Effects of silver diamine fluoride on demineralization protection after a secondary acid challenge

Abstract Objective This investigation describes the effects of 5% sodium fluoride varnish and 38% silver diamine fluoride on demineralization protection of human enamel lesions of three different severities after a secondary acid challenge. Study design Specimens underwent color and enamel surface microhardness change measurements after demineralization and treatment events. Transverse microradiography was conducted following the secondary demineralization. Results After treatments, enamel surface microhardness change showed that 24-hour lesions treated with fluoride varnish had less rehardening than 24-hour lesions treated with silver diamine fluoride (p<0.05), whereas 144-hour lesions from both treatment groups showed a beneficial decrease in surface microhardness change that was markedly better in samples treated with silver diamine fluoride (p<0.05). After the secondary demineralization, 24- and 144-hour lesions treated with silver diamine fluoride showed a sustained beneficial decrease in enamel surface microhardness change when compared to fluoride varnish-treated samples of the corresponding lesion severity (p<0.05). Transverse microradiography showed no difference between fluoride varnish- and silver diamine fluoride-treated samples of any corresponding lesion severity, indicating that remineralization in both fluoride varnish- and silver diamine fluoride-treated samples was proportional to each other after a secondary acid challenge. Conclusions Using silver diamine fluoride may have comparable benefits to fluoride varnish in mineral loss prevention.

Success rate of silver nano-particles in comparison to silver diamine fluoride in management of deep carious lesions: a randomized controlled clinical trial / Taxa de sucesso de nanopartículas de prata em comparação ao fluoreto de diamina de prata no manejo de lesões cariosas profundas: um estudo clínico controlado randomizado

Objective: Evaluate the effectiveness of nanosilver fluoride in comparison to silver diamine fluoride in management of deep carious lesions. Material and Methods: This double-blinded randomized controlled clinical trial included thirty-six patients with deep carious mandibular molars. Patients were recruited form the outpatient clinic of Suez canal university, Egypt and randomly allocated into three groups, Nanosilver fluoride group, Silver diamine fluoride group and control group. For all groups, teeth were isolated by rubber dam. Access was done followed by partial caries removal. Silver diamine fluoride or Nanosilver fluoride were applied, and all teeth were restored with composite resin restorative. Patients were recalled after 3 and 6 months to follow-up the pulp vitality. R-statistical analysis software for Windows, version 4.1.1, was used to conduct the statistical analysis Results: At 3 month, for all groups, all teeth were successful. After 6 months, for silver diamine fluoride group, a single case failed. Regarding the nanosilver fluoride, all cases were successful. For the control group, two cases failed. No statistically significant difference was found between the tested groups. Conclusion: Application of 5% Nanosilver to fluoride varnish has similar clinical efficacy as silver diamine fluoride in arresting the dentin caries progression (AU)

Objetivo: Avaliar a eficácia de fluoreto de nanoprata em comparação ao fluoreto de diamina de prata no manejo de lesões profundas de cárie. Material e Métodos: Este estudo clínico controlado randomizado duplo-cego incluiu trinta e seis pacientes com lesões de cárie profunda em molares inferiores. Os pacientes foram recrutados no ambulatório da Universidade do Canal de Suez, no Egito, e alocados aleatoriamente em três grupos de tratamento: fluoreto de nanoprata, fluoreto de diamina de prata e grupo controle. Para todos os grupos, os dentes foram submetidos ao isolamento absoluto. O acesso à lesão foi feito seguido pela remoção parcial de tecido cariado. Tanto o fluoreto de diamina quanto fluoreto de nanoprata foram aplicados, e todos os dentes foram restaurados com resina composta. Os pacientes foram avaliados após 3 e 6 meses para o acompanhamento da vitalidade pulpar. O software estatístico R-statistical para Windows, versão 4.1.1, foi usado para as análises. Resultados: Em 3 meses, para todos os grupos, todos os dentes apresentaram sucesso no tratamento. Após 6 meses, para o grupo que utilizou o fluoreto de diamina de prata um único caso falhou. Em relação ao fluoreto de nanoprata, todos os casos apresentaram sucesso. Para o grupo controle, dois casos falharam. Não houve diferença estatística entre os grupos testados. Conclusão: A aplicação de verniz de fluoreto de nanoprata a 5% tem eficácia clínica semelhante ao fluoreto de diamina de prata na interrupção da progressão de cárie no tecido dentinário (AU)

Fluoride and silver ion concentrations and pH in silver diamine fluoride solutions from Argentina / Concentraciones de fluoruro y plata y pH en soluciones de diamino fluoruro de plata producidos en Argentina

ABSTRACT The aim of this study was to measure the fluoride (F) and silver (Ag) ion concentration and the pH, over time, of 2 solutions of 38% silver diamine fluoride (SDF) produced in Argentina. The brand Fluorsilver® was established as Group 1 (G1) (Densell), and the brand FAgamin® (Tedequim) as Group 2 (G2), each with two different lots. The following were determined at time 0 (t0) and 30 days after opening (t30): a) fluoride concentration (w/v) by visible spectrophotometry b) Ag content (w/v) by atomic absorption spectrophotometry c) pH. Results: The data in the freshly opened bottles were for G1 lot1/lot2: a) 0.96/1, b) 8.3/7.8, c).11.5/11.3; G2 lot1/lot2: a) 11.5/9.9, b) 39/39, c) 7/6,9; and after 30 days, G1 lot1/lot2: a) 0.85/0.81, b) 7.2/8.2, c) 11.3/11.6; G2 lot1/lot2: a) 9.35/8.43, b) 38/38, c) 7.6/7.6. Conclusion In relation to the expected values (5.0-5.9% fluoride and 24.4-28.8% silver), the average concentration of fluoride and silver ions was lower for G1, but higher for G2. The pH was alkaline for G1 and neutral for G2. Over the 30 days, the content of fluoride and silver tended to decrease.

