Is Silver Diamine Fluoride Really a Magic Alternative in Pediatric Caries Management? : An Advanced Clinical Approach

Abstract Background: The microbiome of Severe-Early Childhood Caries (S-ECC), is characterized by an ecosystem comprising bacterial and fungal species, with a predominance of Candida species. Hence, an anti-cariogen effective against both bacteria and fungi would be valuable in the management of S-ECC. Here we evaluate the antifungal effect of silver diamine fluoride (SDF) against 35-clinical yeast isolates (Ten-each of C. albicans , C. krusei, C. tropicalis and five C. glabrata strains) from dentinal caries-lesions from S-ECC. Results: Disc-diffusion and time-kill assays as well as MIC 50 and MIC 90 evaluations against therapeutic concentrations confirmed the broad-spectrum anti-candidal potency of SDF. Ultrastructural images revealed morphologic aberrations of yeast-cell walls on exposure to SDF. All C. krusei and C. glabrata isolates were significantly more sensitive to SDF, relative to the standard antifungal fluconazole. Further, SDF appears to effectively abrogate filamentation of C. albicans even at very low concentrations. Conclusions: Our data, for the first time, elucidate the anti-candidal potency of SDF, in addition to its known antibacterial activity, in the management of S-ECC.

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Silver Diamine Fluoride: a critical review and treatment recommendations

Dental Update ◽

10.12968/denu.2019.46.7.626 ◽

2019 ◽

Vol 46 (7) ◽

pp. 626-632

Author(s):

Jilen Patel ◽

Robert P Anthonappa ◽

Nigel M King

Keyword(s):

High Risk ◽

Current Evidence ◽

Evidence Based ◽

Dental Practice ◽

Silver Diamine Fluoride ◽

Disadvantaged Populations ◽

Carious Lesions ◽

Caries Management ◽

High Risk Populations ◽

High Risk Children

Over the last decade there has been a renewed interest in the use of Silver Diamine Fluoride (SDF) as an adjunctive modality in the management of caries among high-risk populations. This review presents the current evidence behind the use of SDF and recommendations for its use in caries management dental practice. CPD/Clinical Relevance: Silver diamine fluoride is an effective, evidence-based modality that can contribute towards arresting carious lesions among high-risk children and disadvantaged populations.

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Silver fluoride as a treatment for the disease dental caries

10.1101/152207 ◽

2017 ◽

Author(s):

Jeremy A Horst ◽

Jong Seto

Keyword(s):

Dental Caries ◽

Primary Teeth ◽

The United States ◽

Permanent Tooth ◽

Invasive Treatment ◽

Silver Diamine Fluoride ◽

Tooth Structure ◽

Caries Management ◽

The Impact ◽

Threat To Life

ABSTRACTThe current paradigm of treatment for dental caries (tooth decay) in primary teeth is dangerous, fails to reach many children, and suffers high recurrence. Acceptance of the paradigm arises from a misperception that untreated caries in primary teeth is a threat to life. We show a linear relationship between age and deaths in the United States from 1999 through 2015 caused by dental caries, pulpal / periapical abscess, or facial cellulitis. The intercept of 6 years coincides with emergence of the first permanent tooth: it appears that caries in primary teeth is not a threat to life. Thus, treatment goals should be to avoid pain, which is not possible with operative dentistry, as it causes pain. Medical management of caries is a distinct treatment philosophy which employs topical minimally invasive therapies that treat the disease, and is not merely prevention. Silver diamine fluoride (SDF) is a central agent to enable effective non-invasive treatment. The announcement of FDA Breakthrough Therapy designation suggests that SDF will become the first FDA approved drug for treating the disease dental caries. Since our last review, 4 clinical trials have been completed, which inform an update to the application protocol and frequency regimen. Suggestions from these studies are to skip the rinsing step due to demonstration of safety and concern of diminished effectiveness by dilution, and to start patients with an intensive regimen of multiple applications over the first few weeks. Breakthroughs in elucidating the impact of SDF on tooth structure and the plaque microbiome inform potential opportunities for bioengineering and understanding caries arrest, respectively. Dentists have been surprised by preference of this treatment over traditional invasive approaches. Renewed interest in this old material has delivered progress to optimize the judicious use of SDF, and enable a revolution in caries management – particularly for primary teeth.ONE SENTENCE SUMMARYAnesthesia is inappropriate for first-line treatment of early childhood caries now that safe topical treatments such as silver diamine fluoride are available.

