Assessment of the Silver Penetration and Distribution in Carious Lesions of Deciduous Teeth Treated with Silver Diamine Fluoride

Abstract

The aim of this study was to determine the effects of 38% silver diamine fluoride (SDF) on carious lesions of human deciduous teeth. Ten extracted deciduous incisors with caries were collected and treated with SDF. After the treatment, the teeth were sectioned through the center of the carious lesion. The extent of sliver precipitation was examined using quantitative backscattered electron scanning electron microscopy (qBSE-SEM), energy-dispersive X-ray spectroscopy (EDX), and micro-computed tomography (micro-CT). The qBSE-SEM images revealed that the silver particles could penetrate through the pellicle complex, along with the rod sheaths into the demineralized enamel rods and the dentinal tubules, and form silver-enriched barriers surrounding the carious lesions at depths up to 2,490.2 μm (mean 744.7 ± 448.7 μm) within the dentinal tubules of the carious lesions, but less likely in the sound enamel. The EDX spectrum analysis revealed that carbon, oxygen, phosphorus, chlorine, silver, and calcium were the main elements detected in the lesions treated with SDF. Additionally, sodium, magnesium, aluminum, silicon, zinc, sulfur, and fluorine were detected as the minor elements within the SDF precipitation “zone.” The micro-CT analysis further showed that in the deep cavitated lesions, the silver precipitation could be observed in the pulp chamber. These findings provide new evidence defining the SDF mode of action for arresting caries and suggest that the application of a highly concentrated SDF solution on deciduous teeth should be used with caution for various carious lesions.

Shear bond strength and interfacial analysis of high-viscosity glass ionomer cement bonded to dentin with protocols including silver diammine fluoride

“…The presence of chlorine after SDF application, as demonstrated in groups 3 to 6, has also been demonstrated in a previous study [38]; possible explanations for this include the presence of chlorine in the product used, or contamination of the dentinal tubules by chloramine in which the tooth had been stored.…”

“…The present study did not examine the penetration depth of silver compounds into dentinal tubules. Previous studies of carious dentin have demonstrated a high standard deviation of the penetration depth [38,39]. This can be explained by variations in patient physiological parameters such as age and the type of dentine, resulting in a range of tubule diameters or orientations, depending on the area of the tooth examined.…”

The Use of Silver Diamine Fluoride in Pediatric Dentistry

“…This finding is corroborated by histological studies, which showed that carious deciduous dentin treated with 38% SDF exhibited hypermineralization of the intertubular dentin [58], with a higher content of calcium and phosphorus [59] and a few blocked tubules [58]. Beneath that hypermineralized region, the tubules had characteristics of normality.…”

Indigenous community members' views on silver diamine fluoride to manage early childhood caries

“…Many respondents said that they would require more information or research evidence on the safety of SDF before agreeing to have their child undergo such treatment. Although there is increasing evidence of the effectiveness and safety of SDF as a minimally invasive treatment to arrest ECC 13,36,37 and examples of successful intervention with such products in Indigenous children, 38 parents in this study nonetheless wanted more practical information and evidence in order to make informed choices on SDF. One study concluded that pediatric dentists' confidence in using SDF was correlated with how much knowledge they had of its efficacy.…”