Silver diamine fluoride (SDF) is a topical dental treatment that has been used for 50 years to arrest dental caries. It works by promoting remineralization of tooth enamel and inhibiting demineralization. SDF also has antibacterial properties and prevents degradation of dental collagen. It is effective for managing root caries in elderly patients and coronal caries in both children and adults. Although it causes black staining of treated lesions, SDF is an affordable, effective, and safe option for dental caries treatment that aligns with minimally invasive dentistry principles.

1. Silver Diamine
Fluoride [SDF]
Handling and Clinical Outcomes
Dr. Zohaib Khurshid
BDS, MRes, MDFTEd, MFGDP (UK)

2. • Silver diamine fluoride is an alkaline (pH-10), colorless topical agent containing silver and fluoride, which
has been used as a cariostatic agent for almost 50 years.
• SDF has been regarded as an efficient, affordable, effective, and safe cariostatic agent, whose application in
dental caries management complies with the concept of minimally invasive dentistry (MID).
• However, the black staining of the treated lesion is a major disadvantage of topical SDF treatment.
Introduction

3. Mode of Supply

4. Clinical Situations

5. 1) Management of root caries in the elderly
2) Management of coronal caries in adults
3) Management of coronal caries in children
Clinical Applications

6. Mode of Action of SDF
• Inhibition of demineralization of tooth
enamel
• Promotes remineralization of tooth
mineral, hydroxyapatite [HA].
• As a result, successfully fight caries.

7. Cariostatic mechanism of Silver Diamine Fluoride [SDF]
Cariostatic effects of silver diamine fluoride on dental mineral
• As CaF2 and Ag3PO4 are formed following topical SDF treatment, both Ca2+ and PO3-
4 released from demineralizing dental mineral
can be preserved.
• It has been reported that SDF-treated teeth could adsorb Ca2+ from a remineralization solution, and inhibit the Ca2+ release from
enamel treated with SDF when in demineralization solution.
Cariostatic effects of silver diamine fluoride on cariogenic bacteria
• SDF has strong antibacterial properties
• 38 wt.% SDF can reduce the amounts of bacteria in biofilms composed of cariogenic bacteria like S. mutans, Lactobacillus
acidophilus, and Actinomyces naeslundii
• It has been proposed that with high fluoride concentrations in SDF products, F can bind to bacterial cellular components and
influence the enzymes in charge of glycolysis, such as enolase and proton-extruding adenosine triphosphatase and leading to the
inhibition of biofilm formation.
Cariostatic effects of silver diamine fluoride on organic content of dentine
• SDF can inhibit the degradation of dentine collagen
• SDF can inhibit the proteolytic activities of matrix metalloproteinases (MMPs) and cysteine cathepins, the proteolytic enzymes in
charge of dentine collagen degradation.

8. An 18-year-old woman's rheumatology group referred her for oral evaluation; she had secondary Sjögren syndrome, systemic
lupus erythematosus, and rheumatoid arthritis. The patient had multiple advanced carious lesions, extreme sensitivity, and
hyposalivation. The patient selected a minimally invasive treatment plan that focused on silver diamine fluoride (SDF), partial
caries removal, and glass ionomer cement (GIC) restorations. The SDF treatment and GIC restorations were successful in
arresting carious lesions and restoring form and function but may not completely prevent new carious lesions from forming in
the future.
Case Study

10. • In conclusion, SDF is an efficient, affordable, effective, and safe cariostatic agent, which can be used in the
management of dental caries in both deciduous and permanent teeth.
• The cariostatic mechanism of SDF treatment is associated with the formation of fluoride and silver compounds,
antibacterial properties, and anticollagen degradation efficacy.