Unexpected sequel to the application of silver fluoride followed by stannous fluoride to an open carious lesion in a primary molar: A case report.

OBJECTIVES: The use of silver fluoride followed by stannous fluoride was designed for the treatment of open carious lesions in primary molars in dental outreach programs. However, during the COVID-19 pandemic when aerosol-producing procedures were inadvisable, one dental location started using it as the first stage in a two-visit restorative procedure for carious primary molars. If the gap between the fluoride application and the restoration placement stages was around 3-5 weeks it was noticed that a black friable crust appeared on the caries surface. To investigate further a normally discarded crust from one patient was retrieved and sent for analysis. MATERIALS AND METHODS: Two techniques suitable for identification and preliminary analysis of material of unknown composition, scanning electron microscopy and energy dispersive spectroscopy (EDS) were used. The only preparation was that the specimen was dried and coated beforehand. RESULTS AND CONCLUSIONS: This preliminary examination showed two unexpected findings. The first was that the crust surface indicated a possible dentine derivation as it was covered with reasonably evenly spaced holes. In addition, the EDS spectrum showed it to be, at least, partially mineralized. The second unexpected finding was that the surface was coated with electron-dense particles. The size of the particles and the EDS spectrum pointed to the likelihood of the majority of them being nanosilver. These unexpected findings suggest a possible new direction for research.

Unexpected sequel to silver fluoride followed by stannous fluoride treatment of root stumps supporting an overlay denture in an aged-care patient.

An institutionalized high care dementia patient, who is unable to maintain his own oral health, presented with five lower anterior carious root stumps supporting a lower overlay denture. Due to limited cooperation, his root stumps were treated with only silver fluoride followed by stannous fluoride applied topically on a 4-monthly cycle. Almost one and a half years after his initial application, there were unexpected calculus formations on the root stumps accompanied by marked gingival inflammation and gingival hyperplasia. At this point prognosis was considered very poor. Because the patient's cooperation was so poor, no attempt was made to remove the calculus deposits. Following continued topical applications directly to the area, there was evidence of a marked and unexpected improvement in gingival health. Some 4 years and 4 months after the initial application, the root stumps demonstrated a hard glossy surface surrounded by healthy gingival tissue. There had been no change in the patient's oral care, minor changes to medications and there had been no operative or periodontal interventions.

Clinical evaluation of a modified silver fluoride application technique designed to facilitate lesion assessment in outreach programs.

BACKGROUND: An advantage of using silver fluoride treatments for carious primary teeth in outreach programs especially where dental resources are limited is that the treatments can be carried out by dental auxiliaries. One limitation to date is that assessments of lesion status have been based on a tactile test where a sharp probe or explorer is drawn across the surface of a lesion to assess its hardness. This is a technique-sensitive step and has the potential for iatrogenic damage, especially when a lesion is deep. This study was undertaken to determine whether an alternative, non-invasive, visual assessment could be a reliable indicator of lesion status. The approach was based on the retention, or otherwise, of a black surface deliberately created at the time of initial treatment. METHODS: A total of 88 lesions in the primary molars of 45 children, aged 5 to 10 years, were treated with a one-minute application of 40% silver fluoride. The surface of the lesions was then deliberately turned black by the application of 10% stannous fluoride as a reducing agent. All lesions were on an approximal or occlusal surface of a first or second primary molar. The presence or absence of a continuous black surface at 6 months and any changes in radiographic depth that had occurred in that period were determined from digitized photographs and bitewing radiographs. RESULTS: The retention of an uninterrupted black surface was associated with minimal or no caries progression whereas lesions with an incomplete or lost black surface were 4.6 times more likely to have progressed. Use of the Datta and Satten Rank-Sum Test to account for any clustering effect showed that the difference was statistically significant (p < 0.0001). The sensitivity and specificity of the approach were 80% and 81% respectively. CONCLUSION: The retention of a continuous black surface after the application of silver fluoride followed by a reducing agent on carious lesions in primary molars can provide a useful visual indicator of lesion progression and so be relevant for use in dental outreach programs.

Inability to form a biofilm of Streptococcus mutans on silver fluoride- and potassium iodide-treated demineralized dentin.

OBJECTIVE: The presence of a biofilm is necessary for both initiation and progression of dental caries. Silver-based preparations incorporated into, or applied onto, various materials designed for medical use have been shown to be effective in inhibiting biofilm formation. The purpose of this in vitro study was to measure whether a topical application of diamine silver fluoride (AgF) followed by potassium iodide (KI) on partially demineralized dentin affected the formation of a Streptococcus mutans biofilm. METHOD AND MATERIALS: Forty partially demineralized dentin disks were divided into 4 groups as follows: 10 disks as a control, 10 disks treated with AgF followed by KI, 10 disks treated with KI, and 10 disks treated with AgF. The outer surfaces of the disks were examined with a scanning electron microscope. Cross sections of the disks were subjected to electron probe microanalysis (EPMA) to determine the levels of calcium, phosphorous, silver, and fluoride in the dentin. RESULTS: An S mutans biofilm covered the entire exposed surfaces of all control and KI-treated disks. No discernible bacterial biofilm was detected on disks treated with AgF or AgF/KI. Detectable amounts of silver and fluoride were found up to 450 microm in the AgF and AgF/KI sections. CONCLUSIONS: Demineralized dentin disks treated with AgF and AgF/KI prevented the formation of an S mutans biofilm and were significantly more resistant to further demineralization than the control and KI-treated disks over the experimental period. The presence of silver and fluoride in the outer layers of the disks treated with AgF and AgF/KI was the likely cause of the prevention of biofilm formation. Additional studies are required before any clinical recommendations can be made.