Primary Coronal Caries Prevention with Silver Diamine Fluoride – Investigations into Efficacy and Mode of Action

Abstract

Dental caries continues to be one of the most prevalent preventable diseases worldwide. Silver diamine fluoride (SDF) is a topical solution comprised of silver, ammonia and fluoride. It is a safe, effective, efficient, noninvasive and cost-effective method in caries management. However, there is little clinical evidence supporting the use of SDF (or SDF followed by application of potassium iodide[KI] to mitigate staining) as anti-caries agents on sound enamel and early enamel carious lesions. In this dissertation, I studied the mechanism behind SDF’s ability to prevent coronal caries which has not been studied yet. In the first and second aims, I investigated the effectiveness of SDF, SDF+KI, fluoride (potassium fluoride [KF]) and silver (silver nitrate [AgNO3]) controls to SDF and deionized water (DIW) in preventing enamel demineralization and enhancing remineralization using chemical, biofilm and pH-cycling models. In both chemical demineralization and pH-cycling models there were no statistically significant differences between SDF and SDF+KI in preventing coronal caries. In the biofilm model, however, SDF+KI was significantly less effective in preventing demineralization than SDF. In the third aim, I investigated the efficacy of SDF, SDF+KI, KF, AgNO3, and DIW on the remineralization of active subclinical enamel carious lesions. Here, SDF+KI was significantly more effective in promoting remineralization than SDF. I calculated changes in color, and the results show applying KI after SDF significantly reduced the dark staining caused by SDF. In conclusion: SDF and SDF+KI appear to be effective options in preventing and in the treatment of primary coronal caries. Further clinical research is required to confirm the present findings.