RESUMEN El objetivo de este estudio fue medir las concentraciones de iones de fluoruro (F) y plata (Ag) y el pH, de 2 soluciones de diamino fluoruro de plata (SDF) al 38% producidas en Argentina. Se estableció como Grupo 1 (G1) la marca Fluorsilver® (Densell), y FAgamin® (Tedequim) como Grupo 2 (G2), cada uno con dos lotes diferentes. Se determinó: a) la concentración de fluoruro (p/v) por espectrofotometría visible, b) el contenido de Ag (p/v) por espectrofotometría de absorción atómica y c) el pH, y fue medido en un tiempo 0 (t0) y 30 días después de la apertura del frasco (t30). Resultado: En tiempo 0 para G1 lote1/lote2 fue: a) 0,96/1, b) 8,3/7,8 c).11,5/11,3 y G2 lote1/lote2: a) 11,5/9,9, b) 39/39, c) 7/6,9. A los 30 días G1 lote1/lote2: a) 0,85/0,81, b) 7,2/8,2, c) 11,3/11,6 y G2 lote1/lote2: a) 9,35/8,43, b) 38/38, c) 7,6/7,6. La concentración de iones de fluoruro y plata para G1 fue menor en relación a los valores esperados (5,0-5,9% de fluoruro y 24,4- 28.8% plata), sin embargo G2 obtuvo valores más altos. G1 muestra resultados de pH alcalino y G2 neutro. A lo largo de los 30 días, el contenido de fluoruro y plata tiende a disminuir.

Effect of silver diamine fluoride, potassium iodide, and glutathione on micro-shear bond strength of glass ionomer cement to caries affected dentine

Background: Silver diamine fluoride (SDF, 38%) is an efficient topical fluoride used to arrest dental caries though it causes black staining of both teeth and restoration. The application of potassium iodide (KI) after SDF reduces the stain, but the color change is only temporary. An alternative method suggested is by mixing glutathione (GSH) with SDF, which preserves the silver ions of SDF within the solution. Hence, the purpose of this in vitro study was to evaluate the microshear bond strength (?SBS) of glass ionomer cement (GIC) to caries affected dentin (CAD) pretreated with SDF/KI/GSH. Materials and Methods: Thirty dentine slices of 2 mm thickness from human permanent upper premolars were demineralized using pH cycling method to mimic CAD. They were allocated to three groups of 10 each and treated with SDF, SDF-KI (SDF followed by KI), SDF + GSH (SDF mixed with GSH), respectively. Specimens were bonded with GICs. The ?SBS was assessed using a universal testing machine and the data obtained were analyzed using one-way ANOVA and Tukey's post hoc test. Results: The ?SBS (mean ± standard deviation) values for groups SDF, SDF-KI, and SDF + GSH were 4.81 ± 2.026, 5.78 ± 1.809, 8.18 ± 2.828 megapascal respectively. Group 3 showed significantly better bond strength compared to groups 1 and 2. In group 2, the addition of KI showed better bond strength when compared to group 1, but the difference was not statistically significant. Conclusion: Pretreatment of teeth with GSH along with SDF application showed significantly better bond strength of GIC to CAD compared to SDF and SDF-KI.

Comparative evaluation of antimicrobial efficacy of silver diamine fluoride, chlorhexidine varnish with conventional fluoride varnish as a caries arresting agent. An in vivo sodium dodecyl sulfate-polyacrylamide gel electrophoresis study

Introduction: Silver diamine fluoride (SDF) is employed as an adjunct cariostatic agent in the management of dental caries in high-risk population. Other than fluorides, chlorhexidine (CHX) is the most potent antimicrobial and efficacious agent against Streptococcus mutans. Aim: The aim of this study is to evaluate and differentiate the efficacy of 38% silver diamine fluoride, CHX varnish, and fluoride varnish on carious primary teeth. Materials and Methods: Ninety children having a count of ?1 carious lesion were recruited. Thirty-eighty percent silver diamine fluoride or fluoride varnish and CHX varnish were topically applied on the lesion. The primary outcome measured was the arrest of carious lesion (lesion rendered inactive as per the Nyvad criteria) after a follow-up of 14–21 days. Dental biofilm sample was obtained from each child and subsequently assessed for microbial composition by colony-forming unit method before and after treatment followed by protein analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis method. Results: Average proportion of arrested caries lesions in the SDF group was higher followed by CHX and fluoride varnish groups. Decreased total protein amount was found in SDF group. This proves that there is decrease in microbial load posttreatment in SDF group. Conclusion: Thirty-eight percent SDF is more effective than CHX varnish and fluoride varnish in arresting dentin carious lesions in young children.

