Literature review Dr.Rachael Gupta

1. Silver Diamine
Fluoride: A Review
and Current
Applications
Journal of Advanced Oral Research / Jan-Apr 2014 / Vol. 5 No.1
Shalin Shah1, Vijay Bhaskar2, Karthik Venkatraghavan3, Prashant
Choudhary4, Ganesh M.5, Krishna Trivedi6

2. Contents
• Introduction
• Method of literature search
• History of use of silver compound
• Development of silver diamine fluoride in dentistry
• Physical characteristics
• Mode of action of silver diamine fluoride
- Mechanism of action of silver
• Clinical application of silver diamine fluoride
• Drawback of silver diamine fluoride
• Safety of silver diamine fluoride
• Methods on horizon
• Conclusion
• References

3. INTRODUCTION
• Dental caries is a bacterial driven,
generally chronic, site-specific,
multifactorial, dynamic disease
process that results from the
imbalance in the physiologic
equilibrium between the tooth
mineral and the plaque fluid; that is,
when the pH drop results in net
mineral loss over time.
• Most prevalent diseases
Fejerskov O, Kidd EAM, Nyvad B, et al. Defining the disease: an
introduction. In: Fejerskov O, Kidd E, editors. Dental caries: the
disease and its clinical management. 2nd edition. Oxford (UK):
Blakswell Munksgaard; 2008. p. 4–6

4. Introduction
• The traditional treatment for a cavitated tooth involves
Removal of infected tooth structure and replace with restoration

5. • But, T/T of dental caries can be challenging
• Especially when dental caries present - very young
children because of their limited coping ability, it can be
an difficult for the clinician to remove all the caries and
give a proper restoration.
-requiring advanced skill of the
clinician
high cost of instrumentation
and materials
good cooperation
from patient

6. Introduction
• A fluoridated agent silver diamine fluoride’s (SDF)
introduced-
- ability to halt the caries process
- simultaneously prevent the formation of new caries.
• SDF after its initial use in Japan in late 1960s and 1970s
- lost its charm and was not much exposed to other
parts of the world.
• Beginning of 21st century, its use started again in China
- caries arresting agent in school children.

7. • From 2005 to 2009 Knight et al. (Australia) a series of in vitro studies
and proved its effect as a caries arresting and antimicrobial agent.
• In 2009 Braga et al. (US) and Yee et al. (Nepal) - used SDF as caries
arresting agent successfully.
Still, more studies are going on in different parts of the world regarding
the various clinical implication of SDF.

8. A search strategy
Developed articles PUBMED
INDEX and English written
Years 1966 – Sep
2013
Hand searching relevant papers cited in the indices
back to the year 1905 and in Japanese journals
after 1970.
Inclusion criteria were used to identify potentially
relevant reports:
- addressed the use of key words such as SDF,
- silver fluoride (AgF),
- silver compounds and
- comment on reviews and articles published in
languages other than English, caries arresting agents.
METHODOFLITERATURESEARCH
92 articles are found

9. Inclusion criteria - all in vivo and in vitro studies in
which SDF was used as a study group as well as review
articles on SDF.
Exclusion criteria were: early reports of longer studies,
editorials, (With exceptions of few articles in Chinese
and Japanese journals as those articles includes early
study and history of SDF. Google translation software
was used for translation).
42 articles were
selected for the review
purpose.

10. History of use of silver
compound
• About 1000 years ago (in Japan) -
custom Among the ladies to dye their
teeth black called
“Ohaguro,” - for expressing
married.
It was tooth cosmetics, at the same
time, it is conceived to prevent the
dental caries.
• The first medicinal use for silver -
around 1000 BC

11. • Current uses of silver compounds in medicine revolve
- the application of silver nitrate, silver foil, and silver sutures.
• Von Naegeli (1893)- silver nitrate being a very effective
antimicrobial agent. Von Naegeli V. Dtsch Sci Schweiz Natürforsch
Ges 1893 33:174-182.

