, Yoshida S, Sobue S, Kato J, Nishida M. Effect of topically applied ammoniacal silver fluoride on dental caries in children. J Osaka Univ Dent Sch 1969; 9: 149-155.

  13. Craig G G, Powell K R, Cooper M H. Caries progression in primary molars: 24-month results from a minimal treatment programme. Community Dent Oral Epidemiol 1969 9: 260-265.

  14. McDonald S P, Sheiham A. A clinical comparison of non-traumatic methods of treating dental caries. Int Dent J 1994; 44: 465-470.

  15. Thibodeau E A, Handelman S L, Marquis R E. Inhibition and killing of oral bacteria by silver ions generated with low intensity direct current. J Dent Res 1978; 57: 922-926.

  16. Ostela I, Tenovuo J. Antibacterial activity of dental gels containing combinations of amine fluoride, stannous fluoride, and chlorhexidine against cariogenic bacteria. Scand J Dent Res 1990; 98: 1-7.

  17. Oppermann R V, Johansen J R. Effect of fluoride and non-fluoride salts of copper, silver and tin on the acidogenicity of dental plaque in vivo. Scand J Dent Res 1980; 88: 476-480.

  18. Oppermann R V, Rölla G. Effect of some polyvalent cations on the acidogenicity of dental plaque in vivo. Caries Res 1980; 14: 422-427.

  19. Knight G, McIntyre J, Craig G et al. An in vitro model to measure the effect of a silver fluoride and potassium iodide treatment on the permeability of demineralized dentine to Streptococcus mutans. Aust Dent J 2005; 50: 242-245.

  20. Mei M L, Li Q L, Chu C H, Lo E M, Samaranayake L P. Antibacterial effects of silver diamine fluoride on multi-species cariogenic biofilm on caries. Ann Clin Microbiol Antimicrob 2013; 12: 4.

  21. Mei M L, Chu C H, Low K H et al. Caries arresting effect of silver diamine fluoride on dentine carious lesion with S. mutans and L. acidophilus dual-species cariogenic biofilm. Med Oral Patol Oral Cir Bucal 2013; 18: 824-831.

  22. Peng J Y, Botelho M G, Matinlinna J P. Silver compounds used in dentistry for caries management: a review. J Dent 2012; 40: 531-541.

  23. Mei M L, Ito L, Cao Y, Li Q L, Lo E C, Chu C H. Inhibitory effect of silver diamine fluoride on dentine demineralisation and collagen degradation. J Dent 2013; 41: 809-817.

  24. Zhao I S, Gao S S, Hiraishi N et al. Mechanisms of silver diamine fluoride on arresting caries: a literature review. Int Dent J 2018; 68: 67-76.

  25. Mei M L, Li Q L, Chu C H, Yiu C K, Lo E C. The inhibitory effects of silver diamine fluoride at different concentrations on matrix metalloproteinases. Dent Mat 2012; 28: 903-908.

  26. Mei M L, Ito L, Cao Y, Li Q L, Chu C H, Lo E C. The inhibitory effects of silver diamine fluorides on cysteine cathepsins. J Dent 2014; 42: 329-335.

  27. Tjäderhane L, Nascimento F D, Breschi L et al. Optimizing dentin bond durability: control of collagen degradation by matrix metalloproteinases and cysteine cathepsins. Dent Mat 2013; 29: 116-135.

  28. Chu C H, Lo E C, Lin H C. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. J Dent Res 2002; 81: 767-770.

  29. Llodra J C, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res 2005; 84: 721-724.

  30. Braga M M, Mendes F M, De Benedetto M S, Imparato J C. Effect of silver diammine fluoride on incipient caries lesions in erupting permanent first molars: a pilot study. J Dent Child (Chic) 2009; 76: 28-33.

  31. dos Santos Jr V E, De Vasconcelos F M, Ribeiro A G, Rosenblatt A. Paradigm shift in the effective treatment of caries in schoolchildren at risk. Int Dent J 2012; 62: 47-51.

  32. Duangthip D, Chu C H, Lo E C. A randomized clinical trial on arresting dentine caries in preschool children by topical fluorides - 18 month results. J Dent 2016; 44: 57-63.

  33. U.S. Food & Drug Administration. 510(k) Premarket Notification: Diammine Silver Fluoride Dental Hypersensitivity Varnish. 2014. Available at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K102973 (accessed March 2019).

  34. Horst J A, Ellenikiotis H, Milgrom P M, UCSF Silver Caries Arrest Committee. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications, and consent. J Calif Dent Assoc 2016; 44: 16.

  35. Markowitz K, Pashley D H. Discovering new treatments for sensitive teeth: the long path from biology to therapy. J Oral Rehabil 2008; 35: 300-315.

  36. Craig G G, Knight G M, McIntyre J M. Clinical evaluation of diamine silver fluoride/potassium iodide as a dentine desensitizing agent. A pilot study. Aust Dent J 2012; 57: 308-311.