Can silver diamine fluoride be an alternative to aerosol-based dentistry during the COVID scenario? A retrospective analysis

Background: Restrictions on routine dental procedures involving aerosols during COVID-19 have resulted in a significant increase in the suffering of pediatric patients. Aim: The study reported the alternative measures followed in our department using SDF during the COVID era when routine elective dental procedures were prohibited. Materials and Methods: The retrospective data of patients aged 2–13 years with carious molar teeth who were treated with silver diamine fluoride without (Group 1) or with (Group 2) caries excavation were collected. Results: One thousand and seventy-two patients (646 males and 426 females) with 2459 carious molar were treated. On follow-up assessment at 3 months, 28 teeth in Group 1 and 21 teeth in Group 2 showed progression of carious lesion using International Caries Detection and Assessment System (ICDAS II criteria). Out of these failure cases, 32 (1.8%) teeth were primary and 17 (2.5%) were permanent. Complete relief in sensitivity/pain on stimulation was reported in 2381 teeth (96.83%), whereas in 78 (3.17%) teeth, mild sensitivity/pain on stimulation was reported. The average time consumed during treatment per tooth in Group 1 was 5.04 min and in Group 2 was 5.78 min. Conclusion: SDF application can be carried out as a nonaerosol-generating procedure and is a simple technique for children and clinicians.

Comparison of staining potential of silver diamine fluoride versus silver diamine fluoride and potassium iodide under tooth-colored restorations

Background: Silver diamine fluoride (SDF) is one of the effectual cariostatic agents widely used in minimal intervention dentistry. However, the major drawback of SDF is dark staining after its application. Aim: In the present study, the staining of 38% SDF alone and 38% SDF and potassium iodide (KI) was compared after restoration with glass-ionomer cement (GIC) and resin composite using ImageJ software. Methods and Material: Forty extracted carious primary teeth were sorted into four groups. In Group I and II, SDF was applied and restored with GIC and composite restorations, respectively. In Group III and IV, SDF application was followed by KI and restored with GIC and composite restorations, respectively. Images were captured after initial applications on day 1 and day 14 after restoration. The captured images were imported to ImageJ software and mean gray values were calculated. Statistical Analysis: The mean gray values obtained were subjected to statistical analysis using paired t-test and independent sample t-test. There was statistically significant if P < 0.05. Results: Following the application of SDF and RIVA STAR, the baseline mean gray values showed no statistical significance. On day 1, the mean gray values were highest in Group IV (208.30) and lowest in Group I (178.51). Similarly, on day 14, the highest mean gray values were observed in Group IV (208.45) and lowest in Group I (147.6) which were statistically significant. Conclusions: The restorations after SDF application attained dark stain eventually, whereas with the application of SDF followed by KI (RIVA STAR), the restorations showed the least staining.

Evaluation of the clinical efficacy of 38% silver diamine fluoride in arresting dental caries in primary teeth and its parental acceptance

Background: Early childhood caries (ECC) has been regarded as one of the most prevalent chronic diseases in children. Conventional restorative management of ECC is difficult to perform in very young and apprehensive children. Silver diamine fluoride (SDF) can be a useful tool in the management of dental caries by arresting the carious lesion in primary teeth. After SDF treatment, the dentinal staining that is associated with SDF influences the acceptance of this treatment among parents of young children. Aim: This study aimed to evaluate the clinical effectiveness of biannual application of 38% SDF followed by 5% sodium fluoride (NaF) varnish for arresting dental caries in children and its parental acceptance. Methods: Twenty-six children aged 2–5 years with 107 active caries lesions in primary teeth were enrolled. At the baseline examination, status of carious lesions was recorded and scored according to the International Caries Detection and Assessment System II. Lesion activity was assessed by visual inspection and tactile detection. Carious lesions with score 3, 4, 5, and 6 were treated with 38%SDF application, followed by 5% NaF varnish. Children were re-evaluated at 3 weeks, 3 months, 6 months, and 12 months. Parental acceptance of SDF treatment was evaluated. Results: This study demonstrated that 38% SDF was 92.31% effective in arresting dental caries in primary teeth and was well accepted by parents. Chi-square test was used to assess the significant difference among the arrested lesions which was statistically significant (P < 0.05). Conclusion: Thirty-eight percent SDF can be effectively used in arresting caries in primary teeth in young and uncooperative children.

The effect of reduced glutathione on the toxicity of silver diamine fluoride in rat pulpal cells