12. • For Dental perspective ,
Stebbins(1984) used silver amalgam and nitric acid on carious
teeth and found that caries inhibition was present.
Howe directly applied silver nitrate to caries lesions with
similar results, and it was termed as “Howe’s solution.”
• used for caries arresting purpose for the next 50 years.
Li YJ. Effect of a silver ammonia fluoride solution on the prevention
and inhibition of caries. Zhonghua Kou Qiang Ke Za Zhi 1984 19:
97-100. (in Chinese)
Howe PR. A method of sterilizing and at the same time impregnating
with a metal affected dentinal tissue. Dent Cosmos 1917 59:891-904.

13. Development of silver diamine
fluoride in dentistry
• Craig et al.(1981) reported that AgF solution was used in
dentistry as early as the 1970s.
• A similar compound, SDF, has been accepted as a therapeutic
agent by the Central Pharmaceutical Council of the Ministry of
Health and Welfare in Japan for dental treatment since the
1960s.
• A solution of 38% SDF was also used in China to arrest caries.

14. • Also, a few dentists in Southern California who used SDF to
arrest caries of young children with early childhood caries.
• Community projects using SDF to arrest caries were planned
for Cuba, in several African countries.
• The use of SDF is quite scarce during this period and not much
literature is available in English during this period
Duperon DF. Early childhood caries: a continuing dilemma. J Calif
Dent Assoc 1995 23: 15-25.

15. PHYSICAL CHARACTERISTICS
• Silver fluoride is a colorless aqueous solution containing silver
ions and fluoride ions.
• It is highly alkaline (pH = 11), which requires a two-stage
application procedure using SnF2 as a reducing agent.
• Silver diamine fluoride, a chemical that is claimed to be more
stable and that can be kept in a constant concentration, has been
in use in many countries, including China and Japan, to arrest
dental caries for many years.
• SDF is not as alkaline (pH = 8-9) as AgF. It does not require a
reducing agent

16. MODEOFACTIONOFSILVERDIAMINEFLUORIDE
Mechanism of action of silver:
• Studies have indicated that silver interacts with sulfhydryl groups of
proteins and with deoxyribonucleic acid (DNA),
- Altering hydrogen bonding
- Inhibiting Respiratory processes,
- Inhibiting DNA unwinding,
- Inhibiying Cell-wall synthesis, and cell division.
• At the macro level, these interactions effect bacterial killing and
inhibit biofilm formation.
Lansdown AB. Silver I: Its antibacterial properties and
mechanism of action. J Wound Care 2002a 11:125-130.
Wu MY, Suryanarayanan K, van Ooij WJ, Oerther DB. Using
microbial genomics to evaluate the effectiveness of silver to prevent biofilm
formation. Water Sci Technol 2007 55:413-419.

17. • The central mechanism for these diverse effects is proposed to be the
interaction of silver with thiol groups of enzymes and deactivate
enzymes, resulting in bacterial cell death by the following mechanism:
A/N − SH + AgX → A/N − S − Ag + HX
Where A/N - amino (A) or nucleic (N) acids
SH - a thiol group,
Ag - silver, and
X - an anion (in the current example, diamine fluoride).
This interaction indicates
- silver containing compound, might interact with bacteria and
mediate caries arrest through bacterial killing and inhibit caries
progress through the inhibition of biofilm formation.
Russell AD, Hugo WB. Antimicrobiological activity and
action of silver. Prog Med Chem 1994 31:351-370.

18. • Shimizu A (1976) described three possible mechanisms of
action of SDF on caries.
1. The first mechanism - The obturation of dentinal tubules.
Gottlieb(1947)described
- caries would be prevented by obturation of the organic invasion
road. The main invasion road of caries in dentin is dentinal
tubules.
Shimizu A, Kawagoe M. A clinical study of diamine silver fluoride
on recurrent caries. J Osaka Univ Dent Sch 1976 16: 103-109.
Gottlieb B. Dental Caries, pp. 222-236. Philadelphia: Lea & Febiger, 1947.

