Short term serum pharmacokinetics of diammine silver fluoride after oral application

Abstract

BackgroundThere is growing interest in the use of diammine silver fluoride (DSF) as a topical agent to treat dentin hypersensitivity and dental caries as gauged by increasing published research from many parts of the world. While DSF has been available in various formulations for many years, most of its pharmacokinetic aspects within the therapeutic concentration range have never been fully characterized.MethodsThis preliminary study determined the applied doses (3 teeth treated), maximum serum concentrations, and time to maximum serum concentration for fluoride and silver in 6 adults over 4 h. Fluoride was determined using the indirect diffusion method with a fluoride selective electrode, and silver was determined using inductively coupled plasma-mass spectrometry. The mean amount of DSF solution applied to the 3 teeth was 7.57 mg (6.04 μL).ResultsOver the 4 hour observation period, the mean maximum serum concentrations were 1.86 μmol/L for fluoride and 206 nmol/L for silver. These maximums were reached 3.0 h and 2.5 h for fluoride and silver, respectively.ConclusionsFluoride exposure was below the U.S. Environmental Protection Agency (EPA) oral reference dose. Silver exposure exceeded the EPA oral reference dose for cumulative daily exposure over a lifetime, but for occasional use was well below concentrations associated with toxicity. This preliminary study suggests that serum concentrations of fluoride and silver after topical application of DSF should pose little toxicity risk when used in adults.Clinical trials registrationNCT01664871.

A randomized clinical trial on arresting dentine caries in preschool children by topical fluorides—18 month results

“…Regarding the potential risk associated with silver ingestion, preliminary data in adults showed that occasional use of SDF was well below the concentration associated with toxicity. 27 However, without data on young children, this possibility cannot be excluded and one needs to pay attention to the safety aspect when applying high concentration fluoride and silver agents to young children.…”

Evidence-Based Dentistry Update on Silver Diamine Fluoride

“…Investigators who have conducted many of the clinical trials cited herein 60 have recommended that, although the amount of SDF applied is minute, precautions should be taken and multiple and frequent applications on young children should be avoided. The only study that reported on the pharmacokinetics of SDF after oral application 61 was done on only 6 adults over a period of 4 hours using 6 mL (about one-fifth of a drop) to treat 3 teeth on each subject. Their conclusion was that serum concentrations of fluoride and silver should pose little toxicity risk when used only occasionally in adults.…”

Silver deposition on demineralized dentine surface dosed by silver diammine fluoride with different saliva

“…Silver diammine fluoride (SDF) is known to be an effective topical agent to treat dental caries and dentine hypersensitivity . There is a growing interest in the use of and understanding how SDF works, as gauged by increasing dental research publications . SDF was reported to react with principle components of tooth tissue (hydroxyapatite and gelatin) to form metallic silver and soluble CaF 2.…”

“…Thus, with the properties of higher sensitivity and better reliability, ICP‐MS has gained popularity in analytical science. In dentistry, until recently, the ICP‐MS technique was reported to detect the serum concentration of silver after 38 wt% SDF application to determine the safety dose …”