Abstract Introduction Due to its ability to arrest untreated dental caries, silver diamine fluoride (SDF) has been advocated for indirect pulp capping procedures. However, the high concentrations of silver and fluoride in SDF raise concerns about its biocompatibility to pulpal tissues. Objectives This study aimed to investigate the effect of SDF on the viability, alkaline phosphatase (ALP) activity, and morphology of pulpal-like cells (RPC-C2A) and to evaluate the influence of reduced glutathione (GSH) on SDF-induced cytotoxicity and deposit formation on dentin. Methodology The cytotoxicity of diluted 38% SDF solutions (10-4 and 10-5), with or without the addition of 5 mM or 50 mM GSH, was evaluated at 6 and 24 hours. Cell viability was detected using WST-8 and the effect on ALP activity was performed using an ALP assay kit. Cell morphology was observed using a phase-contrast microscope. Scanning electron microscopy analysis was conducted to evaluate the effect of GSH incorporation or conditioning on SDF-induced deposit formation on dentin discs. Cytotoxicity data were analyzed by two-way analysis of variance (ANOVA) and Tukey post hoc tests (p<0.05). Results There were significant differences between the groups. The results demonstrated that all tested SDF dilutions caused a remarkable cytotoxic effect, while the addition of GSH prevented SDF-induced damage at 6-hour exposure time in the higher dilution of SDF. Dentin treated with plain SDF or GSH-incorporated SDF solution showed deposit formation with occluded dentinal tubules, unlike the other groups. Conclusion SDF severely disturbed the viability, mineralization-ability, and morphology of pulpal-like cells, while controlled concentrations of GSH had a short-term protective effect against SDF-induced damage. GSH showed an inhibitory effect on SDF-induced dentinal deposit formation. Further research is warranted to evaluate the effect of GSH on caries-arresting, anti-hypersensitivity, and antibacterial functions of SDF.

Knowledge and Awareness on Silver Diamine Fluoride among Paediatric Dentists and Post Graduates in India - A Survey

Silver diamine fluoride (SDF) is a topically applied liquid that has been used to treat tooth hypersensitivity and arrest cavitated carious lesions. Lesion arrest can be achieved by painting the cavitated lesion with the SDF liquid without removing any infected soft dentin. SDF can serve as an alternative, particularly for patients who cannot tolerate traditional dental treatment, and can reduce the need for dental care to be performed under general anesthesia, with its associated health risks. The aims of this study were to assess Indian pediatric dentist’s SDF educational experiences, knowledge, attitudes, and professional behavior and to explore the relationships among these constructs. A cross-sectional survey was conducted among 100 paediatric dentists and post graduates by asking them to take up a survey. All dentists from India. were invited to participate in the survey. An online multiple-choice and fill-in response questionnaire was created in Google Forms. Questions. The data obtained were compiled systematically and then statistically analyzed. Survey responses were received from 100 members. The data showed that 41% percent of respondents under 40 years of age in our study. Out of the 100 respondents were male (53%) than female (47%). The respondents ranged in age from 26 to 65 years; they had graduated from their BDS /MDS program. A lack of self-reported knowledge was most frequently reported concerning whether a restoration must be placed after SDF treatment even if SDF is being reapplied twice per year, whether SDF can be used on root caries lesions, and under which codes SDF treatment can be billed.

Effect of silver antibacterial agents on bond strength of fiber posts to root dentin

Abstract This study was conducted to evaluate whether antibacterial pretreatment irrigation with silver nanoparticles (SNPs) and silver diamine fluoride (SDF) has any effect on bond strength of fiber posts cemented with three types of resin cements in root canal space. Fifty-four endodontically treated maxillary central incisor roots were prepared for fiber post (FRC Postec Plus NO.3, Ivoclar Vivadent) cementation and divided into nine groups in terms of three cement types and two pretreatments with silver antibacterial agents. The cements were as follows: an etch-and-rinse cement (ER, Excite DSC/Variolink N), a self-etch cement (SE, ED Primer/Panavia F2.0), and a self-adhesive cement (SA, Panavia SA Luting Plus). For each cement, the control group was with no treatment and two experimental groups were with SNPs and SDF treatments that were used after acid-etching for ER cement and after EDTA treatment for SE and SA cements. After fiber post cementation, each bonded root was horizontally sectioned into 1-mm thickness microslices to create two slices for each root region (apical, middle and coronal) and underwent push-out bond strength (PBS) test. Data in MPa were analyzed with two-way ANOVA and Tukey test (p=0.05). The interaction of the pretreatment type and cement type was significant (p<0.001). SNPs and SDF significantly increased PBS with ER cement (p≤0.04). This positive effect was also marginally significant for SDF with SE cement (p=0.049). For SA cement, SNPs showed a significant positive effect, but SDF had a significant adverse effect on PBS (p<0.001). The effect of pretreatment with silver antibacterial agents prior to adhesive cementation of fiber posts depends on the resin cement used. Contrary to SNPs with beneficial or no significant effect on bonding for all cements, SDF exhibited a deleterious effect with self-adhesive cement.

