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As the coronavirus disease-2019 pandemic outbreak continues to be a global public health concern, dentists should seek means to provide oral health care with minimal risk. To meet the recommendations of the Center for Disease Control, alternative non-aerosol generating techniques have been proposed to minimize the risk of disease transmission to patients and dental healthcare personnel. Among recent materials, silver diammine fluoride (SDF) has been shown to be effective in preventing and arresting caries. This along with an atraumatic restorative treatment with glass ionomer cements (GICs) makes it a potentially attractive adjunctive therapy for caries management in pediatric patients. In this technique, SDF is applied over carious tissue and the lesion is restored with auto-polymerizing GIC. This review article aims to provide a practical background and clinical guide for the application of silver-modified atraumatic restorative technique (SMART) as a safe way to provide dental services to children during the pandemic.

Objective: The aim of this study was to determine how well 38% SDF and 5% NaF varnish inhibited primary molar decay. Materials and Methods: 84 children between the ages of 6 and 9 who had caries without pulpal involvement in their primary teeth were included in the randomized controlled experiment. Children were divided between two groups at random. 5% NaF varnish was applied to Group 1 (n = 42), and 38% SDF was applied to Group 2 (n = 42). In both groups, the second application was completed six months later. Children were examined for caries arrest and recalled at 6- and 12-month. Results: After 6-month intervals, the rate of caries arrest was in group 1(NaF varnish – 40.4%) while in group 2 (SDF – 66.6%) and after 12-month intervals the rate of caries arrest was (NaF varnish – 47.6%) for group 1 and (SDF- 88%) for group 2 (p<0.05). Conclusion: The SDF group was shown to have higher caries arresting potential than the NaF varnish group.

This study assessed the remineralization efficacy of a novel agent that contains silver-loaded metal-organic frameworks with fluoride (Ag@MOF/F) on dentin surface of primary teeth. Ag@MOF/F was prepared and characterized by scanning electron microscopy (SEM). The dentin surfaces of 104 sound primary canine were demineralized for 4 days and randomly divided into four groups ( n  = 26/group): (1) 400 ppm Ag@MOF/F, (2) 1400 ppm Ag@MOF/F, (3) 38% silver diamine fluoride (SDF), and (4) 5% sodium fluoride (NaF). Topographic changes, depth of penetration, and crystal formation were evaluated by SEM, energy-dispersive spectroscopy (EDS), and X-ray diffraction (XRD), respectively. Vickers microhardness and spectrophotometry were used to assess surface hardness and discoloration of the samples. The 1400 ppm Ag@MOF/F group indicated greater depth of penetration and sharper hydroxyapatite peak than the SDF and NaF. The 1400 ppm Ag@MOF/F group had a significantly greater increase in surface and cross-sectional microhardness than the other groups ( P  < 0.001). The 400 ppm Ag@MOF/F and SDF groups showed similar recovery of microhardness ( P  = 0.913). SDF-treated specimens were significantly darker than the other groups ( P  < 0.05), whereas the Ag@MOF/F samples had minimal discoloration. Our results indicate that Ag@MOF/F can be an alternative for SDF in arresting dentin caries because of its enhanced remineralization property and minimal discoloration.

The aim of this systematic review was to provide an update on caries prevalence in older adults aged 60 years or above around the globe. Two independent reviewers performed a systematic literature search of English publications from January 2016 to December 2020 using Pubmed, Scopus, Embase/Ovid and Web of Science. The MeSH terms used were “dental caries”, “root caries”, “DMF index”, “aged” and “aged 80 and over”. Further searches in Google Scholar retrieved eight additional publications. The epidemiological surveys reporting the prevalence of dental caries or root caries or caries experience using DMFT (decayed, missing and filled teeth) and DFR (decayed and filled root) in older adults aged 60 years or above were included. Quality of the publications was assessed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. Among the 5271 identified publications, 39 articles of moderate or good quality were included. Twenty studies were conducted in Asia (China, India, Vietnam, Singapore and Turkey), ten in Europe (Ireland, Norway, Finland, Germany, Portugal, Poland, Romania and Kosovo), three in North America (USA and Mexico), one in South America (Brazil), two in Oceania (Australia) and three in Africa (Malawi, Egypt and South Africa). The prevalence of dental caries ranged from 25% (Australia) to 99% (South Africa), while the prevalence of root caries ranged from 8% (Finland) to 74% (Brazil) in community dwellers. The situation was even worse in institutionalised older adults of which the mean DMFT score varied from 6.9 (Malawi) to 29.7 (South Africa). Based on the included studies published in the last 5 years, caries is still prevalent in older adults worldwide and their prevalence varies across countries.

