Professional Silver Diamine Fluoride (SDF)

It is the cariostatic material, efficient, conservative and less invasive than other treatments. The application of SDF according to various studies and protocols indicate that its application usually takes an average time of 60 seconds.³⁵ A recent Cochrane review showed that, in the primary dentition, current evidence remains inconclusive regarding the effectiveness of silver diamine fluoride (SDF) in preventing new caries or progression of existing lesions when compared to placebo or no treatment. SDF may be more effective than placebo or no treatment in arresting caries. It also prevents new root caries. However, the evidence is uncertain for other caries outcome measures in this dentition. For caries on coronal surfaces of permanent dentition, the evidence is also uncertain. When compared to fluoride varnish, SDF may offer little to no additional benefit in preventing new caries in the primary dentition, and evidence is highly uncertain regarding other caries outcomes and its preventive effects in the permanent dentition. Due to very low-certainty evidence, it was not possible to determine whether one SDF treatment regimen is superior to two or more SDF treatment regimens.

As adverse effects, tooth staining and metallic taste have been reported. However, reporting on tooth staining associated with SDF use was limited, and the evidence regarding adverse effects remains unclear.

Other Professional fluoridated cariostatic agents

a. Nanosilver Fluoride (NSF): Recently, through the use of nanotechnology, the addition of silver nanoparticles to dental products such as fluorides has been proposed Nanoparticles could control the formation of oral biofilm because of their biocidal and anti-adhesive microbial capabilities. Silver nanoparticles may be effective for controlling S. mutans and the antimicrobial effect is better when the nanoparticle is smaller than 10 nm. By combining the benefits of silver nanoparticles with fluoride, the nanosilver fluoride was described as a successful cariostatic material in a controlled clinical trial that showed effectiveness in paralyzing dentine caries in children from poor communities. Unlike silver diamine fluoride (SDF), the NSF did not show distinctive tissue darkening due to the oxidation of silver ions when in contact with the teeth. A recent randomized clinical trial showed that NSF represents an alternative remineralizing treatment for the management of carious lesions in the dentin of primary molars.³⁶

b. Chlorhexidine modified with fluoride: Chlorhexidine is a potent broad-spectrum antimicrobial, and it can improve the adhesion of restorative materials to the tooth by inhibiting metalloproteinases, enzymes that degrade the bond between the two.³⁷ A new chlorhexidine-fluoride varnish product tested on S. mutans levels showed that the varnish significantly reduced S. mutans levels after four applications over 24 weeks. However, more clinical trials are needed to confirm their preventive effect on dental caries, mentioning that no adverse effects were reported.³⁸