Journal of South Asian Association of Pediatric Dentistry

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VOLUME 2 , ISSUE 2 ( July-December, 2019 ) > List of Articles


Silver Diamine Fluoride in Pediatric Dentistry

Sivakumar Nuvvula, Sreekanth Kumar Mallineni

Keywords : Caries arrest, Silver diamine fluoride, Silver modified atraumatic restorative technique

Citation Information : Nuvvula S, Mallineni SK. Silver Diamine Fluoride in Pediatric Dentistry. J South Asian Assoc Pediatr Dent 2019; 2 (2):73-80.

DOI: 10.5005/jp-journals-10077-3024

License: CC BY-NC 4.0

Published Online: 17-07-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Dental caries remains a severe oral health problem in children and its impact in terms of pain, impairment of function, and oral health-related quality of life of the population is high, especially the disadvantaged individuals and communities. Despite the widespread use of fluoride dentifrice, preschool children, compared to the other age groups, still show a high number of untreated caries lesions. Minimal and noninvasive approaches for the management of dental caries are preferred currently, in lieu of the conventional approaches. Though not new, silver diamine fluoride (SDF) had recently gained attention by clinicians globally due to its effectiveness in arresting the progression of carious lesions. Silver diamine fluoride allows a more conservative tooth preparation as it has been shown to arrest remaining decay, remineralize, and harden leathery dentin leading to the dark color change. Silver diamine fluoride is applied directly to carious lesions to arrest and prevent dental caries. Since the management of dental caries with SDF is noninvasive and much comfortably performed, it can be a favorable means to treat dental caries in children. The present review is an insight into the use of SDF in pediatric dentistry and its clinical significance based on the published literature.