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Silver diamine fluoride as a minimally invasive and aerosol free approach in pediatric dentistry: An extensive case series

Contemporary Pediatric Dentistry ◽

10.51463/cpd.2021.51 ◽

2021 ◽

Vol 2 (2) ◽

pp. 42-54

Author(s):

Abhishek Soni ◽

Sanchit Paul ◽

Priyanka Sachdeva

Keyword(s):

Minimally Invasive ◽

Outcome Measure ◽

Age Groups ◽

Case Series ◽

Pediatric Dentistry ◽

Permanent Teeth ◽

Secondary Outcome ◽

Clinical Approach ◽

Secondary Outcome Measure ◽

Silver Diamine Fluoride

The current pandemic of COVID-19 warrants a repeal from conventional dentistry to an aerosol free, minimally invasive yet maximally effective clinical approach. Silver diamine fluoride (SDF) is an established modality for caries arrest in children fulfilling all the above. This extensive 25 case series highlights various clinical situations in which SDF was successfully used in children between 1-12 years of age with asymptomatic carious lesions of ICDAS score 2 or more in primary and permanent teeth. Primary outcome measure was caries arrest in the form of the hard and shiny lesion with no/minimal sensitivity. The secondary outcome measure was the zombie effect which was the residual staining on other tooth surfaces and indications of substantivity. SDF can be effectively and efficaciously used across different behaviour patterns and age groups of children in a various clinical scenario for both primary and permanent teeth routinely experienced in a paediatric dental office especially during these pandemic times with minimal aerosol generation.

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Parents’ Views on Silver Diamine Fluoride to Manage Early Childhood Caries

JDR Clinical & Translational Research ◽

10.1177/2380084420930690 ◽

2020 ◽

pp. 238008442093069

Author(s):

G. Kyoon-Achan ◽

R.J. Schroth ◽

H. Martin ◽

M. Bertone ◽

B.A. Mittermuller ◽

...

Keyword(s):

Early Childhood ◽

Informed Consent ◽

Qualitative Study ◽

Early Childhood Caries ◽

Study Data ◽

Silver Diamine Fluoride ◽

Anterior Teeth ◽

Caries Management ◽

Caries Lesions ◽

Childhood Caries

Background: The use of silver diamine fluoride (SDF) as a nonsurgical caries management product is growing. Evidence suggests that SDF is very successful in arresting caries. However, a common concern with SDF treatment is the unaesthetic black staining. The purpose of this qualitative study was to determine parents’ views following their children’s treatment with SDF to manage severe early childhood caries (ECC). Method: Parents were interviewed as part of a mixed-method study of SDF to arrest severe ECC. Children with caries lesions in primary teeth were treated with 2 applications of 38% SDF, followed by fluoride varnish. Semistructured in-person and phone interviews were conducted with 19 parents of children in the study. Data were transcribed verbatim and manually coded and uploaded to NVivo 12 for further coding analysis. Results: None of the parents had previously heard about SDF, and they learned about it from the study dentist. Although parents trusted the dentist’s information on SDF, they welcomed additional evidence, especially relating to product safety and effectiveness. Some parents were minimally concerned with the black staining caused by SDF treatment. It was more important that SDF arrested caries progression, minimized pain and sensitivity, and prevented dental infection. However, some parents expressed concerns related to the unaesthetic black staining. Interestingly, many parents indicated that their children were not overly concerned with the black staining. A majority of parents said that they would recommend the treatment to others. Conclusion: This is the first qualitative study involving parents of children who were treated with SDF. Most parents were accepting of SDF as a nonsurgical treatment to arrest caries and minimize dentinal sensitivity secondary to caries, although some expressed concern about the black staining in anterior teeth. It is important to adequately inform parents of the negative aesthetic consequences and obtain informed consent before treatment. Knowledge Transfer Statement: This qualitative study revealed that many parents of children with severe ECC are accepting of SDF as a nonrestorative caries management option, despite the black staining of caries lesions. Dental professionals need to be aware of these parental concerns and obtain written informed consent prior to treatment. Parents also requested more information and resources on SDF on its benefits, effectiveness, and any associated risks.

