Silver diamine fluoride for caries management

SDF is a colourless alkaline solution with a pH value between 9 and 10. SDF products basically contain silver, fluoride and ammonia. In 2020, the American Dental Association supported the use of SDF for caries management. In 2021, the WHO included SDF in the WHO Model List of Essential Medicines for both adults and children.

Researchers generally accept that silver and fluoride have a synergistic caries-arresting effect due to the following properties:

Inhibits bacterial growth and biofilm formation:
SDF possesses strong antimicrobial action against cariogenic bacteria like S. mutans, A. naeslundii and L. Acidophilus on the tooth surface as well as E. faecalis biofilm on root canals.
Promotes remineralisation and counteracts demineralisation:
In the presence of saliva, it fosters remineralisation of teeth in the oral cavity when the pH value is higher than 5.5. Inhibits calcium dissolution from hydroxyapatite and prevents the demineralisation of enamel and dentine.
Inhibits Collagen Degradation:
SDF inactivates proteolytic enzymes like matrix metalloproteinases (MMPs) and cysteine cathepsins, preventing the breakdown of dentine collagen in carious lesions.
Occludes dentinal tubules and promotes tertiary dentine formation:
Calcium fluoride, silver phosphate and silver protein can be formed and precipitate on the dentine surface after SDF application which occlude dentine tubules. The fluorohydroxyapatite produced after SDF application promotes remineralisation, which can block or decrease tubule diameter, resulting in relief of dentine hypersensitivity.

Benefits and Limitations

Advantages:
Simple, painless, non-aerosol generating (suitable during pandemics), affordable, and requires minimal equipment.
Main Drawback:
Causes permanent black staining on carious lesions, requiring informed patient consent prior to use.

Clinical Applications

Treating dentine hypersensitivity:
Clinical studies showed topical application of SDF relieved pain in adults with hypersensitive permanent teeth within one week. SDF is also applied on a vital tooth in preparation for extra-coronal restoration to reduce post-operative sensitivity.
Managing dental caries:
SDF is an exemplary non-restorative caries treatment that controls bacterial infection and promotes remineralization. Dentists use SDF to arrest early childhood caries. SDF is also used to manage root caries.
Remineralising hypomineralised molars:
Biannual SDF application prevented caries development and reduced dentine hypersensitivity in hypomineralised molars. Its repeated applications provide long-lasting relief of dentine hypersensitivity.
Disinfecting a root canal in endodontic therapy:
Studies show 3.8% SDF effectively removes E. faecalis biofilms in root canals. SDF disinfects root canals and prevents reinfection by killing dentinophilic bacteria and sealing dentinal tubules with silver salt precipitates.
Managing dental erosion:
SDF effectively prevents dental erosion through remineralization, forming metallic silver, silver chloride, and silver-containing hydroxyapatite on tooth surfaces.
Treating gross gingivitis:
Studies show SDF has significant antibacterial properties against periodontal pathogens, making it a potential therapeutic agent for periodontitis. It effectively treats hyperplastic gingivitis, reduces inflammation, and improves gingival health in older adults without adverse effects

GGI-CO-A1-AQS-300032384-ELC-L24-0923
Reference:
Zheng FM, Yan IG, Duangthip D, Gao SS, Lo ECM, Chu CH. Silver diamine fluoride therapy for dental care. Jpn Dent Sci Rev. 2022;58:249-257. doi:10.1016/j.jdsr.2022.08.001

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Dental & Oral Health

Dentinal Hypersensitivity

Vantej Long Lasting Relief

Vantej, enriched with the Calcium Sodium Phosphosilicate (CSPS) molecule, is a highly effective occluding desensitizer. It provides relief from dentinal hypersensitivity caused by enamel damage due to attrition, abrasion, and erosion.

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Silver diamine fluoride for caries management

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