Department of Dentistry, Faculty of Health Science, University of Brasilia, Brasilia, Brazil,
Department of Dentistry, Faculty of Health Science, University of Brasilia, Brasilia, Brazil.
Am J Dent. 2021 Feb;34(1):49-53.
To compare the antimicrobial effect of treating dentin caries lesions with silver diamine fluoride (SDF) in different concentrations and chlorhexidine (CHX).
Children aged 7-10 years presenting one occlusal dentin carious lesion in primary molars were selected, totaling 40 teeth. The sample was randomly divided into four groups: (G1) 38%-SDF + potassium iodide (KI); (G2) 30%-SDF; (G3) 2%-CHX; and (G4) control group. After cleaning the cavity up to firm dentin, a sample of dentin from the pulp wall was collected; the cavity was then treated with the antimicrobial agent tested and, immediately after, another dentin sample was collected. Cavities were restored with high viscosity glass ionomer cement. Microorganisms were counted, and species from the Streptococcus genus were analyzed for susceptibility to antimicrobial agents. Shapiro-Wilk and Levene's tests were used to assess normality and homogeneity, respectively. Student's t-test, two-way ANOVA, and Bonferroni post-test were applied for multiple comparisons.
For the overall microorganisms count, it was observed that G1 and G2 presented a statistically lower number of microorganisms following treatment in comparison to G3 and G4 (P< 0.05). When analyzing the Streptococcus spp. and Enterococcus sp. separately, a statistical reduction in the microorganism count before and after the treatment was observed for all groups (P< 0.05), excluding the control group. Among the species tested, S. mutans were the least susceptible to SDF treatments compared to the other species. The treatments with SDF were more effective in reducing microorganisms when compared to CHX. Similarly, the susceptibility of Streptococcus to CHX was lower than that observed for SDF.
In cases where the dental professional decides to apply an antimicrobial agent prior to the placement of a restoration, silver diamine fluoride proved to be more effective than chlorhexidine, slowing the progression of carious lesions, and possibly preventing future restorative interventions thus improving children's quality of life. It is important to note that clinicians should consider the type of restorative material that will be used due to the possibility that the use of SDF may influence adhesion of the subsequent restoration.
比较不同浓度的银胺氟化物（SDF）和洗必泰（CHX）治疗牙本质龋损的抗菌效果。
选择 7-10 岁儿童，每个儿童有一颗上颌第一恒磨牙的窝沟龋损，共 40 颗牙齿。将样本随机分为四组：（G1）38%-SDF+碘化钾（KI）；（G2）30%-SDF；（G3）2%-CHX；和（G4）对照组。在清洁至坚固牙本质的窝洞后，从牙髓壁采集牙本质样本；然后用测试的抗菌剂处理窝洞，处理后立即采集另一个牙本质样本。用高粘度玻璃离子水门汀修复窝洞。对微生物进行计数，并分析链球菌属的物种对抗菌剂的敏感性。Shapiro-Wilk 和 Levene 检验分别用于评估正态性和同质性。应用学生 t 检验、双向方差分析和 Bonferroni 事后检验进行多重比较。
总体微生物计数结果表明，与 G3 和 G4 相比，G1 和 G2 处理后微生物数量明显较少（P<0.05）。单独分析链球菌属和肠球菌属时，所有组在治疗前后微生物数量均有统计学减少（P<0.05），对照组除外。在所测试的物种中，与其他物种相比，S. mutans 对 SDF 处理的敏感性最低。与 CHX 相比，SDF 处理在减少微生物方面更有效。同样，链球菌对 CHX 的敏感性低于对 SDF 的敏感性。
如果口腔医生决定在放置修复体之前使用抗菌剂，那么银胺氟化物比洗必泰更有效，它可以减缓龋病的进展，可能预防未来的修复干预，从而提高儿童的生活质量。需要注意的是，由于 SDF 的使用可能会影响后续修复的粘结性，临床医生应考虑将要使用的修复材料类型。
