Introduction:
Dental caries is one of the most occurring chronic diseases in the human population. However, a significant reduction in the severity of this disease can be seen due to the maintenance of proper oral hygiene, fluoride-containing dental products, and water fluoridation. Many researchers have studied the eradication and prevention of dental caries, especially concentrating on fluorides. Silver diamine fluorides have the potential to reverse the arresting caries lesions without removing the healthy and sound tooth. Also, it was observed that the silver diamine fluoride remineralizes the dentin. When the carious lesions of the teeth were treated with silver diamine fluoride, it was seen that the mineral density of the teeth increased. The primary benefits of silver diamine fluoride are pain and infection-controlling power, easy application, not costly, low application time, and it is also minimally invasive. It is stated that a single application of silver diamine fluoride was not sufficient, and reapplying it was mandatory.
The treatment of conventional caries in young children or special care needs individuals may need advanced sedation techniques, silver diamine fluoride can be a viable treatment option if sedation is undesirable or unavailable.
What Is Silver Diamine Fluoride?
Silver diamine fluoride (SDF) is a clear, odorless liquid used to treat desensitization of non-carious tooth lesions and molar incisor hypomineralisation. Silver diamine fluorides at a pH of 10 are around up to 28.9 % silver and up to 5.10 % fluoride. It facilitates arresting carious lesions in adults and children who are highly likely to have high caries or caries that are almost out of control, progressing carious lesions. It can also be used in people who are medically compromised, those who cannot tolerate invasive treatments, old-age patients, and those who are medically compromised or need additional care and support.
One of the flaws of silver diamine fluorides is that it has a metallic taste, have the potential to irritate the gingival and mucosal surfaces, and also blacken the surfaces of the tooth to which it is applied.
Silver diamine fluorides are used to manage carious lesions that are too difficult to restore but are free from pain or infection. This factor can play an important role when extractions are contra-indicated for medical or other reasons. Silver diamine fluorides are preferred to facilitate the arrest of caries in deciduous teeth, elderly patients, or there are physical limitations for using the more extensive treatment and where the conventional restorative treatments by resin composite or amalgam restorations are unavailable. In fewer studies, it was stated that silver diamine fluoride is a little more effective than the other restorative materials used for the treatment of dental caries. Silver diamine fluorides are generally recommended for children with a high risk of developing caries or carious lesions; such a population of children was observed to be living in poor conditions or developing countries. The U.S food and drug administration (FDA) stated silver diamine fluoride is a class II medical device and has been cleared by them for use in the management and treatment of tooth sensitivity and has to be professionally applied.
What Is the Composition and Mechanism of Action of Silver Diamine Fluoride?
Silver diamine fluoride is a basic colorless solution having a pH of about 10 to 12 with 38 % weight/volume of silver diamine cation Ag(NH3)2F. Its silver content behaves as an antimicrobial, while the fluoride content in sufficient amounts promotes remineralization. The ammonia (NH3) content stabilizes the solution. When this solution comes in contact with the tooth, the diamine-silver ion complexes react with hydroxyapatite forming silver phosphate complexes and silver oxide. Silver diamine fluoride initiates the inhibition of the collagenolytic enzymes, which are responsible for breaking down exposed dentin organic matrix, by disrupting membranes, denaturing proteins, and inhibiting DNA (deoxyribonucleic acid) replication. Ionic silver acts as an antibacterial agent. The antibacterial mechanisms performed by silver diamine fluoride may also be attributed to the formation of organometallic complexities inside the bacteria cell. Organometallic complexes can do the following processes:
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Deactivating enzymes by blocking the electron transport system in bacteria results in the death of the bacterial cell.
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It induces the procedure of rupture of the bacterial cell.
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It interacts with the DNA of bacteria cells, resulting in mutation and eventually death.
The tooth structure changes its color in a striking way after the formation of silver compounds. This is the most prominent adverse effect of silver diamine fluoride treatment. Many patients are concerned with fluoride treatments, so to respect their concerns, it is explained that there is a low content of fluoride in the amount of silver diamine fluoride used in the treatment of the tooth compared to fluoride varnishes. The research authorities reported that there are no known systemic or serious adverse effects in the use of silver diamine fluoride treatments if used according to the directions of the manufacturing companies.
What Are Early Childhood Caries?
Early childhood caries is a form of early, moderate-occurring kind of dental decay that affects children's primary teeth. It is a major oral health problem. This problem occurs mostly in socially disadvantaged populations. It affects infants, toddlers, and young children worldwide. Early childhood caries are more prevalent in socially disadvantaged or poor groups. Early childhood caries are identified as the presence of one or more decayed, missing, or filled primary teeth dentitions among children aged up to 5 years. The beginning of early childhood caries is characterized by the formation of white-spot lesions in the upper primary incisors along the margin of the gingiva. If the progression of the disease is not interrupted by proper suitable treatment, then it may continue to progress, eventually leading to the complete destruction of the crown of the tooth. Many risk factors are associated with the development of early childhood caries, such as dietary, environmental, and microbiological. Early childhood caries can be prevented by proper dental care and by following the guidance of a dental practitioner, still it is stated as a most common childhood dental problem. Other major factors which contribute to the formation of early childhood caries are:
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Improper feeding.
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The socioeconomic background of the family.
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The educational status of the parents.
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Poor access to dental care.
Overall, health is important, but in a similar way, oral health also plays a vital role the functions like eating and speech development. Good and healthy dentition may give the child a positive self-image.
Conclusion:
Studies have shown that silver diamine fluoride is an effective treatment for managing dental caries. The pieces of evidence stated that silver diamine fluoride at 38 % can be a non-invasive treatment option to inhibit dental caries progression as well as eradicate them. Its successful performance is due to properties like the synergistic effect of silver and fluoride ions, inhibiting power for bacterial or biofilm growth, and its function to support remineralization. Also, the anti-enzymatic activity of silver and fluoride ions can stop the collagenolytic enzymes from breaking down the exposed dentin matrix. The most talked about adverse effect of silver diamine fluoride is the permanent staining of the dentin and enamel caries arrested lesions, limiting its use for esthetic purposes.