Resumo Este estudo foi conduzido para avaliar se a irrigação de pré-tratamento antibacteriano com nanopartículas de prata (SNPs) e fluoreto de diamina de prata (SDF) tem algum efeito na resistência de união de pinos de fibra cimentados com três tipos de cimentos resinosos no espaço do canal radicular. Cinquenta e quatro raízes de incisivos centrais superiores tratadas endodonticamente foram preparadas para cimentação de pino de fibra (FRC Postec Plus NO.3, Ivoclar Vivadent) e divididas em nove grupos em termos de três tipos de cimento e dois pré-tratamentos com agentes antibacterianos de prata. Os cimentos foram os seguintes: um cimento etch-and-rinse (ER, Excite DSC / Variolink N), um cimento autocondicionante (SE, ED Primer / Panavia F2.0) e um cimento autoadesivo (SA, Panavia SA Luting Plus). Para cada cimento, o grupo controle foi sem tratamento e dois grupos experimentais foram com SNPs e SDF tratamentos que foram usados após o condicionamento ácido para o cimento ER e após o tratamento com EDTA para os cimentos SE e SA. Após a cimentação do pilar de fibra, cada raiz ligada foi seccionada horizontalmente em microclimas de 1 mm de espessura para criar duas fatias para cada região da raiz (apical, média e coronal) e submetida ao teste de resistência de união por push-out (PBS). Os dados em MPa foram analisados ​​com ANOVA de dois fatores e teste de Tukey (p = 0,05). A interação do tipo de pré-tratamento e tipo de cimento foi significativa (p<0,001). SNPs e SDF aumentaram significativamente o PBS com cimento ER (p≤0,04). Este efeito positivo também foi marginalmente significativo para SDF com cimento SE (p = 0,049). Para o cimento SA, os SNPs mostraram um efeito positivo significativo, mas o SDF teve um efeito adverso significativo no PBS (p <0,001). O efeito do pré-tratamento com agentes antibacterianos de prata antes da cimentação adesiva dos pinos de fibra depende do cimento resinoso utilizado. Ao contrário dos SNPs com efeito benéfico ou nenhum efeito significativo na adesão para todos os cimentos, o SDF exibiu um efeito deletério com o cimento autoadesivo.

Fluoruro diamino de plata comparado con técnica de restauración atraumática para el tratamiento de caries cavitadas en dentición primaria y mixta primera fase / Silver diamine fluoride compared to atraumatic restorative technique for the treatment of caries in primary and mixed first phase dentition

INTRODUCCIÓN: Las lesiones de caries cavitadas en dentición primaria y mixta requieren un tratamiento oportuno, para evitar así la progresión de la caries. El fluoruro diamino de plata ha surgido como una alternativa a la técnica de restauración atraumática debido a su fácil aplicación. Sin embargo, aún existe incertidumbre en relación a su efectividad y seguridad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos diez revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos ensayos aleatorizados. Concluimos que el fluoruro diamino de plata en comparación a la técnica de restauración atraumática podría aumentar el arresto de caries en dentición primaria y mixta primera fase, pero la certeza de la evidencia ha sido evaluada como baja. Por otra parte, el tratamiento con fluoruro diamino de plata comparado con la técnica de restauración atraumática (ART) probablemente aumenta el riesgo de eventos adversos

INTRODUCTION: Cavitated carious lesions in primary and mixed dentition require prompt treatment to control caries progression. Silver diamine fluoride has emerged as an alternative to the atraumatic restorative technique due to its easy application. However, there is still uncertainty regarding its effectiveness and safety. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a metanalysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified ten systematic reviews, including two studies overall, which are randomized trials. We concluded that silver diamine fluoride compared to the atraumatic restorative technique may increase the arrest of caries in primary and mixed first phase dentition, however, the certainty of the evidence has been assessed as low. On the other hand, treatment with silver diamine fluoride compared to the atraumatic restorative technique (ART) probably increases the risk of adverse events.

Efectividad bactericida del diamino fluoruro de plata a diferente concentración sobre estreptococos cariogénicos en muestras de saliva y dentina de escolares: un estudio in vitro / Bactericidal effectveness of silver diamine fluoride in different concentrations on cariogenic Streptococcus in salivary and dentinal samples of schoolchildren: an in vitro study

La OMS y la FDI han publicado que entre el 60 y 90% de los escolares padecen caries. En nuestro país, el Sistema de Vigilancia Epidemiológica de Patologías Orales (SIVEPAB) 2012, reporta un 85% de caries a nivel nacional en población pediátrica. Los agentes anticariogénicos como el diamino y el fluoruro de plata son un tratamiento alentador, este agente puede actuar como bactericida o bacteriostático en función de su concentración y su capacidad para inhibir el crecimiento de estreptococos del grupo viridans, y por ende, de la caries. Problema: ¿Cuál es la efectividad bactericida del diamino fluoruro de plata (Saforide®) a diferente concentración sobre la microbiota cariogénica de escolares? Objetivo: Determinar la eficacia bactericida del diamino fluoruro de plata (DFP) a diferentes concentraciones en el crecimiento bacteriano de Streptococcus mitis, S. mutans y S. salivarius en muestras de saliva y dentina en escolares. Material y métodos: Se llevó a cabo un estudio experimental con una variable independiente, el efecto bactericida del diamino fluoruro de plata y se tomó el halo de inhibición como la dependiente. Se utilizaron medidas descriptivas como prueba de comparación y análisis de varianza usando post-hoc Tukey≠ con una confianza del 95%, y análisis de datos exploratorios. Resultados: Se analizaron 100 muestras, de las cuales 48.3% correspondió a S. mutans, 41.4% a S. salivarius y 10.3% a S. mitis, se obtuvo una mayor zona de inhibición para las tres bacterias al 38% mostrando una diferencia estadísticamente significativa 12% (p < 0.05). También se observó un efecto bacteriostático al 12%, no así para el 38%, donde se encontró un efecto bactericida Conclusión: Nuestros resultados sugieren que al 38% de la concentración hay un claro efecto bactericida en el grupo de estreptococos viridans y el 12% no se recomienda para la detención de caries debido al efecto bacteriostático (AU)