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Silver diamine fluoride (SDF) used in childhood caries management has potent antifungal activity against oral Candida species

BMC Microbiology ◽

10.1186/s12866-020-01776-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Kausar Sadia Fakhruddin ◽

Hiroshi Egusa ◽

Hien Chi Ngo ◽

Chamila Panduwawala ◽

Siripen Pesee ◽

...

Keyword(s):

Antifungal Activity ◽

Candida Species ◽

Silver Diamine Fluoride ◽

Caries Management ◽

Oral Candida ◽

Childhood Caries

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Silver diamine fluoride - Magic alternative in caries management: A review

Journal of Dental Specialities ◽

10.18231/j.jds.2020.012 ◽

2021 ◽

Vol 8 (2) ◽

pp. 47-51

Author(s):

Pallavi Anand ◽

Pulkit Jhingan ◽

Manvi Malik ◽

Shivani Mathur ◽

Vinod Sachdev

Keyword(s):

Minimally Invasive ◽

Potassium Iodide ◽

Age Groups ◽

Caries Prevention ◽

Silver Diamine Fluoride ◽

Form And Function ◽

Commercial Use ◽

Caries Management ◽

And Function ◽

Dentinal Hypersensitivity

Silver diamine fluoride (SDF) is a clear and odorless liquid used for dentinal hypersensitivity and arresting caries unless there’s no pulpal involvement for all age groups across all countries. Discoveries let us change old paradigms with the new ones. SDF being cleared for commercial use now can help in achieving the all-time goal of caries prevention. Various studies have established that options like potassium iodide and different restorations can help mask the staining problem of SDF. This can restore form and function as well for the teeth. With the unimaginable COVID 19 situation, dentistry has realized the importance of minimally invasive interventions than ever before. SDF is a blessing in such challenging times and it may be the magical alternative to caries management in the future.

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Silver diamine fluoride (SDF) used in childhood caries management has potent antifungal activity against oral Candida species

10.21203/rs.2.17219/v2 ◽

2020 ◽

Author(s):

Kausar Sadia Fakhruddin ◽

Lakshman Samaranayake ◽

Hiroshi Egusa ◽

Hien Chi Ngo ◽

Venkatachalam Thenmozhi ◽

...

Keyword(s):

Candida Species ◽

Fungal Species ◽

Silver Diamine Fluoride ◽

Low Concentrations ◽

Caries Management ◽

Bacteria And Fungi ◽

Oral Candida ◽

Time Kill ◽

First Time ◽

Childhood Caries

Abstract Background: The microbiome of Severe-Early Childhood Caries (S-ECC), is characterized by an ecosystem comprising bacterial and fungal species, with a predominance of Candida species. Hence, an anti-cariogen effective against both bacteria and fungi would be valuable in the management of S-ECC. Methods : Here we evaluate the antifungal effect of silver diamine fluoride (SDF) against 35-clinical yeast isolates (Ten-each of C. albicans , C. krusei, C. tropicalis and five C. glabrata strains) from dentinal caries-lesions from S-ECC. Results: Disc-diffusion and time-kill assays as well as MIC 50 and MIC 90 evaluations against therapeutic concentrations confirmed the broad-spectrum anti-candidal potency of SDF. Ultrastructural images revealed morphologic aberrations of yeast-cell walls on exposure to SDF. All C. krusei and C. glabrata isolates were significantly more sensitive to SDF, relative to the standard antifungal fluconazole. Further, SDF appears to effectively abrogate filamentation of C . albicans even at very low concentrations. Conclusions: Our data, for the first time, elucidate the antifungal potency of SDF, in addition to its known antibacterial activity, in the management of S-ECC.

