Does Teeth Whitening Weaken Enamel? The Truth

Teeth whitening is a popular way to improve the appearance of a smile, but many people worry that it may weaken tooth enamel or cause permanent damage.

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The good news is that properly performed teeth whitening does not usually cause permanent enamel damage in healthy teeth.

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However, the safety of whitening depends on the product used, its concentration, how long it is applied, and how frequently the treatment is repeated. Understanding these factors can help patients whiten their teeth safely while protecting their oral health.

✅ Does Teeth Whitening Actually Weaken Enamel?
Not necessarily. Scientific evidence suggests that peroxide-based whitening, when used according to recommended instructions, is unlikely to cause clinically meaningful damage to healthy enamel.
A systematic review and meta-analysis published in 2026 found a small reduction in enamel surface hardness after whitening. However, the changes were sensitive to the studies included in the analysis, and the researchers found no clear evidence of clinically meaningful harm under recommended treatment conditions. Importantly, the included studies were laboratory-based, so the findings should not be interpreted as proof that every whitening method is harmless (Márton et al., 2026).
Enamel is the hard outer layer that protects teeth. Although it cannot regenerate like other body tissues, its surface can undergo remineralization, a natural process in which minerals from saliva help restore some mineral content lost during everyday acid exposure.
This distinction matters: a measurable change in enamel hardness in a laboratory does not automatically mean that teeth become weak, fragile, or more likely to break in everyday life.

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✅ Which Whitening Methods Are Safer for Enamel?
Different products work in different ways. Their safety depends on their ingredients, acidity, abrasiveness, concentration, and how they are used.

Professional whitening
When selected appropriately and performed under dental supervision, peroxide-based treatments can whiten teeth effectively. A dentist can identify cavities, cracks, gum problems, and other conditions that should be addressed first.

Whitening strips and home-use gels
These can be effective when used according to the manufacturer's instructions. Excessive application or repeated courses without appropriate guidance may increase sensitivity and irritation.

Whitening toothpastes
Most primarily remove surface stains through polishing ingredients. Some formulas can increase surface roughness or reduce measured enamel hardness in laboratory studies, particularly depending on their abrasiveness and formulation (Jamwal et al., 2022).

Important: Avoid using lemon juice, vinegar, or other acidic household remedies to whiten teeth. Also, do not assume that charcoal or homemade mixtures are safe simply because they are described as natural. Acid exposure and excessive abrasion can wear away enamel.

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✅ What Problems Can Teeth Whitening Cause?
The most common side effects are temporary tooth sensitivity and gum irritation, rather than clinically significant enamel weakening.

▪️ Tooth sensitivity: Teeth may briefly react to cold drinks, hot foods, or air.
▪️ Gum irritation: Whitening gel can irritate soft tissues if it contacts the gums.
▪️ Surface changes: Some formulations and application conditions can affect enamel hardness or roughness, especially in laboratory settings.

These effects depend on the product, its concentration, exposure time, and the condition of the teeth before treatment. Sensitivity usually improves after treatment is stopped or completed, but persistent or severe pain requires dental assessment (American Dental Association [ADA], n.d.).

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✅ How Can You Protect Your Enamel During Whitening?
The following table summarizes the main precautions for safer whitening.

Precaution	Why It Matters
Follow product instructions	Limits unnecessary exposure to whitening agents.
Check for dental problems first	Cavities, cracks, and exposed roots may increase discomfort or require treatment.
Avoid excessive or repeated whitening	Reduces unnecessary exposure and the risk of sensitivity.
Maintain fluoride-based oral care	Fluoride helps protect enamel against acid-related mineral loss and tooth decay.
Stop if pain or irritation develops	Allows reassessment before further exposure causes additional discomfort.

💬 Discussion
The question of whether teeth whitening weakens enamel requires a balanced interpretation of the evidence. Some laboratory studies have identified changes in surface hardness and roughness, while other studies have reported minimal or no significant changes under specific whitening protocols.
Differences in peroxide concentration, product acidity, application time, and laboratory methods help explain these conflicting findings. In particular, results obtained from extracted teeth cannot always predict what will happen in the mouth, where saliva and other protective factors influence the tooth surface.
The 2026 systematic review and meta-analysis by Márton et al. supports the conclusion that peroxide-based whitening produces small changes in measured enamel hardness, but does not establish clinically meaningful enamel damage when recommended protocols are followed.
Therefore, it is inaccurate to claim that all whitening treatments damage enamel. It is equally inaccurate to claim that every product and every application method is completely risk-free.

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🎯 Clinical Recommendations
▪️ Assess oral health before whitening. Treat active decay, evaluate cracks and sensitivity, and check for exposed dentin or roots.
▪️ Select the product and protocol according to the patient's risk. Avoid unnecessary increases in peroxide concentration or exposure time.
▪️ Reassess persistent sensitivity. Suspend treatment and investigate symptoms rather than advising patients to continue despite pain.
▪️ Set realistic expectations. Existing crowns, veneers, and composite restorations do not whiten in the same way as natural teeth.

