Silver diamine fluoride

Silver diamine fluoride

Clinical data
Trade names	Saforide, Advantage Arrest, Cariesop, Bioride, FluoroplatV, Riva Star
Legal status
Legal status	US: Rx-only, 510(k) cleared class II medical device
Identifiers
CAS Number	34445-07-3
ChemSpider	142121
UNII	DDU19UEV1
Synonyms	Diamine silver fluoride, Diammine Silver Fluoride
Chemical data
Formula	AgF(NH3)2
Molar mass	160.927643 g/mol[1]

Silver diamine fluoride is a topical medicament (drug) used to treat and prevent dental caries (cavities) and relieve dentinal hypersensitivity.^[2][3] Silver diamine fluoride has been available in many countries including China, Japan, New Zealand, Australia and other for many decades. The product was cleared for sale in the USA in August 2014 by the FDA as a class II medical device for the treatment of dentinal hypersensitivity.^[4]

Clinical evidence

6 randomized clinical trials document a profound effect in arresting cavities, simply by drying the cavity and then applying this material. ^{[5] [6] [7] [8] [9] [10] [11]}

2 randomized clinical trials document a profound effect in preventing cavities, by application to other surfaces that have cavities. ^{[5] [6] [7]}

4 randomized clinical trials document a profound effect in preventing cavities, simply by drying the tooth surface and then applying this material. ^{[11] [12] [13] [14]}

A recent Systematic Review of Silver Diamine Fluoride literature and protocols for use was published in the California Dental Journal in January 2016:

• "Risks related to SDF include, but are not limited to: The affected area will stain black permanently. Healthy tooth structure will not stain. Stained tooth structure can be replaced with a filling or a crown".
• "Ongoing Trials: Studies have recently begun to evaluate the ability of silver diamine fluoride to arrest interproximal carious lesions, to compare the relative efficacy of silver diamine fluoride to the combination of silver nitrate plus fluoride varnish and to compare the effects on populations with or without access to fluoridated water. Final reports from these studies will follow in the coming years".
• "Although many fell out, GIC or resin sealants outperformed silver diamine fluoride in preventing caries in the first molars of children, though the cost was ~20 times more". ^[15]

Silver diamine fluoride stains cavities black. A completely darkened cavity is a strong indicator of success. ^[14]

Precautions

Silver diamine fluoride will stain most surfaces black. Skin and soft tissue will discolor within minutes to hours after contact and fade away within a few days. Dentin and enamel with no demineralization present will receive surface (pellicle) stains that can be removed with pumice, while demineralized tooth structure will stain more permanently black. Silver diamine fluoride is corrosive to metal and glass. Contact to metal produces hydrogen gas and hydrogen fluoride while contact with glass will create silicone tetra-fluoride. It is a light sensitive clear liquid with a strong ammonia scent and should be stored in a cool, dark, dry place in a plastic container (LDPE or HDPE).^[16]

Nomenclature

Differences in nomenclature have led to confusion around this material. Silver diamine fluoride is also known as:

• silver fluoride,
• silver diammine fluoride,
• diammine silver fluoride,
• diamine silver fluoride,
• ammonical silver fluoride, and
• ammoniacal silver fluoride.

See also

• Amine Fluoride

References

1. http://www.chemicalregister.com/SILVERDIAMINEFLUORIDE/Suppliers/pid379293.htm
2. http://www.ncbi.nlm.nih.gov/pubmed/22924353
3. http://www.researchgate.net/publication/259246622_The_inhibitory_effects_of_silver_diamine_fluorides_on_cysteine_cathepsins
4. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K102973
5. Chu CH, Lo ECM, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. Journal of Dental Research. 2002;81(11):767-770.
6. Lo EC, Chu CH, Lin HC. A community-based caries control program for pre-school children using topical fluorides: 18-month results. Journal of Dental Research. 2001;80(12):2071-2074.
7. Llodra JC, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. Journal of Dental Research. 2005;84(8):721-724.
8. Yee R, Holmgren C, Mulder J, Lama D, Walker D, van Palenstein Helderman W. Efficacy of silver diamine fluoride for Arresting Caries Treatment. Journal of Dental Research. 2009;88(7):644-647.
9. Zhi QH, Lo ECM, Lin HC. Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. Journal of Dentistry. 2012;40(11):962-967.
10. Santos Dos VE, de Vasconcelos FMN, Ribeiro AG, Rosenblatt A. Paradigm shift in the effective treatment of caries in school children at risk. International Dental Journal. 2012;62(1):47-51.
11. Zhang W, McGrath C, Lo ECM, Li JY. Silver diamine fluoride and education to prevent and arrest root caries among community-dwelling elders. Caries Res. 2013;47(4):284-290.
12. Tan HP, Lo ECM, Dyson JE, Luo Y, Corbet EF. A randomized trial on root caries prevention in elders. Journal of Dental Research. 2010;89(10):1086-1090.
13. Liu BY, Lo ECM, Chu CH, Lin HC. Randomized trial on fluorides and sealants for fissure caries prevention. Journal of Dental Research. 2012;91(8):753-758.
14. Monse B, Heinrich-Weltzien R, Mulder J, Holmgren C, van Palenstein Helderman WH. Caries preventive efficacy of silver diammine fluoride (SDF) and ART sealants in a school-based daily fluoride toothbrushing program in the Philippines. BMC Oral Health. 2012;12(1):52.
15. http://www.cda.org/Portals/0/journal/journal_012016.pdf
16. http://www.elevateoralcare.com/site/images/AdvantageArrestMSDS042515.pdf