The synergistic effect of nanosilver fluoride (NSF) with L-arginine on early carious lesions was evaluated. NSF was synthesized from chitosan, acetic acid, silver nitrate, sodium borohydride, and sodium fluoride. NSF + Arg was synthesized by adding L-arginine. After demineralization the enamel slabs from extracted molar, remineralization agents were applied by randomly dividing them into five groups (n = 15): sodium fluoride varnish (NaF), silver diamine fluoride (SDF), NSF, NSF + Arg, and control. The surface microhardness (SMH), remineralization effects using microcomputed tomography and color changes using a spectrophotometer were measured before and after pH cycling. SMH was analyzed by Kruskal–Wallis test with Dunn’s test. Remineralization effects, and color changes were analyzed using the one-way analysis of variance with Duncan’s test; p-value < 0.05 was considered significant. SMH recovered to similar levels in all groups ( p  > 0.05), except in the control group after pH cycling. The NSF + Arg and SDF groups showed a higher remineralization than the NaF and NSF groups ( p  < 0.05). SDF caused the largest discoloration ( p  < 0.05). The other groups showed no difference in discoloration. NSF + Arg could be an alternative to SDF given its ability to remineralize early caries lesions without discoloration.

Objective: To evaluate the effectiveness of Silver Diamine Fluoride (SDF) as a conservative treatment for root caries, offering an alternative to more invasive restorative procedures. Study Design: Randomized Controlled Trial (ACTRN: 0000386513). Place and Duration of Study: Bakhtawar Amin Dental College, Multan, Pakistan, from Mar-Aug 2023. Methodology: The study enrolled 90 patients with caries lesions and assigned them to two groups: Group A received 38% SDF, and Group B received 5% NaF sodium fluoride varnish. Follow-up assessments were conducted at one month, evaluating caries arrest through clinical examinations. Results: The SDF group demonstrated a higher efficacy in caries arrest (78.12%) compared to NaF varnish (35.29%). Visual inspection, lesion size measurement, and texture assessment were crucial in determining the success of SDF application. Statistical analysis revealed a significant difference between the groups, having p-value of .000459, supporting the superior efficacy of SDF. Conclusion: Our study found that the 38% SDF is a better treatment option for root caries compared to NaF varnish, providing long-lasting effects.

ObjectivesThis study evaluated and compared the effect of silver diamine fluoride (SDF) and silver-modified atraumatic restorative treatment (SMART) sealants for the treatment of initial carious lesions of permanent molars affected by molar incisor hypomineralization (MIH).MethodsOne hundred and twelve hypomineralized permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF and SMART sealant groups (n = 56 teeth/group) in a split-mouth fashion. Hypersensitivity, formation of caries, and enamel breakdown were evaluated in both groups. Hypersensitivity was assessed by Schiff Cold Air Sensitivity Scale (SCASS), and clinical assessments of SMART sealants were performed according to modified USPHS criteria at 1, 6, and 12 months. The data were analyzed statistically using Fisher’s exact test, Kaplan–Meier analysis, Mann–Whitney U test, and Friedman test.ResultsTwenty-six hypomineralized molars with marked baseline hypersensitivity showed significantly lower SCASS scores at all evaluation periods (p < 0.001). There was no significant difference in hypersensitivity scores between the groups at the repeated applications of SDF at 1, 6, and 12 months. The cumulative survival rates of SMART sealants on occlusal and palatal surfaces were 88.7% and 58.8%, respectively.ConclusionsIn hypomineralized molars, both SDF and SMART sealants showed favorable short-term prevention against dental caries while providing effective desensitization. Marginal discoloration was the most common side effect of the SMART sealants as a result of SDF application.Clinical SignificanceBoth SDF and SMART sealants showed similar short-term effectiveness as non-aerosol procedures in arresting enamel caries and reducing hypersensitivity in hypomineralized molars.Trial registrationClinical Trials Registration Number: NCT03862014.