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Global Oral Health Policies and Guidelines: Using Silver Diamine Fluoride for Caries Control

Frontiers in Oral Health ◽

10.3389/froh.2021.685557 ◽

2021 ◽

Vol 2 ◽

Author(s):

Sherry Shiqian Gao ◽

Gwendolyn Amarquaye ◽

Peter Arrow ◽

Kalpana Bansal ◽

Raman Bedi ◽

...

Keyword(s):

Oral Health ◽

Dental Caries ◽

Young Children ◽

Large Scale ◽

Virus Transmission ◽

Relevant Information ◽

The United States ◽

Fluoride Ions ◽

Silver Diamine Fluoride ◽

Caries Management

Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is a clear solution containing silver and fluoride ions. Because of its anti-bacterial and remineralizing effect, silver diamine fluoride has been used in managing dental caries for decades worldwide. This paper aims to summarize and discuss the global policies, guidelines, and relevant information on utilizing SDF for caries management. SDF can be used for treating dental caries in most countries. However, it is not permitted to be used in mainland China. Several manufacturers, mainly in Australia, Brazil, India, Japan, and the United States, produce SDF at different concentrations that are commercially available around the world. The prices differ between contents and brands. Different government organizations and dental associations have developed guidelines for clinical use of SDF. Dental professionals can refer to the specific guidelines in their own countries or territories. Training for using SDF is part of undergraduate and/or postgraduate curriculums in almost all countries. However, real utilization of SDF of dentists, especially in the private sector, remains unclear in most places because little research has been conducted. There are at least two ongoing regional-wide large-scale oral health programs, using SDF as one of the components to manage dental caries in young children (one in Hong Kong and one in Mongolia). Because SDF treatment does not require caries removal, and it is simple, non-invasive, and inexpensive, SDF is a valuable strategy for caries management in young children, elderly people, and patients with special needs. In addition, to reduce the risk of bacteria or virus transmission in dental settings, using SDF as a non-aerosol producing procedure should be emphasized under the COVID-19 outbreak.

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Silver diamine fluoride (SDF) used in childhood caries management has potent antifungal activity against oral Candida species

10.21203/rs.2.17219/v1 ◽

2019 ◽

Author(s):

Kausar Sadia Fakhruddin ◽

Lakshman Samaranayake ◽

Hiroshi Egusa ◽

Hien Chi Ngo ◽

Venkatachalam Thenmozhi ◽

...

Keyword(s):

Candida Species ◽

Fungal Species ◽

Silver Diamine Fluoride ◽

Caries Management ◽

Bacteria And Fungi ◽

Oral Candida ◽

Time Kill ◽

First Time ◽

Caries Lesions ◽

Childhood Caries

Abstract Background The microbiome of Severe-Early Childhood Caries (S-ECC), is characterized by an ecosystem comprising bacterial and fungal species, with a predominance of Candida species. Hence, an anti-cariogen effective against both bacteria and fungi would be valuable in the management of S-ECC.Methods Here we evaluate the antifungal effect of silver diamine fluoride (SDF) against 35-clinical yeast isolates (Ten-each of C. albicans , C. krusei, C. tropicalis and five C. glabrata strains) from dentinal caries-lesions from S-ECC.Results Disc-diffusion and time-kill assays as well as MIC 50 and MIC 90 evaluations against therapeutic concentrations confirmed the broad-spectrum anti-candidal potency of SDF. Ultrastructural images revealed morphologic aberrations of yeast-cell walls on exposure to SDF. All C. krusei and C. glabrata isolates were significantly more sensitive to SDF, relative to the standard antifungal fluconazole.Conclusions Our data, for the first time, elucidate the antifungal potency of SDF, in addition to its known antibacterial activity, in the management of S-ECC.

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