✍️ Conclusion
Teeth whitening does not usually weaken healthy enamel in a clinically meaningful way when performed appropriately. Nevertheless, some products and treatment conditions can produce measurable surface changes, and excessive use increases the risk of unwanted effects.
The safest approach is to choose a suitable whitening method, follow its instructions, maintain good oral hygiene, and seek dental advice when sensitivity or other symptoms persist. A whiter smile should never come at the expense of unnecessary damage to the teeth.

📚 References
✔ American Dental Association. (n.d.). Whitening. https://www.ada.org/resources/ada-library/oral-health-topics/whitening
✔ Jamwal, N., Rao, A., Shenoy, R., Pai, M., Ks, A., & Br, A. (2022). Effect of whitening toothpaste on surface roughness and microhardness of human teeth: A systematic review and meta-analysis. F1000Research, 11, 22. https://doi.org/10.12688/f1000research.76180.3
✔ Márton, P., Antal, M., Kiss-Dala, S., Agócs, G., Qian, X., Hegyi, P., Varga, G., & Ábrám, E. (2026). Enamel damage from tooth-whitening—a systematic review and meta-analysis. Journal of Dentistry, 172, 106786. https://doi.org/10.1016/j.jdent.2026.106786
✔ Zanolla, J., Marques, A. B. C., da Costa, D. C., de Souza, A. S., & Coutinho, M. (2017). Influence of tooth bleaching on dental enamel microhardness: A systematic review and meta-analysis. Australian Dental Journal, 62(3), 276–282. https://doi.org/10.1111/adj.12494

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Pediatric Bruxism Treatment: What Works Best?

Pediatric bruxism is characterized by repetitive jaw-muscle activity involving clenching or grinding of the teeth and may occur during sleep or wakefulness.

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In children, it is relatively common and is influenced by multiple factors, including sleep disturbances, psychosocial factors, medication exposure, and occlusal or dental conditions.

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The most appropriate treatment depends on the child's age, symptoms, severity, associated conditions, and potential consequences. Current evidence does not support a single universally effective treatment for all children. In many cases, conservative management and monitoring are preferred, particularly when there is no significant tooth wear, pain, functional impairment, or sleep-related disorder.

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✅ What Is the Best Treatment for Bruxism in Children?
The best treatment is generally individualized conservative management, rather than immediate use of a dental appliance or medication.

The initial clinical assessment should determine whether the child has:
▪️ Clinically significant tooth wear or enamel damage
▪️ Jaw-muscle or temporomandibular pain
▪️ Headaches or morning facial discomfort
▪️ Sleep disturbances
▪️ Behavioral or psychosocial factors that may contribute to bruxism
▪️ Medication or medical conditions potentially associated with bruxism
▪️ Functional problems affecting mastication or oral health

When bruxism is mild and asymptomatic, periodic clinical monitoring may be sufficient.

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✅ Behavioral and Sleep Management
For children with sleep bruxism, attention should be directed toward sleep quality and general sleep hygiene. A consistent sleep schedule, adequate sleep duration, and appropriate bedtime routines may be beneficial, particularly when sleep problems coexist.
In children who clench or grind during wakefulness, behavioral awareness and habit modification can be more appropriate. The objective is to reduce unnecessary tooth contact and excessive jaw-muscle activity rather than repeatedly instructing the child to stop grinding.
Psychological or behavioral interventions may be considered when anxiety, stress, or other psychosocial factors appear clinically relevant.

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✅ Should Children With Bruxism Use a Night Guard?
A night guard or occlusal splint should not automatically be prescribed for every child with bruxism.
Dental appliances may be considered in selected cases when there is substantial tooth wear, pain, functional impairment, or a specific clinical indication. However, pediatric use requires careful consideration because children are growing and their dentition is continuously changing.

When an appliance is indicated, it should be:
▪️ Individually fabricated and professionally supervised
▪️ Appropriate for the child's dentition and stage of development
▪️ Regularly monitored for fit and occlusal changes
▪️ Discontinued or modified when clinical circumstances change

The evidence supporting occlusal appliances as a routine treatment for pediatric sleep bruxism remains limited.

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✅ Is Medication Recommended?
Medication is not considered a routine treatment for childhood bruxism.
Pharmacological therapy should not be used simply to suppress tooth grinding in otherwise healthy children. When bruxism is associated with another medical, neurological, psychiatric, or sleep condition, management should focus primarily on the underlying disorder and involve the appropriate healthcare professional.

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✅ When Should the Dentist Investigate Further?
Further evaluation is appropriate when bruxism is accompanied by:

▪️ Significant or rapidly progressing tooth wear
▪️ Dental sensitivity or structural damage
▪️ Persistent jaw-muscle or temporomandibular pain
▪️ Recurrent morning headaches
▪️ Sleep fragmentation or other significant sleep symptoms
▪️ Snoring or suspected sleep-disordered breathing
▪️ Functional limitations
▪️ A relevant medication or systemic condition

Bruxism should therefore be considered within the broader clinical assessment rather than treated as an isolated dental habit.