19. Dentin treated with SDF decreased in dye
permeability and increased in electric resistance
Silver and its compound present in
dentinal tubules
Diffusion of acid is
blocked
Microorgansims
invasion is blocked
If microorganisms invade dentinal
tubules, their growth will be inhibited
- oligodynamic action of silver
Obturation of dentinal tubules
the surface area of dentin,
which may be attacked by
caries will decrease, and
peritubular zone, which is
most easily demineralized
part of dentin may be
covered with obturating
materials (silver particles).
Shimizu A. Effect of diammine silver fluoride on recurrent caries.
Jap. J. Conserv. Dent. 1974 17:183-201. (in Japanese, summary
in English)
Yamaga R. Mechanisms of action of diammine silver fluoride
and its use. Nippon Dent. Rev 1970 328:180-187. (In
Japanese)
According to Shimizu(1974),

20. • Those factors in association with the obturation of dentinal
tubules must contribute to increase in resistance to recurrent
caries.
• Mei et al. (2013)-
mentioned that the use of 38% SDF inhibited demineralization
and preserved collagen from degradation in demineralized dentin

21. 2. The second mechanisms - The Cariostatic action of the
reaction products between SDF and mineral component of the
tooth.
Selvig (1968) showed that the fluoride T/T increased the resistance
- peri- and inter-tubular dentin to acid decalcification
RESULTS :Retarded the penetration of acid into deeper layers of
the dentin.
Selvig K. A. Ultrastructural changes in human dentine
exposed to a weak acid. Archs oral Biol 1968 a 13:719-734.

22. Shimooka(1972) pointed out
F− ion of SDF applied to dentin under in vivo conditions penetrated to a depth of 50–100 μ.
SDF (Ag(NH3)2F) reacts with the tooth mineral hydroxyapatite (HA)(Ca10(PO4)6(OH)2) to
release calcium fluoride (CaF2) and silver phosphate (Ag3PO4), which are responsible for the
prevention and hardening of dental caries.
Ca10(PO4)6(OH)2 + (Ag(NH3)2F) → CaF2 + Ag3PO4 +NH4OH
CaF2 → Ca++ + 2F−
Ca10(PO4)6(OH)2 + 2F− → Ca10(PO4)6F2 + 2OH−
The Ag3PO4 that precipitates on the tooth surface - insoluble.
The CaF2 formed provides a reservoir of fluoride for the formation of fluorapatite
(Ca10(PO4)6F2), which is more resistant to acid attack than HA (Ca10(PO4)6(OH)2).
Fluorapatite is so stable that it extremely resists decalcification by acid and chelating agent.
In addition, it is known that F− promotes calcification, and also restores lattice
imperfection,and improves the crystallinity of HA.
Shimooka S. On the penetration of silver nitrate and ammoniacal silver fluoride
into microstructure of the sound dentin. J. Nippon Dent. Coll 1972 59:534-566.
(in Japanese, summary in English)

24. 3. The third mechanism - The antienzymatic actions of the reaction
products between Ag(NH3)2F and organic component of the tooth.
- Its antibacterial properties arise from inhibition of the enzyme
activities and dextran-induced agglutination of cariogenic strains of
Streptococcus mutans.
Sunada et al.(1962) found - dentin, which had been treated with SDF-
increased in resistance to trypsin.
They stated that it-might be owing to reaction of Ag and organic
component of dentin.
Yanagida et al.(1971) showed that dentin protein treated with SDF had
increased in resistance to collagenase and trypsin. These actions of Ag
and Ag(NH3)2F to organic component of the tooth may also be
contribute to inhibit caries.

25. Suzuki et al.(1976) studied the mechanism of antiplaque action of
diamine silver fluoride (Ag(NH3)2F).
- This agent showed excellent antibacterial action against cariogenic
strains of S. mutans and completely inhibited the dextran induced
agglutination of S. mutans and sucrase activities of S. mutans
- These effects were found to be the result of the action of silver
ion. These results indicate that silver ion may inhibit the
colonization of S. mutans on enamel surface and offer a possible
explanation for the antiplaque action of the agent.

26. • It was also shown that the binding of glucan to HA was inhibited
by the T/T of HA with fluoride solution, but was slightly
promoted by that with silver solution.
• The adsorption of salivary proteins by HA was inhibited by the
treatment of HA with Ag(NH3)2F. This was due to both fluoride
and silver ions. Thus, the potential to inhibit the S. mutans is
more for SDF than any other fluoridated solution.
Mei et al. (2013) mentioned that 38% SDF inhibits multi-species
cariogenic biofilm formation on dentin carious lesions and reduces
the demineralization process.