This research aimed to determine the difference in enamel hardness after the application of silver diamine fluoride and fluoride varnish on the surface of demineralized tooth. An in vitro true experimental research was conducted by collecting 27 maxillary premolars, which were separated into crowns and roots and divided into three groups (control, silver diamine fluoride, fluoride varnish). Demineralization was performed on all groups. Silver diamine fluoride remineralizing agent and fluoride varnish were applied for 3 min to the tooth enamel surface before the specimens were immersed in artificial saliva and placed in an incubator at 37 °C for 7 days. Tooth enamel hardness was measured using the MicroVickers hardness tester before demineralization, after demineralization, and after remineralization. The data analysis used in this research was one-way ANOVA with post hoc Tukey test for analyzing the differences in enamel hardness between groups and paired t-tests for analyzing the differences in enamel hardness in each group. The level of significance α was set at ≤ 0.05. All groups showed a significant increase in enamel hardness after remineralization ( p  < 0.05), with the highest mean value observed in the silver diamine fluoride group. Post hoc Tukey analysis revealed a significant difference between silver diamine fluoride and fluoride varnish groups ( p  < 0.05). There was a significant difference in enamel hardness between silver diamine fluoride and fluoride varnish post-application on the demineralized tooth surface. Silver diamine fluoride may be more effective option in managing early enamel demineralization and preventing the progression of caries.

Background Silver diamine fluoride (SDF) solution gains increasing popularity in arresting dentine caries in clinical practice. The aim of this systematic review was to summarize the findings from laboratory studies on the influence of SDF application on the bond strength of dentine to various adhesives and to glass ionomer cements (GICs). Methods Two independent reviewers conducted a literature search in the databases Medline, Ovid, PubMed and Web of Science until 15th August 2019 using the search keywords [‘bond strength’] AND [‘silver diamine fluoride’ OR ‘silver diammine fluoride’ OR ‘SDF’ OR ‘silver fluoride’ OR ‘diamine silver fluoride’]. Articles investigating the effect of SDF application on the bond strength of dentine to various adhesives and to GICs were included in this review. Information on how SDF application influenced the bond strength was extracted from the included articles. Besides, related information, e.g. test method of bond strength, concentration and brand of SDF, type of adhesive system and GIC, testing dental substrate, protocol of specimen preparation, and failure mode was also reviewed. Results A total of 13 articles were included in this review, with 8 and 6 studies investigating the effect of SDF application on the bond strength of dentine to various adhesives and to GICs, respectively. Sound dentine as well as demineralized dentine created by chemical methods, e.g. immersing in a demineralizing solution, was commonly adopted as the testing dental substrate. The microtensile bond strength (mTBS) test was the predominant method employed. However, the bond strength values had large variations among studies, ranging from <10 to 162 Mpa. Regarding the bond strength to different adhesives, 4 studies indicated that SDF application followed by rinsing with water had no significant influence. However, another 4 studies reported reduced bond strength after SDF application. Regarding the bond strength to GICs, 4 studies concluded that SDF application had no adverse impact on the bond strength. Conclusions No solid conclusion can be drawn on the effect of SDF application on the bond strength of dentine to adhesives and to GICs due to the high degree of variation of the included studies.

A systematic review and meta-analysis were carried out to evaluate the efficacy of silver diamine fluoride (SDF) in controlling caries progression in cavitated primary molars. A search for randomized and non-randomized trials with follow-up > 6 months was performed using PubMed, Scopus and Embase. The Cochrane risk of bias tools were used for the quality assessment. The success rate and odds ratios were chosen to calculate the effect size for the meta-analysis. A total of 792 papers were identified and 9 were selected. A high variability regarding SDF application protocol was found; otherwise, caries arrest was always recorded using visual/tactile methods. Two studies were judged at low risk of bias, six at moderate risk and one at high risk. Data from five studies were aggregated for meta-analysis. Heterogeneity was found moderate (I2 = 35.69%, p = 0.18). SDF application was found to be overall effective (fixed effect model) in arresting caries progression (ES = 0.35, p < 0.01). In a total of 622 arrested lesions, out of 1205 considered, the caries arrest rate was 51.62% ± 27.40% (Confidence = 1.55) using SDF ≥ 38% applied annually or biannually. In conclusion, when applied to active cavitated caries lesions in primary molars, SDF appears to be effective in arresting dental caries progression, especially if applied biannually.