  1. Pitts N, Amaechi B, Niederman R, Global oral health inequalities: dental caries task group-research agenda. Adv Dent Res 2011;23(2):211–220. DOI: 10.1177/0022034511402016.
  2. dos Santos AP, Nadanovsky P, de Oliveira BH. A systematic review and meta-analysis of the effects of fluoride toothpastes on the prevention of dental caries in the primary dentition of preschool children. Community Dent Oral Epidemiol 2013;41(1):1–12. DOI: 10.1111/j.1600-0528.2012.00708.x.
  3. Duangthip D, Ming J, Chu CH, et al. Nonsurgical treatment of dentin caries in preschool children – systematic review. BMC Oral Health 2015;15:44. DOI: 10.1186/s12903-015-0033-7.
  4. Dye BA, Hsu KL, Afful J. Prevalence and measurement of dental caries in young children. Pediatr Dent 2015;37(3):200–216.
  5. Yee R, Holmgren C, Mulder J, et al. Efficacy of silver diamine fluoride for arresting caries treatment. J Dent Res 2009;88(7):644–647. DOI: 10.1177/0022034509338671.
  6. Meyer BD, Lee JY, Lampiris LN, et al. “They Told Me to Take Him Somewhere Else:” caregivers’ experiences seeking emergency dental care for their children. Pediatr Dent 2017;39(3):209–214.
  7. Peng JJ, Botelho MG, Matinlinna JP. Silver compounds used in dentistry for caries management: a review. J Dent 2012;40(7):531–541. DOI: 10.1016/j.jdent.2012.03.009.
  8. Frencken JE, Peters MC, Manton DJ, et al. Minimal intervention dentistry for managing dental caries - a review: report of a FDI task group. DOI: Int Dent J 2012;62(5):223–243. DOI: 10.1111/idj.12007.
  9. Lehmann M, Veitz-Keenan A, Matthews AG, et. al. Dentin caries activity in early occlusal lesions selected to receive operative treatment: findings from the practitioners engaged in applied research and learning (PEARL) network. J Am Dent Assoc 2012;143(4):377–385. DOI: 10.14219/jada.archive.2012.0180.
  10. Gao SS, Zhang S, Mei ML, et al. Caries remineralisation and arresting effect in children by professionally applied fluoride treatment—a systematic review. BMC Oral Health 2016;16:12. DOI: 10.1186/s12903-016-0171-6.
  11. Oliveira BH, Rajendra A, Veitz-Keenan A, et al. The effect of silver diamine fluoride in preventing caries in the primary dentition: a systematic review and meta-analysis. Caries Res 2019;53(1):24–32. DOI: 10.1159/000488686.
  12. Rosenblatt A, Stamford TC, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet”. J Dent Res 2009;88(2):116–125. DOI: 10.1177/0022034508329406.
  13. Horst JA, Ellenikiotis H, Milgrom PL. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications, and consent. J Calif Dent Assoc 2016;44(1):16–28.
  14. Crystal YO, Niederman R. Evidence-based dentistry update on silver diamine fluoride. Dent Clin North Am 2019;63(1):45–68. DOI: 10.1016/j.cden.2018.08.011.
  15. Russell AD, Hugo WB. Antimicrobial activity and action of silver. Prog Med Chem 1994;31:351–370.
  16. Stebbins EA. What value has argenti nitras as a therapeutic agent in dentistry? Int Dent J 1891;12:661–670.
  17. Howe PR. A method of sterilizing and at the same time impregnating with a metal affected dentinal tissue. Dent Cosmos 1917;59(9):891–904.
  18. Craig GG, Powell KR, Cooper MH. Caries progression in primary molars: 24-month results from a minimal treatment programme. Community Dent Oral Epidemiol 1981;9(6):260–265. DOI: 10.1111/j.1600-0528.1981.tb00342.x.
  19. Nishino M, Yoshida S, Sobue S, et al. Effect of topically applied ammoniacal silver fluoride on dental caries in children. J Osaka Univ Dent Sch 1969;9:149–155.
  20. Yamaga R, Nishino M, Yoshida S, et al. Diammine silver fluoride and its clinical application. J Osaka Univ Dent Sch 1972;12:1–20.
  21. Llodra JC, Rodriguez A, Ferrer B, et al. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res 2005;84(8):721–724. DOI: 10.1177/154405910508400807.
  22. Burgess JO, Vaghela PM. Silver diamine fluoride: a successful anticarious solution with limits. Adv Dent Res 2018;29(1):131–134. DOI: 10.1177/0022034517740123.
  23. Mei ML, Chu CH, Lo EC, et al. Fluoride and silver concentrations of silver diammine fluoride solutions for dental use. Int J Paediatr Dent 2013;23(4):279–285. DOI: 10.1111/ipd.12005.
  24. Mei ML, Lo EC, Chu CH. Clinical use of silver diamine fluoride in dental treatment. Compend Contin Educ Dent 2016;37(2):93–98.
  25. eSDF-38% silver diamine fluoride. URL: last accessed on 22-08-2019 at 11-00 AM.
  26. Crystal YO, Marghalani AA, Ureles SD, et. al. Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatr Dent 2017;39(5):135–145.
  27. Slayton RL, Urquhart O, Araujo MWB, et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: a report from the American Dental Association. J Am Dent Assoc 2018;149(10):837–849. DOI: 10.1016/j.adaj.2018.07.002. e19.