28. CLINICALAPPLICATIONOFSILVERDIAMINE
FLUORIDE
• To deal with the high caries prevalence and
management problem of young children with a
minimal invasion approach
First proposal to use this approach was made by
Yamaga et al.(1971)Japan.
The most common approach to deal with dental
caries is to use
- rotary dental handpiece,
- use sharp spoon excavators to remove the
infected dentin.
- A difficulty for the dental practitioner especially
dealing with young children, is the use of
conventional rotary instrument or pressure
from spoon excavator are often cited as
triggering patient fear and anxiety

29. • As silver diamine fluoride has an ability to arrest caries, it can be
considered as a useful approach to deal with such young patient.
• Once the carious process is slowed down or arrested, caries removal
will be done at later date when child’s ability to rationalize fear is
increased with age.
• Various study mentioned supports this implication
Hihara et al. (1994) in Japan,
McDonald (1994)in London,,
Braga et al. (2009) in Brazil and
Yee et al. (2009)in Nepal
found that SDF is significantly effective in arresting the cavitated as well
as incipient carious lesions.
Arresting caries with 38% SDF provides an alternative when restorative
treatment for primary teeth is not an option

30. • The ability of SDF to arrest caries in anterior
primary teeth of young children
Nishino et al. (1969)and Moritani et al. (1970)
found less caries increment in children
receiving SDF compared with those without
SDF therapy, also very rare cases complained
of the pain by cool or warm air, or friction and
that the cavities were arrested its progress.
Chu, Lo and Lin (2002) found that SDF was
effective in arresting dentin caries in primary
anterior teeth in pre-school children in a
Community-based Caries Control Program.

31. • To prevent pit and fissure caries
- Pits and fissures are more susceptible to dental caries due
to morphological reasons
- difficult to clean pits and fissures with a toothbrush.
- While it is difficult to discover incipient lesion at pits and
fissures, the topical fluoride application is revealed far
less effective for the prevention of the pit and fissure
caries than that of the smooth surface.
According to Sato et al. (1970) due to its antibacterial and
caries preventive property SDF can be effective for the
prevention of pits and fissures caries of the first molar
teeth.

32. Nishino and Massler (1977) in their study mentioned that
caries score of Ag(NH3)2F treated teeth was significantly
lower than the fissures treated with SnF2 8%
Precautions: Because of grayish-black and black stain at
the pit and fissure by SDF may be mistaken for incipient
caries, so the application should be recorded

33. • To prevent secondary caries
• Most restorative materials used in dentistry today truly adhere to the
tooth structure or completely insoluble in oral fluids;
saliva, bacteria and food debris penetrate through the space
between the cavity walls and the restorative materials. Hence, the
cavity wall may always be in danger of recurrent caries.
• To inhibit recurrent caries, therefore, resistance of cavity wall to
caries must be enhanced.
• Shimizu and Kawaga(1976) found no recurrent caries on amalgam
restorations on primary teeth pre-treated with SDF after 26 months.

34. • To arrest root caries
• The incidence of root caries increases with age, and the
prevalence of root caries in elders are high.
• Two different studies by Tan et al. (2010) and Zang et al.(2013)
mentioned that due to its high ability to arrest dental caries,
annual application of SDF is quite effective in arresting the caries
on root surfaces.

35. • To desensitize sensitive teeth
• SDF has an ability to occlude the dentinal tubule it can give
promising results in patients with dentinal hypersensitivity.
• Murase et al. (1969) and Kimura et al.(1971) have shown SDF -
most effective against erosion and abrasion followed
hypersensitive dentin to mechanical, cold, and heat sensation.
Suggested that 4 times repeated application was the most
appropriate and no further desensitizing effect could be obtained.

36. • To treat infected root canals
• An ammoniated silver nitrate solution - commonly used for the
t/t of infected root canal.
• Tanaka[1970]
an aqueous solution of AgF - powerful disinfectant and protein-
coagulating actions, and also has a considerably potent action,
which occludes the dentinal tubules of root canal wall in terms of
the electric resistance
• Okamoto et al.[1971]
found that application of the SDF solution considerably reduced
the number of treatments required.

