Silver and fluoride content and short-term stability of 38% silver diamine fluoride

Abstract

Background.-As silver diamine fluoride (SDF) gains popularity for caries arrest, the authors aimed to investigate the content of fluoride and silver in 38% SDF produced for the US market and its short-term stability. Methods.-Five samples of 38% SDF were evaluated when the bottle was first opened, and at 7 and 28 days. Fluoride concentrations were determined with a fluoride ion-selective electrode, and silver concentrations were determined with a simultaneous inductively coupled plasma mass spectrometer. pH was measured with a pH probe. Weight and volume of individual drops were measured. Results.-At day 0, 40% of individual measured values were above the expected fluoride concentration, and at day 28, 93% were above the expected fluoride concentration (P = .005). At day 0, 19% of individual measured values were below the lowest expected silver concentration, and at day 28, 93% were below (P < .001). Acidity (pH 10) was consistent over the 3 periods. Mean (standard deviation) weight of a drop was 40 (4.0) milligrams, and mean (standard deviation) volume was 32.55 (1.89) microliters, 30% more than the reported value of 25 μL. Conclusion.-Over 28 days, the product pH is stable, whereas the fluoride content tends to increase and the silver content tends to decrease. Drops were larger than expected when dispensed from the bottle.

Acidity, fluoride and silver ion concentrations in silver diamine fluoride solutions: a pilot study

“…12 In testing the stability of Ag in SDF, Crystal and colleagues found that the Ag content decreased over time and suggested that this may be due to silver precipitation from repeated bottle opening and testing. 11 However, the authors note that these changes would have little clinical consequence because the changes were relatively small. In comparison, the measured Ag concentrations in the present study were higher than the expected values across all samples, which may be due to the testing being carried out on new unopened bottles in which precipitation from solution has not yet occurred.…”

“…Free F and Ag ion concentrations in SDF solutions have been shown to vary over time. 11,12 Crystal and colleagues studied the stability of F and Ag in SDF solutions and found F concentrations to increase slightly over time due to water evaporation. In the present study, all samples tested exhibited a difference between measured and expected F concentrations.…”

Microbial population shift and metabolic characterization of silver diamine fluoride treatment failure on dental caries

“…All subjects with caries had small lesions into enamel and dentin and confined to a single surface only. Infection was treated using a standardized amount of SDF (single drop); an average drop of SDF measuring 32.5 mL consists of approximately 1.64 to 1.75 mg of fluoride and 8.08 to 8.71 mg of silver [ 21 ].…”

The antibacterial efficacy of silver diamine fluoride (SDF) is not modulated by potassium iodide (KI) supplements: A study on in-situ plaque biofilms using viability real-time PCR with propidium monoazide

“…The major drawback to SDF treatment has been the black residual stain, which has limited its use particularly in the aesthetic region of the dentition. This has been a major concern for patients from the pediatric population as well as their parents, especially in the case of ECC management [ 11 , 32 ]. Therefore, to overcome the staining phenomenon, and to increase patient acceptance, application of KI immediately after SDF application has been suggested [ 17 ].…”

“…SDF was first used in Japan, in the late 1960s, for the specific purpose of caries management. However, until the beginning of the 21 st century it did not gain much popularity, due to its staining properties of the dental tissues subjacent to the carious lesion, and questions related to toxicity [ 11 ]. Nevertheless in 2014 SDF was finally approved by the US Food and Drug Administration authority as a class II medical device [ 12 ].…”