ABSTRACT
Objectives:
Current research was done to evaluate the effectiveness of 38% silver diamine fluoride (SDF) on carious lesions in deciduous teeth.
Materials and Method:
The study included kids who had at least one carious lesion in accordance to the International Caries Detection and Assessment System II. A 38% SDF (FAgamin, Tedequim Company, Córdoba, Argentina) solution was applied directly to the lesion on the deciduous teeth as per the manufacturer’s instructions. A follow-up evaluation was performed after one, three, and six months. Clinical results were used to assess the efficacy of SDF. The obtained data were statistically evaluated.
Result:
When it came to halting dental caries in primary teeth, 38% SDF was 92% effective.
Conclusion:
In conclusion, 38% SDF can be used to effectively stop caries in primary teeth.
KEYWORDS: Caries arrest, efficacy, fluoride, SDF
INTRODUCTION
Dental caries is characterized by dynamic period of demineralization and remineralization resulting into cavitation. Dental caries affecting mankind worldwide, this results into financial burden.
The most frequently used substances for stopping and preventing dental caries are fluoride compounds. A less expensive and an atraumatic treatment option is the use of fluoride materials that have been professionally applied, such as acidulated phosphate fluoride, sodium fluoride varnish and gel, and silver diamine fluoride (SDF). By disrupting the cariogenic microorganisms and precipitating calcium fluoride and silver phosphate, SDF can remineralize tooth structure and stop dental caries.[1] SDF has an antibacterial effect on cariogenic biofilm, prevents collagen degradation due to its inhibitory effect on the matrix metalloproteinase, and increases the microhardness of dentin.[2]
SDF is a colourless liquid that contains 62% water with 44,800 ppm fluoride ion at a pH of 10 and 25% silver, 8% ammonia, and 5% fluoride. SDF has been used to treat young children’s dental caries, to stop elderly patients’ root caries, and prevent pit and fissure caries.[3] Commercially, SDF solution is offered in a range of concentrations, from 10% to 38%. But when applied, it leaves a lasting black stain on the porous tooth structure. By immediate application of potassium iodide solution (KI) on yellowish silver iodide deposits of SDF, it lessens the availability of silver ions and consequently reduces the intensity of tooth staining.[1]
The current research was done to assess the efficacy of a 38% SDF solution in arresting dental caries in primary teeth.
MATERIALS AND METHODS
This research was done in Pediatric dentistry department after obtaining approval from institutional ethics committee. The study was done by single trained investigator after considering the inclusion and exclusion criteria.
The study included kids who had at least one carious lesion in accordance with the International Caries Detection and Assessment System II. The primary dentition’s lesions were classified as active (soft) cavitated carious lesions using the International Caries Detection and Assessment System II. Fifty carious lesions on a total of 24 cooperative kids between the ages of 2 and 6 years were considered in the study. Carious lesions were assessed and classified as either cavitated or arrested.
As per the manufacturer’s instructions, 38% SDF (FAgamin, Tedequim Company, Córdoba, Argentina) solution was put in a plastic dish and applied with a disposable microtip applicator directly to the lesion on primary teeth. It was then left to absorb for up to 30-60 seconds. A follow-up examination was performed to evaluate the lesion’s colour and consistency after one month, three months, and six months. At each follow-up visit, the presence or absence of pain and infection was noted. Dark, hard, and black lesions without pain or infection were regarded as positive outcomes when evaluating the efficacy of SDF based on clinical outcomes.
The obtained data were statistically evaluated using SPSS for Window version 21.00 (SPSS Inc, Chicago, USA) and Chi-square test at P value less than .05.
RESULT
Table 1 indicates that after SDF application there was arresting of carious lesion. After 1, 3, and 6 months the carious arrest was 96%, 94%, and 92%, respectively. The difference was statistically significant. Table 2 indicates that lesion color and consistency changes after SDF application. Arrested hard carious lesion occurs with SDF application. Ninety two percent of carious lesion was arrested after 6 months of follow-up. The difference was statistically significant.
Table 1.
Caries arrest status after silver diamine fluoride treatment
| Caries status | Time duration | P | ||
|---|---|---|---|---|
|
| ||||
| 1 month | 3 months | 6 months | ||
| Caries Arrested | 48 (96%) | 47 (94%) | 46 (92%) | 0.001 |
| Caries active | 2 (4%) | 3 (6%) | 7 (8%) | |
Table 2.
Lesion color, consistency, and arrested after SDF application
| Time duration | Lesion color | Consistency | P | ||
|---|---|---|---|---|---|
|
|
|
||||
| Yellow/brown | Black | Soft | Hard/Arrested lesion | ||
| Baseline (n=50) | 50 (100%) | 0 | 29 (58%) | 21 (42%) | 0.001 |
| 1 month (n=48) | 46 (92%) | 7 (8%) | 2 (4%) | 48 (96%) | |
| 3 months (n=47) | 44 (88%) | 6 (12%) | 3 (6%) | 47 (94%) | |
| 6 months (n=46) | 41 (82%) | 9 (18%) | 7 (8%) | 46 (92%) | |
DISCUSSION
The goal of the present research was to evaluate the efficiency of 38% SDF solution in halting dental caries in deciduous teeth. At 6 months of follow-up, we found that SDF was 92% efficient in arresting dental caries in deciduous teeth.
Until the tooth is restored or exfoliates, application twice a year was found to be more effective in preventing caries than application once a year. As per Zhi et al., application of 38% SDF twice a year was 91% efficient in stopping carious lesions.[4] Based on the location and size of the lesion and the tooth, a single application of SDF can stop carious lesions with an effectiveness of 47% to 90%.[5]
At a 12-month follow-up, Chaurasiya and Gojanur evaluated the efficiency of 38% SDF in halting caries in primary teeth. They came to the conclusion that SDF can be used to stop caries in primary teeth.[3] As per Rodrigues et al., 30% SDF arrest dentin caries lesion.[2] As per Azuoru et al., Rady et al., and Chu et al., SDF works well to stop caries in kids.[6-8] SDF application is more efficient than NaF varnish, as per research by Duangthip et al.[9] Sihra et al. came to the conclusion that SDF with 5% fluoride varnish is a successful strategy for treating early childhood caries.[10]
As per Rafiee et al’s evaluation of the effects of application of fluoridated 10% carbamide peroxide with or without KI, SDF application on demineralized deciduous tooth enamel completely improves enamel microhardness.[1] Both SDF and SDF/KI are effective at stopping carious lesions in primary teeth, as per Aly and Yousry’s findings, but in terms of the potential for discoloration, the use of KI significantly lessened the discoloration caused by SDF immediately postoperatively.[11] Further studies are needed to validate the results.
CONCLUSION
It can be concluded that 38% SDF can be efficiently used in arresting caries in primary teeth.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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