37. • Hiraishi et al. (2010)
mentioned that 3.8% SDF has potential to be used as an
antimicrobial root canal irrigant or interappointment dressing,
especially in locations in which potential browning/blackening of
dentin by metallic silver is not a major concern.
• Mathew et al. (2012)
found that SDF as an endodontic irrigant can effectively remove
the microbes present in the canal and circumpulpal dentin.

38. 1. SDF can be used to tackle the caries problem in community dental
health programs in developing countries. The main advantages as
pointed out by Bedi and Infirri (1999)are as follows:
• Control of pain and infection. SDF is effective in arresting caries
progression that if left untreated will cause pain and infection Affordable
cost.
• The cost of SDF T/T- low and should be affordable in most
• The procedures are simple. This allows nondental professionals
including primary health care workers to be easily trained to apply SDF to
children Minimal support required.
• The t/t does not require expensive equipment or support infrastructure
such as piped water and electricity.
• The treatment is noninvasive and thus the risk of spreading infections
very low.

39. DRAWBACKOFSILVERDIAMINEFLUORIDE
• The lesions will be stained black;
some children and their parents may not be pleased with the
aesthetics of this treatment outcome.
• Suggested that when carious dentin was treated with SDF,
silver phosphate was formed, and this was insoluble.
Silver phosphate Is yellow when it is first formed, but readily
turns black under sunlight or the influence of reducing agents

40. • To overcome this limitation Knight et al.[2005] proposed -
used Potassium iodide after application of SDF to the tooth
structure remaining free silver ions in solution will react with
Potassium Iodide to precipitate creamy white silver iodide crystals.
• Hence, free silver ions no longer available to react with sulfur
and other reagents in the mouth to form black precipitates into
the teeth.
• Further research in this direction is still required.

41. • SDF can stain the skin of the body and clothes.
The stain caused by SDF on the skin, though not causing any pain,
cannot be washed away, and it takes a long time for it to be
removed.
If the skin or clothes have been stained the following procedure is
suggested for removing the stain:
(a) Wash out with running water, soap, or ammonia water, if
immediately after staining.
(b) If the discoloration is not removed and persists, apply the solution of
sodium hypochlorite or a bleaching powder (with caution in dyed cloth).
• SDF solution also has a metallic taste which is unpleasant

42. • Gingival and mucosal irritation can occur.
In most cases, the damage is transient and the tissue affected
turns white, but it will heal within 1–2 days.
When the solution is to be applied to the lesions very close to
the gingiva, use a rubber dam, or protect the gingiva with
Vaseline or cocoa butter

43. • A study on the fluoride content of AgF found that a sample of 40% AgF
(Australia) - higher concentration of fluoride than the expected fluoride
level of 60,000 ppm.
• 40% AgF high for treatment - risk of toxicity leading to dental fluorosis
when used on young children.
AgF Gotjamanos(1996) showed a favorable pulpal response when SDF was
applied to deep caries in primary teeth of children.
-Induced the presence of abundant reparative dentin
and a wide odontoblast layer.
-No complications have been reported in the literature.
Safety of silver diamine fluoride
Gotjamanos T, Afonso F. Unacceptably high levels of fluoride in
commercial preparations of silver fluoride. Austral Dent J 1997 42:
52-53.

44. Safety of silver diamine fluoride
• Nishino et al., Okuyama (Japan) investigating
pulpal response to SDF
- found gingival irritation, but there was no severe pulpal
damage and no severe reaction reported.
• Also, no report is found in the literature, which suggests that
SDF will cause severe reactions such as contact dermatitis of
the skin or stomatitis of the oral mucosa.
Okuyama T. On the penetration of diamine silver fluoride into the
carious dentin of deciduous teeth. Shigaku 1974 61: 1048-1071.
(in Japanese)
68. Chu CH, Lo EC. Promoting caries arrest in children with silver
diamine fluoride: a review. Oral Health Prev Dent 2008 6:315-21.

45. Vasquez E, Zegarra G, Chirinos E, Castillo JL, Taves DR, Watson GE et
al. Short term serum pharmacokinetics of diammine silver fluoride
after oral application. BMC Oral Health 2012 Dec 12:60.
A study done by Vasquez et al. found
serum concentrations of fluoride and silver after topical application of DSF
should pose
-little or no toxicity risk when used in adults.