WHO and FDI have ruled that 60-90% of schoolchildren are affected by caries. In our country, the System of Epidemiological Surveillance of Oral Pathologies (SIVEPAB) (SIVEPAB) 2012. Report a rate of 85% of caries nationally in pediatric population. Anticariogenic diamino agents such as silver fluoride are an encouraging decrease in treatment for these high rates of tooth decay in our country, this agent can act as bactericidal or bacteriostatic based on their concentration and their ability to inhibit endogenous metalloproteinase (MMP-2, 8, 9). Problem: What will be the bactericidal effectiveness of silver diamine fluoride different concentration on cariogenic Streptococci saliva samples taken from school and dentin? Objective: Determine the bactericidal effectiveness Silver diamine fluoride (SDF) to different concentration on bacterial growth of Streptococcus mitis, S. mutans, and S. salivarius in saliva samples and dentin in school. Material and methods: An experimental study was conducted as an independent variable the bactericidal effect of silver diamine fluoride was taken as dependent inhibition halo. Descriptive measures were used as a comparison test and analysis of variance using Post-hoc Tukey with 95% confidence, and exploratory data analysis. Results: One hundred samples, of which 48.3% corresponded to S. mutans, 41.4% to S. salivarius and 10.3% to S. mitis, were analyzed, we obtained a larger zone of inhibition for all three organisms at 38% showing a statistically significant difference from 12% (p < 0.05). It was also observed that the 12% sample bacteriostatic effect, not to the concentration of 38% was found a bactericidal effect. Conclusion: Our results suggest that 38% concentration has a bactericidal effect on Streptococcus viridans group and 12% showed not recommended for the arrest or detention of dentine caries bacteriostatic effect (AU)

Comparative Evaluation Of The Effect Of Various Remineralizing Agents On Root Dentin: An In Vitro Study

50 root dentin sections were obtained from 25 extracted premolars and divided randomly into 5 groups of 10 samples each. Except group 1, all the other group specimens were demineralised by immersing in a demineralising solution for 96 hours at 370C. The specimens were then subjected to surface treatment with grape seed extract, silverdiamine fluoride and calcium sucrose orthophosphate complex according to the groups. The samples were stored in artificial saliva during the intervals and subjected to pH cycling and evaluated using SEM-EDAX and the results statistically compared. The tested remineralizing agents showed statistically significant increase in remineralization when compared to the demineralized group. Calcium sucrose orthophosphate showed the highest Ca/Pvalues followed by Silver diamine flouride and grape seed extract

Effect of silver diamine fluoride (SDF) on the dentin-pulp complex: ex vivo histological analysis on human primary teeth and rat molars / Efecto del diamino fluoruro de plata (DFP) sobre complejo dentino-pulpar. Análisis histológico ex vivo en dientes primarios humanosy molares de rata

The aim of this study was to determine the effect of SDF on thedentin­pulp complex using two models: teeth after SDFapplication (ex vivo) and experimental animal molars. Adescriptive study was performed using two models. In the firstmodel, primary teeth (ex vivo) with enamel­dentin caries, withoutpulp involvement and previously treated with 38% SDF, wereevaluated by means of two techniques: (a) Scanning ElectronMicroscopy (SEM) and energy­dispersive X­ray detector (EDS)to determine qualitative and quantitative composition, and (b)brightfield optical microscopy (OM) after decalcification. Thesecond model used laboratory animal molars from 12 maleWistar rats. Standardized enamel­dentin cavities approximately0.5 mm deep were made the distal fossa of the occlusal face ofboth first lower molars, to one of which a 38% SDF solution wasapplied, while the other was used as a control. Histologicalsections were prepared and dental pulp was evaluatedqualitatively in both groups. SEM on ex vivo teeth showed areasof hypermineralization in the intertubular dentin and few blockedtubules, while EDS detected Ag in the center of the lesion(7.34%), its concentration declining at the edges (1.71%), withnone in the areas farthest from the lesion...

El objetivo del trabajo fue determinar del efecto del DFP encomplejo dentino­pulpar aplicando dos modelos: piezasdentarias luego de su aplicación (ex vivo) y en molares deanimales experimentales. Se realizó un estudio descriptivoaplicando dos modelos: en piezas dentarias primarias (ex vivo)con caries amelodentinarias sin compromiso pulpar que hayansido sometidas previamente con DFP 38%, mediante dosevaluaciones: Microscopía electrónica de Barrido (MEB) ydetector de energía dispersiva de rayos X (EDS) a fin dedeterminar su composición cuali y cuantitativa y Microscopíaóptica de campo claro (MCC) mediante la técnica descalcifi ­cación y en molares de animales de laboratorio donde seutilizaron 12 ratas Wistar macho. La técnica fue estandarizadaen la fosa distal de la cara oclusal del primer molar inferior, serealizó una cavidad amelodentinaria aprox. 0.5 mm de profun ­didad, en ambos molares. En un molar se aplicó la soluciónDFP al 38 % y el opuesto como control. Se realizaron corteshistológicos y se evaluó en forma cualitativa la pulpa dentalen ambos grupos. En las piezas ex vivas mediante MEBse observaron áreas de hipermineralización en la dentinaintertubular y escasos conductillos obliterados y por EDS sedetectó Ag en el centro de la lesión (7.34%), disminuyendo suconcentración en los límites (1,71%) y no se detectó en las zonasmás alejadas de la misma. En MCC se observó DFP sellando losconductillos sólo en sitio de colocación y con una penetraciónlimitada, por debajo, los conductillos se observaron de aspectonormal y el tejido pulpar asociado con la caries tratadaha mostrado un infiltrado inflamatorio crónico y formaciónde dentina terciaria, sin observarse precipitado de Ag...