  28. MacLean J. Clinical uses for silver diamine fluoride – oral health group. Available on URL:, last accessed on 28th July 2019 at 11.00 am IST.
  29. Chu CH, Lo EC. Promoting caries arrest in children with silver diamine fluoride: a review. Oral Health Prev Dent 2008;6(4):315–321.
  30. Burgette JM, Weintraub JA, Birken SA, et al. Development of a silver diamine fluoride protocol in safety net dental settings. J Dent Child (Chic) 2019;86(1):32–39.
  31. Suzuki T, Nishida M, Sobue S, et al. Effects of diammine silver fluoride on tooth enamel. J Osaka Univ Dent Sch 1974;14:61–72.
  32. Zhao IS, Gao SS, Hiraishi N, et. al. Mechanisms of silver diamine fluoride on arresting caries: a literature review. Int Dent J 2018;68(2):67–76. DOI: 10.1111/idj.12320.
  33. Chibinski AC, Wambier LM, Feltrin J, et al. Silver diamine fluoride has efficacy in controlling caries progression in primary teeth: a systematic review and meta-analysis. Caries Res 2017;51(5):527–541. DOI: 10.1159/000478668.
  34. Chu CH, Lo EC, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese preschool children. J Dent Res 2002;81(11):767–770. DOI: 10.1177/0810767.
  35. Zhi QH, Lo EC, Lin HC. Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. J Dent 2012;40(11):962–967. DOI: 10.1016/j.jdent.2012.08.002.
  36. dos Santos Jr VE, de Vasconcelos FM, Ribeiro AG, et al. Paradigm shift in the effective treatment of caries in schoolchildren at risk. Int Dent J 2012;62(1):47–51. DOI: 10.1111/j.1875-595X.2011.00088.x.
  37. Duangthip D, Chu CH, Lo ECM. A randomized clinical trial on arresting dentine caries in preschool children by topical fluorides—18 month results. J Dent 2016;44:57–63. DOI: 10.1016/j.jdent.2015.05.006.
  38. Duangthip D, Wong MCM, Chu CH, et al. Caries arrest by topical fluorides in preschool children: 30-month results. J Dent 2018;70:74–79. DOI: 10.1016/j.jdent.2017.12.013.
  39. Fung MHT, Duangthip D, Wong MCM, et al. Randomized clinical trial of 12% and 38% silver diamine fluoride treatment. J Dent Res 2018;97(2):171–178. DOI: 10.1177/0022034517728496.
  40. Contreras V, Toro MJ, Elias-Boneta AR, et al. Effectiveness of silver diamine fluoride in caries prevention and arrest: a systematic literature review. Gen Dent 2017;65(3):22–29.
  41. Braga MM, Mendes FM, De Benedetto MS, et al. Effect of silver diamine fluoride on incipient caries lesions in erupting permanent first molars: a pilot study. J Dent Child (Chic) 2009;76(1):28–33.
  42. Monse B, Heinrich-Weltzien R, Mulder J, et al. Caries preventive efficacy of silver diammine fluoride (SDF) and ART sealants in a school-based daily fluoride toothbrushing program in the Philippines. BMC Oral Health 2012;12:52. DOI: 10.1186/1472-6831-12-52.
  43. Liu BY, Lo EC, Chu CH, et al. Randomized trial on fluorides and sealants for fissure caries prevention. J Dent Res 2012;91(8):753–758. DOI: 10.1177/0022034512452278.
  44. Knight GM, McIntyre JM. The effect of silver fluoride and potassium iodide on the bond strength of autocure glass ionomer cement to dentine. Aus Dent J 2006;51(1):42–45. DOI: 10.1111/j.1834-7819.2006.tb00399.x.
  45. Yamaga M, Koide T, Hieda T. Adhesiveness of glass ionomer cement containing tannin-fluoride preparation (HY agent) to dentin—an evaluation of adding various ratios of HY agent and combination with application diamine silver fluoride. Dent Mater J 1993;12(1):36–44. DOI: 10.4012/dmj.12.36.
  46. Mei ML, Zhao IS, Ito L, et al. Prevention of secondary caries by silver diamine fluoride. Int Dent J 2016;66(2):71–77. DOI: 10.1111/idj.12207.
  47. McDonald SP, Sheiham A. A clinical comparison of non-traumatic methods of treating dental caries. Int Dent J 1994;44(5):465–470.
  48. Shah SG, Bhaskar V, Chawla S, et al. Efficacy of silver diamine fluoride as a topical fluoride agent compared to fluoride varnish and acidulated phosphate fluoride gel: an in vivo study. J Pediatr Dent 2014;2:5–12. DOI: 10.4103/2321-6646.130376.
  49. Vasquez E, Zegarra G, Chirinos E, et. al. Short term serum pharmacokinetics of diammine silver fluoride after oral application. BMC Oral Health 2012;12:60. DOI: 10.1186/1472-6831-12-60.
  50. Gotjamanos T. Pulp response in primary teeth with deep residual caries treated with silver fluoride and glass ionomer cement. Aust Dent J 1996;41(5):328–334. DOI: 10.1111/j.1834-7819.1996.tb03142.x.
  51. Sayed M, Matsui N, Hiraishi N, et al. Effect of glutathione bio-molecule on tooth discoloration associated with silver diammine fluoride. Int J Mol Sci 2018;19(5):E1322. DOI: 10.3390/ijms19051322.
  52. McConnachie I, Friedman CS, Abrams SA. Silver diamine fluoride: a new tool against caries or a game changer? J Ontario Dent Assoc 2018;95:36–40.
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