46. Methods on horizon
Apart from the above-mentioned clinical implications, SDF
can also be used for below-mentioned situations. Further
research is required to accept it for that particular usage.

47. As an indirect pulp capping agent
• Yamaga et al.(1972)
if SDF is applied in the presence of softened dentin, it will arrest
the subsequent progress of dental caries.
This may be considered to indicate that, in case a small amount
of softened dentin remains after preparation of cavities or
abutment teeth, or when the softened dentin cannot be
completely removed for a risk of exposing the pulp, the
application of SDF renders the residual softened dentin
harmless.
Yamaga R, Nishino M, Yoshida S et al. Diamine silver
fluoride and
its clinical application. J Osaka Univ Dent Sch 1972 12:1-20.

48. In animal experiment (1967)
SDF exerted no serious effect histologically on the pulp by
application to the medium deep cavity
• In application to human deciduous teeth with moderate
dentin caries - no clinical symptoms.
Aono M, Muncmoto K, Okada H et al. Effect of Ammoniacal Silver
Fluoride on Cervical Hypersensitivity. The Japanese Journul of
Conservative Dentistry 1967 10: 31-36.
Nishino M, Yoshida S, Sobue S et al. Effect of topically applied
ammonical silver fluoride on dental caries in children. J Osaka
Univ Dent Sch 1969 9: 149-155.

49. • Chu and Lo(2008)- proposed to use SDF as caries arresting agent in
atraumatic restorative technique and as an indirect pulp capping
(IPC) agents.
• Until date, no reported study is found in this direction in primary
teeth.
• Gupta et al. (2011) in their in vitro study found highest zone of
bacterial inhibition was found with SDF.
• In vivo part of the same study done by Sinha et al.(2011) –
SDF has remineralizing, re-hardening and antimicrobial efficacy and
hence can act as effective IPC materials.
Chu CH, Lo EC. Promoting caries arrest in children with silver
diamine fluoride: a review. Oral Health Prev Dent 2008
6:315-21
Gupta A, Sinha N, Logani A, Shah N. An ex vivo study to evaluate the remineralizing and
antimicrobial efficacy of silver diamine fluoride and glass ionomer cement type VII for their
proposed use as indirect pulp capping materials - Part I. J Conserv Dent. 2011 Apr 14:113-116.
Sinha N, Gupta A, Logani A, Shah N. Remineralizing efficacy of silver diamine fluoride and
glass ionomer type VII for their proposed use as indirect pulp capping materials - Part II (A
clinical study). J Conserv Dent. 2011 Jul 14 :233-236.

50. • A study is already started by the author in this direction,
which is not published yet.
1 year follow-up results after application of SDF as an IPC agent
have shown no any adverse effect on pulp and relief of the
symptom of reversible pulpitis were found.

51. As an agent for atraumatic restorative
technique
• Quock et al. proposed hypothesis regarding drill less feeling.
• A drill-less filling will involve the utilizationof SDF (38%) to
arrest and prevent dental caries, followed by restoration with
a bonded filling material to achieve adequate seal at the lesion
margins.
• Hence, more research is required to evaluate the hypothesis
Quock RL, Patel SA, Falcao FA et al. Is a drill-less dental filling
possible? Med Hypotheses. 2011

52. • Santos et al. examined whether, for underprivileged
school children (T/T with 30% SDF gives better results than
intermediate restorative technique (IRT)(Glass ionomer cement
[GIC]) for caries arrest
After 1 year, The SDF technique better results than IRT indicating
that its use for underprivileged communities.
Dos Santos VE Jr, de Vasconcelos FM, Ribeiro AG, Rosenblatt
A. Paradigm shift in the effective treatment of caries in
schoolchildren at risk. Int Dent J. 2012 Feb 62:47-51.