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✅ Pediatric Bruxism: Treatment Approach

Clinical Situation	Preferred Approach	Clinical Consideration
Mild, asymptomatic bruxism	Observation and periodic monitoring	Avoid unnecessary intervention
Bruxism with tooth wear	Monitor progression and identify contributing factors	Assess severity and rate of progression
Pain or functional symptoms	Conservative management and targeted evaluation	Consider multidisciplinary assessment when indicated
Sleep-related symptoms	Sleep assessment and management of associated problems	Evaluate for sleep-disordered breathing when clinically suspected
Significant dental consequences	Individualized dental management	Appliance therapy may be considered selectively

💬 Discussion
The management of bruxism in children remains challenging because its etiology is multifactorial and the available evidence for specific treatments is less robust than that available for adult populations. Importantly, the presence of tooth grinding alone does not necessarily indicate a pathological condition requiring active treatment.
Current evidence supports a risk-based and symptom-oriented approach. Children without pain, significant tooth wear, functional impairment, or relevant comorbidities may be managed conservatively with clinical observation. When symptoms or dental consequences are present, treatment should address the factors most likely to contribute to the condition.
Occlusal appliances may have a role in selected patients, but their routine use should be avoided without a clear clinical indication. Similarly, pharmacological treatment is not supported as standard therapy for uncomplicated pediatric bruxism.
A particularly important consideration is the relationship between sleep bruxism and sleep-related disorders. When clinical findings suggest disrupted sleep or sleep-disordered breathing, evaluation of the underlying sleep problem may provide greater clinical value than attempting to suppress bruxism directly.

🎯 Clinical Recommendations
1. Do not routinely treat asymptomatic pediatric bruxism. Monitor children who have no significant dental, muscular, or functional consequences.
2. Assess the child rather than the grinding sound alone. Document tooth wear, pain, jaw function, sleep symptoms, and relevant medical or behavioral factors.
3. Prioritize conservative management. Sleep hygiene, behavioral awareness, and management of relevant contributing factors should generally precede invasive or pharmacological approaches.
4. Use occlusal appliances selectively. Consider them only when there is a specific clinical indication and provide regular follow-up during growth and dental development.
5. Investigate significant sleep symptoms. Snoring, fragmented sleep, or suspected sleep-disordered breathing warrants appropriate medical or sleep evaluation.
6. Avoid routine pharmacological treatment. Medication should be reserved for management of an underlying condition when clinically indicated, rather than used routinely to suppress bruxism.

✍️ Conclusion
The best treatment for bruxism in children is not a single appliance, medication, or behavioral technique. For most children, the appropriate strategy is individualized assessment, conservative management, and clinical monitoring.
Active intervention becomes more appropriate when bruxism produces significant tooth wear, pain, functional problems, or is associated with an underlying sleep or medical disorder. Occlusal appliances may be useful in carefully selected cases, but they should not be considered routine therapy for every child.

📚 References

✔ American Academy of Pediatric Dentistry. (2024). Management of the developing dentition and occlusion in pediatric dentistry. In The Reference Manual of Pediatric Dentistry (pp. 455–466). American Academy of Pediatric Dentistry.
✔ Carra, M. C., Huynh, N., Lavigne, G. (2012). Sleep bruxism: A comprehensive overview for the dental clinician interested in sleep medicine. Dental Clinics of North America, 56(2), 387–413. https://doi.org/10.1016/j.cden.2012.01.003
✔ Lobbezoo, F., Ahlberg, J., Raphael, K. G., Wetselaar, P., Glaros, A. G., Kato, T., Santiago, V., Winocur, E., De Laat, A., De Leeuw, R., Koyano, K., Lavigne, G. J., Svensson, P., & Manfredini, D. (2018). International consensus on the assessment of bruxism: Report of a work in progress. Journal of Oral Rehabilitation, 45(11), 837–844. https://doi.org/10.1111/joor.12663
✔ Manfredini, D., Serra-Negra, J., Carboncini, F., & Lobbezoo, F. (2017). Current concepts of bruxism. International Journal of Prosthodontics, 30(5), 437–438. https://doi.org/10.11607/ijp.5436
✔ Serra-Negra, J. M., Paiva, S. M., Auad, S. M., Ramos-Jorge, M. L., & Pordeus, I. A. (2012). Signs, symptoms, parafunctions and associated factors of parent-reported sleep bruxism in children: A case-control study. Brazilian Dental Journal, 23(6), 746–752. https://doi.org/10.1590/S0103-64402012000600017
✔ Winocur, E., Gavish, A., Voikovitch, M., Emodi-Perlman, A., & Eli, I. (2006). Drugs and bruxism: A critical review. Journal of Orofacial Pain, 20(2), 99–111.

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Cracked Tooth Treatment: Causes, Diagnosis & Care

Cracked tooth treatment requires more than simply covering a visible crack. A dental crack represents a structural disruption that may progress under repeated occlusal loading and may eventually affect the dentin, dental pulp, or periodontal tissues.

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The clinical objective is to identify the cause, determine the extent of the crack, assess pulpal and periodontal status, and stabilize the remaining tooth structure.

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Early management is particularly important because an untreated crack may progressively extend and compromise tooth survival.