  37. Castillo J L, Rivera S, Aparicio T et al. The short-term effects of diammine silver fluoride on tooth sensitivity: a randomized controlled trial. J Dent Res 2011; 90: 203-208.

  38. Nakabayashi N, Kojima K, Masuhara E. The promotion of adhesion by the infiltration of monomers into tooth substrates. J Biomed Mat Res 1982; 16: 265-273.

  39. Hashimoto M, Ohno H, Kaga M, Endo K, Sano H, Oguchi H. In vivo degradation of resin-dentin bonds in humans over 1 to 3 years. J Dent Res 2000; 79: 1385-1391.

  40. Mei M L, Ito L, Cao Y, Li Q L, Lo E C, Chu C H. Inhibitory effect of silver diamine fluoride on dentine demineralisation and collagen degradation. J Dent 2013; 41: 809-817.

  41. Hiraishi N, Yiu C K, King N M, Tagami J, Tay F R. Antimicrobial efficacy of 3.8% silver diamine fluoride and its effect on root dentin. J Endod 2010; 36: 1026-1029.

  42. Knight G M, Mclntyre J M, Craig G G, Mulyani. Ion uptake into demineralized dentine from glass ionomer cement following pretreatment with silver fluoride and potassium iodide. Aust Dent J 2006; 51: 237-241.

  43. Quock R L, Barros J A, Yang S W, Patel S A. Effect of silver diamine fluoride on microtensile bond strength to dentin. Oper Dent 2012; 37: 610-616.

  44. Camacho K J, English J D, Jacob H B et al. Silver diamine fluoride and bond strength to enamel in vitro: A pilot study. Am J Dent 2018; 31: 317-319.

  45. Wang A S, Botelho M G, Tsoi J K, Matinlinna J P. Effects of silver diammine fluoride on microtensile bond strength of GIC to dentine. Int J Adhes Adhes 2016; 70: 196-203.

  46. Knight G M, McIntyre J M. The effect of silver fluoride and potassium iodide on the bond strength of auto cure glass ionomer cement to dentine. Aust Dent J 2006; 51: 42-45.

  47. Soeno K, Taira Y, Matsumura H, Atsuta M. Effect of desensitizers on bond strength of adhesive luting agents to dentin. J Oral Rehabil 2001; 28: 1122-1128.

  48. Koizumi H, Hamama H H, Burrow M F. Effect of a silver diamine fluoride and potassium iodide-based desensitizing and cavity cleaning agent on bond strength to dentine. Int J Adhes Adhes 2016; 68: 54-61.

  49. Greenwall-Cohen J, Francois P, Dursen E, Le-Geoff S, Pierre-Attal J, Greenwall L H. The influence of silver diamine fluoride adhesive protocols on shear bond strength of high-viscosity glass ionomer cement to dentine. Abstract number 2357. ConsEuro, Berlin. 2019.

  50. Hu S, Meyer B, Duggal M. A silver renaissance in dentistry. Eur Arch Paediatr Dent 2018; 19: 221-227.

  51. Rossi G, Squassi A, Mandalunis P, Kaplan A. Effect of silver diamine fluoride (SDF) on the dentin-pulp complex: ex vivo histological analysis on human primary teeth and rat molars. Acta Odontol Latinoam 2017; 30: 5-12.

  52. Korwar A, Sharma S, Logani A, Shah N. Pulp response to high fluoride releasing glass ionomer, silver diamine fluoride, and calcium hydroxide used for indirect pulp treatment: An in-vivo comparative study. Contemp Clin Dent 2015; 6: 288.

  53. Gotjamanos T. Pulp response in primary teeth with deep residual caries treated with silver fluoride and glass ionomer cement ('atraumatic'technique). Aust Dent J 1996; 41: 328-334.

  54. Duangthip D, Fung M H, Wong M C, Chu C H, Lo E C. Adverse effects of silver diamine fluoride treatment among preschool children. J Dent Res 2018; 97: 395-401.

  55. Yee R, Holmgren C, Mulder J, Lama D, Walker D, van Palenstein Helderman W. Efficacy of silver diamine fluoride for arresting caries treatment. J Dent Res 2009; 88: 644-647.

  56. Fung M H, Duangthip D, Wong M C, Lo E C, Chu C H. Randomized clinical trial of 12% and 38% silver diamine fluoride treatment. J Dent Res 2018; 97: 171-178.

  57. Zhi Q H, Lo E C M, Lin H C. Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. J Dent 2012; 40: 962-967.

  58. Ollie Y Y, Zhao I S, Mei M L, Lo E C, Chu C H. Caries-arresting effects of silver diamine fluoride and sodium fluoride on dentine caries lesions. J Dent 2018; 78: 65-71.

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Greenwall-Cohen, J., Greenwall, L. & Barry, S. Silver diamine fluoride - an overview of the literature and current clinical techniques. Br Dent J 228, 831–838 (2020). https://doi.org/10.1038/s41415-020-1641-4

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