Fluoride Concentration in SDF Commercial Products and Their Bioavailability with Demineralized Dentine

Abstract

The aim of this in vitro study was to determine the fluoride concentration in silver diamine fluoride (SDF) products and their bioavailability with demineralized dentine. The products evaluated (expected fluoride concentrations) were: I: Saforide 38% (45,283 ppm F); II: Advantage Arrest 38.3 to 43.2% (45,283 to 51,013 ppm F); III: Ancárie 12% (14,100 ppm F); IV: Ancárie 30% (35,400 ppm F), V: Cariestop 12% (14,100 ppm F) and VI: Cariestop 30% (35,400 ppm F). The fluoride concentration was evaluated using an ion-specific electrode (ISE) by direct technique, which was confirmed after microdiffusion. The pH of the products was determined with a pH test strip. For the bioavailability test, demineralized dentine slabs were treated with one of the products for 1 min. Loosely (CaF2-like) and firmly-bound fluoride (FAp) were determined. The fluoride concentration found in the products (mean±SD; ppm F) by the ISE direct technique was: I:53,491±554; II:57,249±1,851; III:4,814±268; IV:5,726±43; V:10,145±468; VI:11,858±575; these values were confirmed after microdiffusion (t-test; p>0.05) and disagree with the declared by the manufacturers. The pH of Ancárie 12 and 30% was 6.0 and 4.5, respectively, in disagreement with the alkaline pH expected for SDF solution and found in the other products evaluated. There was no correlation between either CaF2-like (r=0.221; p=0.337) or FAp (r=-0.144; p=0.830) formed in demineralized dentine and fluoride concentration found in the products. The problems of pH and fluoride concentration found in available professional commercial SDF products suggest that they are not under sanitary surveillance.

Effect of application time and concentration of silver diamine fluoride on the enamel remineralization

“…The concentration of the cariostatic agent evaluated in this study does not refer to the fluoride and silver ion concentrations but to the final concentration found in the commercial product ( 21 ). However, regarding the efficacy of SDF, factors such as the concentration of fluoride and silver ions are very important.…”

Response to ‘Letter to the Editor: Fluoride concentration in SDF commercial products’

“…The authors acknowledge the work of Soares-Yoshikawa and colleagues in this area who found similar discrepancies between manufacturer-claimed concentrations and measured concentrations for Advantage Arrest and CarieStop 30%, as tested in this study. 2 As discussed in our pilot study, these variations in concentration may be attributed to several factors ranging from transport and handling, variations in manufacturing standards through to the instability of F-and Ag concentrations in solution over time. 3,4 Although solutions registered in the USA such as Advantage Arrest, may be more closely regulated by organizations such as the FDA, this may not be the case for other solutions that are available and used globally or indeed solutions that may be used off-label for caries management such as Riva Star in Australia.…”

Clinical and primary evidence of silver diamine fluoride on root caries management

“…Recently, a 38% SDF product equivalent to Saforide (named Advantage Arrest) has been launched in the US market, while lower concentrations of 12% and 30% SDF products are marketed in Brazil [ 38 ]. The SDF at 38% seems effective in arresting dentine caries [ [38] , [39] , [40] ].…”

“…Recently, a 38% SDF product equivalent to Saforide (named Advantage Arrest) has been launched in the US market, while lower concentrations of 12% and 30% SDF products are marketed in Brazil [ 38 ]. The SDF at 38% seems effective in arresting dentine caries [ [38] , [39] , [40] ]. The 38% SDF solution contains high concentrations of silver (253,900 ppm) and fluoride (44,800 ppm F) with the pH being between 10 and 12.…”