53. Asatopicalfluorideagentforpreventionofcaries
• SDF - used as a topical fluoride agent.
Property to reduce S. mutans count, it can also prevent initiation
of caries and remineralization incipient carious lesion.
2 in vitro studies have shown contradictory results:
• Suzuki et al. evaluated that fluoride concentration of the
enamel treated with SDF was similar to those of sodium
fluoride and stannous fluoride.
The percent ratio of the concentration of retained fluoride to
that of uptake fluoride was highest when enamel was treated
with SDF.
Suzuki T, Nishida M, Sobue S et al. Effects of diamine silver fluoride
on tooth enamel. J Osaka Univ Dent Sch 1974 14: 61-72.

54. Other hand, Delbem et al. found that fluoridated varnish was
more effective to reduce both the enamel surface
demineralization and caries lesion depth than SDF solution.
More studies are required to conclude the fluoride uptake by
enamel from SDF.
Delbem AC, Bergamaschi M, Sassaki KT et al. Effect of
fluoridated varnish and silver diamine fluoride solution on
enamel demineralization: pH-cycling study. J Appl Oral Sci.
2006 14 :88-92.

55. Restorations and silver
diamine fluoride
• An in vitro study from Japan showed that SDF adversely affected the tensile
bond strength of bovine teeth to steel rods, when resin-based adhesive cement
was used.
Quock et al. found that SDF does not adversely affect the bond strength of resin
composite to non-carious dentin,
another in vitro study from Japan found that SDF enhances the bond strength of
GIC to bovine dentin.
Still, it requires more detailed research to check SDF’s effect on different types of
restorations.
Soeno K, Taira Y, Matsumura H et al. Effect of desensitizers
on bond strength of adhesive luting agents to dentin. J
Oral Rehabil 2001 28:1122–8.
Quock R, Barros J, Yang S, Patel S. Effect of Silver Diamine Fluoride
on Microtensile Bond Strength to Dentin. Oper Dent. 2012 May 22.
Yamaga M, Koide T, Hieda T. Adhesiveness of glass ionomer cement
containing tannin-fluoride preparation (HY agent) to dentin–an
evaluation of adding various ratios of HY agent and combination
with application of diamine silver fluoride. Dent Mat J 1993 12:
36–44.

56. Results/ConclusionfromdifferentstudiesonSDF

59. CONCLUSION
• Reports of the available studies suggest that 38% SDF may be
an effective agent in arresting caries in the primary teeth.
• No severe pulpal damage after SDF applications.
• SDF is simple and quick to use and is an affordable therapeutic
agent in developing countries.
• Still, More studies required in this direction to prove SDF as a
material of choice in the 21st century that will be helpful in
fulfilling goals for 2020 by WHO.

60. References
1.Fejerskov O, Kidd EAM, Nyvad B, et al. Defining the disease: an introduction. In: Fejerskov O, Kidd E, editors.
Dental caries: the disease and its clinical management. 2nd edition. Oxford (UK):Blakswell Munksgaard; 2008. p.
4–6.
2. Nikiforuk G. Understanding dental caries 1. Etiology & mechanisms. Basic & Clinical aspect, Karger 1985.
3. Edelstein BL. Pediatric caries Worldwide: implications for oral hygiene products. References Compend Contin
Educ Dent 2005 26: 4-9.
4. Baelum V, van Palenstein Helderman W, Hugoson A et al. A global perspective on changes in the burden of
caries and periodontitis:
implications for dentistry. J Oral Rehabil 2007 34:872-906.
5. Roberson TM, Heymann HO, Swift EJ. Sturdevant’s Art and Science of Operative Dentistry. Mosby: St. Louis;
2002.
6. Bedi R, Sardo-Infirri J. Oral health care in disadvantaged communities, London: FDI world press 1999.
7. Rosenblatt A, Stamford TCM, Niederman R. Silver Diamine Fluoride: A Caries “Silver Fluoride Bullet”. J Dent Res
2009 88:116-125.
8. Chu CH, Lo EC, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin
caries in Chinese
preschool children. J Dent Res 2002, 81:767-770.
9. Llodra JC, Rodriguez A, Ferrer B et al. 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.
10. Knight GM, McIntyre JM, Craig GG 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 50:242-5.
11. Knight GM, Mclntyre JM, Craig GG et al. Ion uptake into demineralized dentine from glass-ionomer cement
following pretreatment with silver fluoride and potassium iodide. Aust Dent J
2006 51: 237-241.

61. Thank you