✅ Dental Crack vs. Dental Fracture
A dental crack is a structural discontinuity that does not necessarily separate the tooth into segments. In current endodontic terminology, a cracked tooth involves a crack extending into dentin, with its depth and extension often initially uncertain.
A fracture generally indicates a more extensive structural disruption and may involve separated or partially separated tooth segments. A split tooth represents a more advanced stage in which the tooth is completely separated into two or more segments.
A superficial craze line, by contrast, is confined to enamel and generally does not represent a clinically significant structural crack. Treatment is usually unnecessary unless esthetic concerns exist.

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✅ Why Does a Dental Crack Develop?
The etiology is usually multifactorial rather than attributable to a single event. Important predisposing and contributing factors include:
▪️ Occlusal overload and parafunctional habits, particularly clenching and bruxism.
▪️ Unfavorable occlusal contacts or interferences.
▪️ Extensive restorations or loss of tooth structure.
▪️ Tooth morphology and cusp anatomy.
▪️ Repeated masticatory loading, particularly with hard foods.
▪️ Age-related changes in dentin.
▪️ Stress generated during restorative procedures.
The current evidence emphasizes that both the structural condition of the tooth and the magnitude and direction of applied forces influence crack development and propagation.
Identifying the Causative Factors
Treatment should not focus exclusively on the visible crack. The mechanical environment responsible for crack initiation or progression should also be evaluated.
Occlusal examination should assess wear facets, premature contacts, functional cusp loading, parafunctional activity, and other conditions capable of repeatedly stressing the affected tooth. When appropriate, management of these factors should accompany restorative treatment.

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✅ Diagnosis of a Cracked Tooth
Diagnosis requires correlation of clinical findings because early cracks may not be visible radiographically or even under direct examination.
Important diagnostic procedures include:
▪️ Pulp sensibility testing to establish pulpal status.
▪️ Bite testing to reproduce pain associated with crack movement. ▪️ Transillumination to identify crack lines. ▪️ Magnification with loupes or an operating microscope. ▪️ Periodontal probing, particularly to identify isolated narrow defects. ▪️ Occlusal analysis. ▪️ Periapical radiographs when indicated. ▪️ CBCT in selected inconclusive cases, recognizing that CBCT does not reliably visualize all dental cracks.
A crack may produce cold sensitivity, sharp pain during biting or release of pressure, or persistent discomfort. However, some cracks remain asymptomatic, making clinical examination particularly important.

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✅ How Is a Cracked Tooth Treated?
Treatment should be individualized according to crack extension, tooth structure, symptoms, pulpal diagnosis, periodontal status, and risk of further propagation.

Clinical Condition	Preferred Approach	Main Objective
Superficial enamel craze line	Observation; esthetic treatment only when indicated	Avoid unnecessary intervention
Vital tooth with shallow, low-risk crack	Monitoring and control of etiologic factors	Prevent progression while preserving tooth structure
Vital tooth with symptomatic crack	Adhesive composite stabilization or cuspal coverage according to structural risk	Reduce tooth flexure and protect the crack
Cracked tooth with irreversible pulpitis or necrosis	Root canal treatment followed by definitive restorative protection	Manage pulpal disease and stabilize the tooth
Extensive non-restorable crack	Extraction when predictable restoration is not possible	Prevent progression and further biological complications

✅ Is Fluoride Useful for a Dental Crack?
Fluoride should not be considered a treatment that repairs a true dentinal crack.
Fluoride can promote remineralization of demineralized enamel and is valuable in caries prevention. However, a structural crack extending into dentin is a mechanical defect and cannot be biologically “sealed” or regenerated with fluoride.
Therefore, fluoride may be appropriate when the tooth also presents an indication for caries prevention or enamel remineralization, but it should not replace mechanical stabilization and restorative management when a clinically significant crack is present.

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✅ Restorative Treatment in a Vital Cracked Tooth
When the pulp is normal or affected by reversible pulpitis, preservation of pulp vitality should be prioritized whenever the tooth remains restorable.
Depending on crack extension and structural risk, treatment may include:
▪️ Direct bonded composite restoration in appropriately selected cases.
▪️ Cuspal coverage with an onlay or other indirect restoration when greater structural protection is required.
▪️ Interim stabilization with bonded composite or a provisional restoration when pulpal response needs to be reassessed before definitive treatment.
The 2025 systematic review by Gavriil et al. found high one-year tooth survival in symptomatic vital cracked teeth, although the certainty of evidence was very low. Indirect restorations, particularly onlays, showed favorable pulp outcomes compared with some alternative approaches.
Current consensus also emphasizes that there is no single restorative protocol appropriate for every cracked tooth. The extent of the crack, remaining tooth structure, symptoms, occlusal forces, existing restorations, and parafunctional habits should influence the choice of restoration.

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✅ Monitoring and Prevention of Crack Progression
A crack with a normal pulp, minimal symptoms, limited extension, and low structural risk may sometimes be monitored rather than immediately restored.
However, active treatment becomes more appropriate when there is significant structural compromise, persistent symptoms, extensive restorations, unfavorable occlusal loading, or a high risk of crack propagation.
Preventive management should include:
▪️ Reduction of excessive occlusal loading when clinically indicated.
▪️ Management of parafunctional habits.
▪️ Avoidance of repeated excessive forces on the affected tooth.
▪️ Periodic clinical and pulpal reassessment.

