Silver Diamine Fluoride: A Successful Anticarious Solution with Limits.

Silver diamine fluoride (SDF) is a solution containing ionic silver, fluoride, and ammonia that arrests the progress of carious lesions and prevents the development of future caries. The silver particle extends into the dentin tubules and could create some bonding problems for subsequent composite resin restorations placed over SDF-treated darkened tooth structures. The fluoride penetrates deeper into the tooth with SDF as compared with other fluoride solutions, creating a fluoride reservoir in the tooth structure. The fluoride component of SDF contributes to remineralization and fluorapatite formation, producing harder, more caries-resistant tooth structures. The silver provides the antimicrobial activity for the material and inhibits biofilm formation. It has been evaluated in >20 clinical studies and reviewed in systemic reviews. The material was recently approved by the Food and Drug Administration for desensitizing cold-sensitive teeth and has been used off-label to treat carious lesions. SDF will produce a caries lesion darker (brown to black) than the original, which is the major criticism of the material. A nanoparticle-sized silver material was recently developed that may retain the antimicrobial properties of the larger-sized ion silver material without the discoloring effects. The application of SDF is easily adapted for field use. The lesion is isolated, and the solution is painted onto the clean caries lesion and dried. This simple application process requires little equipment, and its low cost per application makes the material ideal for large populations.