Evaluation of microshear bond strength and nanoleakage of etch‑and‑rinse and self‑etch adhesives to dentin pretreated with silver diamine fluoride/potassium iodide: An in vitro study.

Aims: The aim of this in vitro study was to comparatively evaluate the microshear bond strength (MSBS) of etch‑and‑rinse and self‑etch (ER and SE) bonding systems to dentin pretreated with silver diamine fluoride/potassium iodide (SDF/KI) and nanoleakage at the resin‑dentin interface using transmission electron microscope (TEM). Subjects and Methods: Seventy‑two dentin slabs of 3 mm thickness were prepared from extracted human permanent third molars and divided into four groups (n = 18) based on the dentin surface treatment as follows: (1) ER adhesive bonding without dentin pretreatment; (2) SDF/KI pretreatment of dentin followed by ER adhesive bonding; (3) SE adhesive bonding without dentin pretreatment; and (4) SDF/KI pretreatment of dentin followed by SE adhesive bonding. Resin composite was built on the dentin slabs to a height of 4 mm incrementally, and dentin‑composite beams of approximately 1 mm2 cross‑sectional area were prepared. The beams were subjected to MSBS analysis, and the fractured surface was observed under scanning electron microscope to determine the mode of failure. The resin‑dentin interface was examined under TEM for evaluation of nanoleakage. Statistical Analysis Used: One‑way ANOVA followed by Tukey’s post hoc multiple comparison tests. Results: Pretreatment of dentin with SDF/KI increased the MSBS of ER and SE adhesives, though not statistically significant, except between Groups 2 and 3. In all the groups, the predominant mode of failure was adhesive followed by cohesive in resin, mixed and cohesive in dentin. TEM examination of resin‑dentin interface showed that pretreatment with 38% SDF/KI reduced nanoleakage regardless of the type of bonding system used. Conclusions: Pretreatment of dentin with SDF/KI minimized nanoleakage at the resin‑dentin interface without adversely affecting the bond strength of resin composite to dentin.

The effects of diammine silver fluoride solution on demineralized dentine adhesion ability / 实用口腔医学杂志

Objective:To investigate the effect of silver diamine fluoride(SDF)on the bonding strength between dentine and glass ion-omer cement(GIC).Methods:1 2 extracted sound molars were prepared into dintine samples and distributed into sound dentine group and demineralized dentine group.According to the treatment methods,the samples in each group were respectively divided into 3 sub-groups:A(control group),B[coated with 38% Ag(NH3 )F2 ]and C(SDF treatment with additional lighting-curing)(n =20).Then a hand-mixed conventional glass ionomer cement Fuji IX was placed on the dentine surface.After 24 h,micro tensile bond strength test and scanning electron microscope (SEM)analysis were conducted.Results:The bonding strength of demineralized dentine was higher than that of sound dentine(P <0.01 ).SDF with additional lighting-curing treated dentine showed a higer bonding strength value than only SDF treated dentin(P <0.01 ).Conclusion:SDF may improve the bonding between dentine and GIC.

Efecto del Fluoruro Diamino de Plata en caries inducida en ratas Wistar / The effect of Silver Diamine Fluoride on caries induced in Wistar rats

Introducción: la caries dental es considerada un problema de salud pública, para su tratamiento se han propuesto diversos biomateriales, entre ellos el uso de la mezcla de fluoruro+nitrato de plata, llamada Fluoruro Diamino de Plata (FDP) con propiedades cariostáticas, remineralizantes y bactericidas utilizado en dientes primarios. Son pocos los estudios que valoran la respuesta del tejido dentario luego de aplicarlo, es por ello que el objetivo de este estudio fue determinar el efecto del FDP en caries inducidas en ratas Wistar. Métodos: se hizo inducción de caries dental en molares de ratas Wistar, inoculándolos con S. mutans CVCM656, manteniendo dieta rica en sacarosa durante 12 semanas. Diagnosticadas las caries y distribuidas en grupos control (C1,C2) y experimental (E1,E2), se removió dentina reblandecida de los molares y se topificaron con FDP al 3,8% solo los molares de los grupos experimentales. Finalmente se hizo valoración clínica y toma de muestra para estudio histológico a las 7 y 13 semanas posteriores al tratamiento. Resultados: los grupos control registraron aumento del número de lesiones cariosas y progresión de su severidad, mientras que los grupos experimentales no revelaron cambios en estos parámetros, mostrando superficies dentinarias duras y oscuras, el reporte histológico determinó aumento en el espesor de predentina únicamente en los molares de los grupos experimentales. Conclusiones: el protocolo de inducción de caries en ratas Wistar fue exitoso; asimismo, el tratamiento con FDP inactivó los procesos cariosos sin que progresaran en severidad ni aumentara el número de caries, siendo estos resultados extrapolables a los humanos.