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💬 Discussion
The management of a cracked tooth is fundamentally a structural and biological problem, rather than simply a cosmetic one. A crack may provide a pathway for bacterial penetration and may progressively affect the pulp and periodontal tissues under continued mechanical loading.
The current evidence supports a conservative philosophy when appropriate: preserve pulp vitality, preserve sound tooth structure, control etiologic factors, and stabilize the tooth according to its structural risk.
Importantly, direct composite restoration can be appropriate in selected vital cracked teeth, but it should not be considered universally equivalent to cuspal coverage. Treatment selection must remain case-specific because the evidence does not establish a single superior restorative protocol for every presentation.

✍️ Conclusion
Cracked tooth treatment should be directed at both the structural defect and the factors responsible for its progression. Fluoride may support enamel remineralization when indicated, but it does not repair a dentinal crack.
For a vital and restorable tooth, treatment may range from monitoring and etiologic control to adhesive composite stabilization or cuspal coverage, depending on the extent and mechanical risk of the crack. When irreversible pulpal disease or necrosis develops, root canal treatment followed by definitive restorative protection may be indicated.
Early diagnosis, preservation of tooth structure, control of occlusal forces, and appropriate restoration are central to improving the long-term prognosis.

🎯 Clinical Recommendations
1. Do not treat a dental crack with fluoride alone. Fluoride supports remineralization but does not repair structural dentinal disruption.
2. Identify and control contributing mechanical factors, particularly parafunction and unfavorable occlusal loading.
3. Preserve pulp vitality whenever clinically possible in a restorable cracked tooth.
4. Select direct composite or cuspal coverage according to structural risk, rather than applying a uniform restorative protocol.
5. Do not perform root canal treatment solely because a crack is present; establish the pulpal diagnosis first.
6. Reassess cracks periodically when observation is selected, because progression may occur despite an initially favorable presentation.

📚 References

✔ Gavriil, D., Kakka, A., & Del Fabbro, M. (2025). The effect of single versus multiple-stage restorative approaches on the pulp outcomes of symptomatic vital cracked teeth: A systematic review and meta-analysis. Journal of Endodontics, 51(10), 1362–1375. https://doi.org/10.1016/j.joen.2025.06.013
✔ Kakka, A., Gavriil, D., & Whitworth, J. (2022). Treatment of cracked teeth: A comprehensive narrative review. Clinical and Experimental Dental Research, 8(5), 1218–1248. https://doi.org/10.1002/cre2.617
✔ Krell, K. V., & Rivera, E. M. (2018). A study of crack lines in posterior teeth. Journal of Endodontics, 44(4), 611–614.
✔ Li, F., Diao, Y., Wang, J., Hou, X., Qiao, S., Kong, J., Sun, Y., Lee, E.-S., & Jiang, H. B. (2021). Review of cracked tooth syndrome: Etiology, diagnosis, management, and prevention. Pain Research and Management, 2021, 3788660. https://doi.org/10.1155/2021/3788660
✔ Patel, S., Teng, P.-H., Liao, W.-C., Davis, M. C., Fidler, A., Haupt, F., Fabiani, C., Ordinola-Zapata, R., & Bose, R. (2025). Position statement on longitudinal cracks and fractures of teeth. International Endodontic Journal, 58(3), 379–390. https://doi.org/10.1111/iej.14186
✔ Zhang, S., Xu, Y., Ma, Y., Zhao, W., Jin, X., & Fu, B. (2024). The treatment outcomes of cracked teeth: A systematic review and meta-analysis. Journal of Dentistry, 142, 104843. https://doi.org/10.1016/j.jdent.2024.104843
✔ Kaur, S., Puzhankara, L., Shenoy, N., Kini, K. S., & Singhal, D. K. (2026). Saving the split: An umbrella review on therapeutic approaches for cracked tooth syndrome. Journal of Conservative Dentistry and Endodontics, 29(1), 11–19. https://doi.org/10.4103/JCDE.JCDE_796_25

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Topical Fluoride in Pediatric Dentistry: Indications, Age, and Frequency

Topical fluoride in pediatric dentistry is a key component of evidence-based caries prevention. Its clinical use should be guided by age, dentition, caries risk, previous caries experience, and total fluoride exposure rather than by age alone.

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Among professionally applied agents, 5% sodium fluoride (NaF) varnish, containing 2.26% fluoride, has the strongest practical role in young children because it provides concentrated fluoride with a relatively small amount of material and limited systemic exposure.

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Current recommendations support its use beginning when teeth erupt, with treatment intervals adjusted according to individual caries risk.

✅ How Does Topical Fluoride Prevent Dental Caries?
Fluoride acts primarily through topical mechanisms. It promotes remineralization, reduces enamel dissolution during acid challenges, and enhances the resistance of dental hard tissues to demineralization.
Repeated exposure is clinically important because fluoride is continuously cleared from the oral environment. Consequently, professional fluoride application should be considered part of a broader preventive strategy that also includes fluoridated toothpaste, dietary counseling, oral hygiene, caries-risk assessment, and appropriate sealant use.

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✅ Indications for Topical Fluoride
Professional topical fluoride is particularly indicated for children with an elevated risk of dental caries, including those with:

▪️ Previous or active caries experience
▪️ Frequent exposure to fermentable carbohydrates
▪️ Poor plaque control
▪️ Enamel developmental defects or hypomineralization
▪️ Orthodontic appliances
▪️ Reduced salivary flow or other conditions increasing caries susceptibility
▪️ Limited exposure to fluoride from toothpaste or community water
▪️ Socioeconomic or access-related factors associated with increased caries risk
However, fluoride varnish can also be used preventively in children without established caries, particularly during early childhood. The USPSTF recommends application to primary teeth beginning at tooth eruption in children younger than 5 years.

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✅ Which Fluoride Agent Should Be Used?
For children younger than 6 years, the ADA clinical practice guideline recommends 2.26% fluoride varnish as the principal professionally applied topical fluoride agent. In children aged 6 years and older, additional professionally applied options, including 1.23% acidulated phosphate fluoride (APF) gel, may be considered according to clinical circumstances.

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✅ Recommended Professional Fluoride by Age

Age	Preferred Professional Agent	Typical Clinical Consideration
Infants and children <6 years	2.26% fluoride varnish	Preferred professional topical fluoride; particularly useful after tooth eruption
Children 6–18 years	2.26% fluoride varnish or 1.23% APF gel	Selection should consider caries risk, cooperation, dentition, and clinical circumstances
High-risk children	Professional fluoride at shorter intervals	Frequency should be individualized according to caries risk and disease activity

The ADA guideline specifically recommends 2.26% fluoride varnish every 3–6 months for patients at elevated caries risk, with the interval determined clinically.

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✅ At What Age Should Topical Fluoride Begin?
There is no clinical reason to wait until a child reaches a particular chronological age once teeth have erupted. Topical fluoride varnish may begin with the eruption of the primary teeth.
The USPSTF recommends fluoride varnish application to the primary teeth of infants and children beginning at primary tooth eruption. This recommendation is supported by evidence demonstrating a moderate net benefit for caries prevention in children younger than 5 years.
Therefore, the clinically relevant starting point is tooth eruption and caries risk, not simply the child's birthday.

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✅ How Often Should Fluoride Varnish Be Applied?
The appropriate interval should be individualized.
For children at elevated caries risk, evidence-based ADA recommendations support professional topical fluoride application every 3–6 months.
A practical risk-based approach is:

Caries Risk	Suggested Interval	Clinical Approach
Low	Usually 6 months or individualized	Emphasize fluoridated toothpaste, diet, hygiene, and routine risk reassessment
Moderate	Approximately every 3–6 months	Consider shorter intervals when multiple risk factors are present
High	Approximately every 3 months	Combine professional fluoride with comprehensive caries-risk management

The 3-month interval should not be interpreted as mandatory for every high-risk child. The decision should reflect disease activity, fluoride exposure, preventive behaviors, and the child's overall risk profile. The 2026 Dental Quality Alliance specifications recognize the evidence-based range of every 3–6 months according to caries risk.

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✅ Fluoride Varnish and Fluorosis Risk
One important advantage of fluoride varnish in young children is the small quantity of material required for treatment. This limits the amount of fluoride available for ingestion compared with some other professionally applied preparations.
Current evidence does not identify professionally applied fluoride varnish as a significant risk factor for dental fluorosis when appropriately used. Nevertheless, clinicians should consider the child's total fluoride exposure, particularly during the period of permanent tooth development.

💬 Discussion
The evidence supports a risk-based rather than age-based approach to professional topical fluoride therapy. Early application is appropriate because primary teeth become susceptible to caries immediately after eruption, while repeated applications maintain topical fluoride exposure over time.
The strongest evidence and clinical consensus favor 2.26% fluoride varnish in children younger than 6 years. In older children, varnish remains an effective option, while other professionally applied agents may be considered when clinically appropriate.
Importantly, professional fluoride should not be regarded as an isolated preventive intervention. Its effectiveness is greatest when integrated into a comprehensive caries management strategy, including daily fluoride toothpaste, control of dietary sugar exposure, plaque control, appropriate sealants, and periodic reassessment of caries risk.

✍️ Conclusion
Topical fluoride in pediatric dentistry should begin when teeth erupt and should be prescribed according to individual caries risk. For young children, 2.26% fluoride varnish is the preferred professionally applied agent, while children at elevated risk generally benefit from applications at 3–6-month intervals.
The optimal fluoride regimen is therefore determined by risk, not age alone. Regular reassessment allows clinicians to intensify or reduce the frequency of professional fluoride treatment as the child's caries risk changes.