Introduction: dental caries is considered a public health problem. Various biomaterials have been suggested for treating it, including fluride+silver nitrate mix, known as silver diamine fluoride (SDF) which contains cariostatic, remineralizing, and bactericide properties and is used on primary teeth. Only a few studies have assessed the response of dental tissue when this substance is applied; the objective of this study was therefore to determine the effect of SDF on caries induced in Wistar rats. Methods: dental caries was induced in Wistar rats’ molars by inoculating them with S. mutans CVCM656 and feeding them a sucrose-rich diet for 12 weeks. Once caries were diagnosed and sorted out into control groups (C1, C2) and experimental groups (E1, E2), softened dentine was removed from molars; only the molars from experimental groups received a topical application of 3.8% SDF. Finally, clinical assessment was performed and samples were collected for histological study 7 and 13 weeks after treatment. Results: the control groups experienced an increased number of carious lesions and progression in severity, while the same parameters in the experimental groups remained unchanged, showing hard dark dentine surfaces. The histological report showed increased predentine thickness in molars from the experimental groups only. Conclusions: the protocol of caries induction in Wistar rats was successful. Treatment with SDF deactivated the carious processes, arresting not only severity progression but also the increase in number of caries; these findings may be extrapolated to humans.

Efficacy of silver diamine fluoride as an antibacterial as well as antiplaque agent compared to fluoride varnish and acidulated phosphate fluoride gel: An in vivo study.

Background: Silver diamine fluoride (SDF) is already proven as an antibacterial agent in vitro. Present study was formulated to compare the efficacy of SDF as an antibacterial as well as antiplaque agent in vivo with fluoride varnish and acidulated phosphate fluoride (APF) gel. Study Design: Total 123 children (male = 82, female = 41) were included in the study for a period of 18 months. Children were divided into three different groups-Group 1: SDF; Group 2: fluoride varnish; and Group 3: APF gel. All subjects were evaluated via plaque score at 6 th , 12 th , and 18 th months as well as Streptococcus mutans counts in saliva at 72 h, 6 th , 12 th , and 18 th months of follow-up. Results: Significant reduction was found in plaque score as well as S. mutans counts irrespective of group division. On intergroup comparison, no statistically significant difference was found in plaque score, but significant reduction in S. mutans counts was found in Group 1 as compared with Groups 2 and 3, while no significant difference was found between Groups 2 and 3. Conclusion: In vivo application of SDF on enamel significantly decreases S. mutans counts as compared to fluoride varnish and APF gel.

Adverse events on the use of interim therapeutic in schoolchildren: silver diamine fluoride × interim therapeutic restorative - a pilot study / Efeitos adversos de técnicas provisórias em crianças: diamino fluoreto de prata x tratamento restaurador provisório - um estudo piloto

PURPOSE: Silver diamine fluoride (SDF) is a caries prevention and arresting agent that is easy to apply clinically. Interim therapeutic restorations (IRT) are also known to be a simple and effective method for treating caries in children. This study examines whether treatment with 30% silver diamine fluoride (SDF) will cause fewer adverse events than the available interim therapeutic restorations in underprivileged schoolchildren with cavities. METHODS: We conducted a three-month pilot study comparing the adverse effects of IRT using glass ionomer cement (Fuji IX, GC America, Inc.) with those of 30% silver diamine fluoride (Cariostop Biodynamic®, Brazil) in 50 children aged 6 years. RESULTS: In the SDF group, all caries were arrested and no pain, abscess or fistula was reported. Of the children assigned to the Fuji IX group, 24% reported toothache (P < 0.05). There was no significant difference in the occurrence of fistula and abscess in the two groups. CONCLUSION: The authors suggest that for underprivileged schoolchildren with caries, the use of SDF when an appropriate clinical setting is not available resulted in fewer adverse effects than did treatment with an interim therapeutic restorative using FUJI IX.

OBJETIVO: O Diamino fluoreto de prata, uma solução de fácil aplicação e que não precisa de um ambiente clínico para o seu uso, é um agente de notável capacidade de paralisar e prevenir cárie. Outro método simples e eficaz para o tratamento da cárie em crianças são Restaurações provisórias. Este estudo examinou o surgimento de efeitos adversos em escolares tratadas com Diamino fluoreto de prata (DFP) comparado com aquelas tratadas com o Tratamento Restaurador Provisório. METODOLOGIA: Foi realizado um estudo piloto de três meses comparando os efeitos adversos das restaurações provisórias, utilizando cimento de ionômero de vidro Fuji IX (GC America, Inc.), com o Diamino fluoreto de prata a 30% (Cariostop Biodinâmica®, Brasil), em 50 crianças com 6 anos de idade. RESULTADOS: O grupo DFP teve todas as suas cáries paralisadas e não apresentou dor, abscesso ou fístula. Das crianças tratadas com Fuji IX, 24% delas relataram dor de dente (P < 0,05). Para fístula e abscesso, não foi verificado diferença estatisticamente significativa. CONCLUSÃO: Os autores sugerem que, para crianças portadoras de cárie, sem acesso aos serviços de saúde, o DFP apresentou menos efeitos adversos do que o tratamento restaurador provisório utilizando FUJI IX.