🎯 Clinical Recommendations
▪️ Initiate professional fluoride assessment as soon as primary teeth erupt.
▪️ Use 2.26% fluoride varnish as the principal professionally applied topical fluoride in children younger than 6 years.
▪️ For children at elevated caries risk, consider professional fluoride application every 3–6 months, with shorter intervals generally appropriate when risk is high.
▪️ Reassess caries risk and total fluoride exposure at each preventive visit rather than maintaining a fixed schedule indefinitely.
▪️ Do not use professional fluoride as a substitute for daily fluoridated toothpaste and comprehensive caries-risk management.
▪️ Document the child's caries risk, fluoride exposure, agent used, and planned recall interval to support individualized preventive care.

📚 References

✔ American Academy of Pediatric Dentistry. (2023). Fluoride therapy. The Reference Manual of Pediatric Dentistry, 2023–2024. American Academy of Pediatric Dentistry.
✔ American Dental Association. (2013). Professionally-applied and prescription-strength, home-use topical fluoride agents for caries prevention: Clinical practice guideline. American Dental Association.
✔ Chou, R., Pappas, M., Dana, T., Selph, S., Hart, E., Schwarz, E., Fu, R., & others. (2021). Screening and interventions to prevent dental caries in children younger than 5 years: Updated evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA, 326(21), 2179–2192. https://doi.org/10.1001/jama.2021.15658
✔ U.S. Preventive Services Task Force. (2021). Screening and interventions to prevent dental caries in children younger than 5 years: U.S. Preventive Services Task Force recommendation statement. JAMA, 326(21), 2172–2178. https://doi.org/10.1001/jama.2021.20007
✔ Weyant, R. J., Tracy, S. L., Anselmo, T., Beltrán-Aguilar, E. D., Donly, K. J., Frese, W. A., Hujoel, P. P., Iafolla, T., Kohn, W., Kumar, J., Levy, S. M., Tinanoff, N., Wright, J. T., Zero, D., Aravamudhan, K., Frantsve-Hawley, J., & Meyer, D. M. (2013). Topical fluoride for caries prevention: Executive summary of the updated clinical recommendations and supporting systematic review. Journal of the American Dental Association, 144(11), 1279–1291. https://doi.org/10.14219/jada.archive.2013.0057

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Prevention of Molar-Incisor Hypomineralization Complications

Molar-incisor hypomineralization (MIH) is a developmental enamel defect primarily affecting permanent first molars and, frequently, incisors. Because the enamel is less well mineralized, affected teeth are more susceptible to hypersensitivity, post-eruptive breakdown (PEB), dental caries, and restorative problems.

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An important clinical distinction is that there is currently no established preventive treatment that reliably prevents MIH from developing.

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Its etiology is considered multifactorial, involving systemic, environmental, and potentially genetic factors during tooth development. Prevention therefore focuses on reducing complications after MIH is identified, particularly during and shortly after eruption.

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1. Why Early Prevention Matters
The period immediately after eruption is particularly important. Newly erupted MIH-affected molars may be sensitive, difficult to clean, and vulnerable to mechanical enamel breakdown.
Once enamel breaks down, plaque retention and caries risk can increase, while hypersensitivity may further compromise oral hygiene. Early preventive care can therefore help maintain tooth structure and reduce the need for more extensive restorative treatment.
Children with hypomineralized second primary molars (HSPM) also deserve particular attention. A 2024 systematic review and meta-analysis involving 8,944 children found a strong association between HSPM and subsequent MIH, suggesting that HSPM can serve as an important clinical risk marker for closer surveillance.

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2. Fluoride for Caries Prevention
Topical fluoride remains an important component of preventive care for children with MIH because these teeth have an increased susceptibility to caries.
Fluoride toothpaste should be used according to the child's age and caries risk, with appropriate parental supervision. Professional fluoride varnish may also be incorporated into preventive care, particularly when caries risk or sensitivity is elevated.
However, fluoride should not be presented as a treatment that reverses the developmental enamel defect. Its principal preventive value is caries control and support of enamel resistance, rather than correction of the underlying MIH.

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3. Fissure Sealants
For fully erupted permanent molars with mild MIH, resin-based fissure sealants are an important preventive intervention.
The EAPD recommends resin-based sealants as a first-line approach for preventing caries and post-eruptive breakdown in suitable fully erupted molars. The use of an adhesive before sealant placement can improve retention because hypomineralized enamel may provide less predictable bonding.
When moisture control is difficult because the molar is incompletely erupted, a glass ionomer cement (GIC) may be useful as an interim protective material.

Preventive Strategies According to Clinical Situation

Clinical Situation	Preferred Preventive Approach	Main Objective
Newly erupted molar without enamel breakdown	Fluoride-based prevention, oral hygiene reinforcement, early monitoring	Reduce caries risk and detect early breakdown
Fully erupted mild MIH molar	Resin-based fissure sealant, with adhesive when appropriate	Prevent caries and post-eruptive breakdown
Partially erupted molar or poor moisture control	GIC as an interim protective option	Protect vulnerable enamel until definitive sealing is feasible
MIH with hypersensitivity	Fluoride-based preventive care and individualized desensitizing measures	Improve comfort and facilitate effective oral hygiene
Post-eruptive breakdown or caries	Restorative management according to severity	Stop progression and preserve tooth structure

4. Preventing Hypersensitivity-Related Problems
Hypersensitivity is one of the most clinically relevant complications of MIH. It can interfere with toothbrushing, eating, and routine dental care.
Fluoride varnishes and other desensitizing or remineralizing approaches have been studied, including CPP-ACP, CPP-ACFP, arginine-containing products, and calcium-based agents.
However, the evidence remains heterogeneous. A 2024 systematic review and meta-analysis found that CPP-ACP may reduce hypersensitivity compared with fluoride varnish, but substantial heterogeneity and limitations in the available studies prevent strong conclusions regarding a superior remineralizing protocol.
Therefore, these products should be considered adjunctive options rather than universally established MIH treatments.

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5. Oral Hygiene and Dietary Prevention
Children with MIH require particularly effective plaque control because sensitive or irregular enamel surfaces may be difficult to clean.

Preventive counseling should emphasize:
▪️ Twice-daily toothbrushing with age-appropriate fluoride toothpaste.
▪️ Parental assistance when necessary.
▪️ Limiting frequent exposure to fermentable carbohydrates.
▪️ Avoiding prolonged or repeated sugary snacks and drinks.
▪️ Maintaining regular professional examinations.
▪️ Addressing sensitivity early so that toothbrushing is not compromised.
These measures are not specific treatments for the developmental defect itself. Their purpose is to reduce secondary disease around structurally vulnerable teeth.

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6. Recall and Monitoring
Early diagnosis followed by regular monitoring is central to MIH prevention.
The EAPD guidance supports closer follow-up, particularly for newly erupted affected molars. Recall intervals of approximately 3–6 months may be appropriate for children with increased risk, allowing the clinician to detect:
▪️ Early post-eruptive breakdown
▪️ New caries
▪️ Increasing hypersensitivity
▪️ Sealant loss
▪️ Difficulty maintaining oral hygiene
▪️ Changes in restorative prognosis
The recall interval should nevertheless be individualized according to MIH severity, caries risk, eruption status, oral hygiene, and cooperation.

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7. What About Silver Diamine Fluoride?
Silver diamine fluoride (SDF) is well established for arresting caries in selected pediatric situations, but it should not be presented as a proven method for preventing MIH complications in general.
The EAPD guidance noted that, at the time of its publication, there were no clinical studies documenting SDF specifically on MIH-affected teeth.
The current AAPD best-practice document includes SDF among management considerations, but its role should be interpreted within the context of caries management and individual clinical circumstances, rather than as a method of correcting the underlying hypomineralization.

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💬 Discussion
The concept of prevention in MIH requires careful terminology. MIH itself is a developmental enamel defect and cannot currently be reliably prevented once its causative developmental period has occurred. The clinically realistic objective is to prevent or minimize its consequences.
The strongest practical preventive measures are early diagnosis, fluoride-based caries prevention, appropriate fissure sealing, hypersensitivity management, effective oral hygiene, dietary counseling, and close clinical monitoring.
The evidence for many newer remineralization and desensitization products remains limited. A 2024 meta-analysis found potentially beneficial effects for some non-invasive interventions, but emphasized heterogeneity and the need for higher-quality, longer-term clinical trials.
Accordingly, prevention should be risk-based rather than product-based. The severity of enamel breakdown, sensitivity, caries risk, eruption stage, and ability to maintain isolation should determine the intervention.

🎯 Clinical Recommendations
1. Identify MIH as early as possible, particularly around the eruption of the permanent first molars.
2. Treat HSPM as a potential risk marker and consider closer surveillance for subsequent MIH.
3. Establish fluoride-based caries prevention immediately after diagnosis.
4. Consider resin-based fissure sealants for suitable fully erupted mild MIH molars; use an adhesive when appropriate to improve retention.
5. Use GIC as an interim protective option when eruption or moisture control prevents predictable resin sealing.
6. Monitor affected teeth at shorter recall intervals when clinical risk is elevated.
7. Manage hypersensitivity early to prevent compromised oral hygiene and eating function.
8. Do not describe CPP-ACP, SDF, resin infiltration, or other emerging approaches as universally proven preventive treatments; their indications and evidence levels differ.

✍️ Conclusion
Prevention of MIH complications begins with early recognition, not with attempting to reverse the developmental defect. The principal goals are to preserve enamel, prevent caries and post-eruptive breakdown, control hypersensitivity, and maintain function.
Current evidence supports a preventive strategy centered on fluoride, fissure sealants, oral hygiene, dietary control, individualized sensitivity management, and regular monitoring. However, the evidence for many adjunctive remineralization therapies remains limited, making early diagnosis and risk-based clinical decision-making the most reliable foundation for MIH care.

📚 References

American Academy of Pediatric Dentistry. (2025). Molar-incisor hypomineralization. In The Reference Manual of Pediatric Dentistry (pp. 465–472). American Academy of Pediatric Dentistry.
Lygidakis, N. A., Garot, E., Somani, C., Taylor, G. D., Rouas, P., & Wong, F. S. L. (2022). Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): An updated European Academy of Paediatric Dentistry policy document. European Archives of Paediatric Dentistry, 23(1), 3–21. https://doi.org/10.1007/s40368-021-00668-5
Cavalcante, B. G. N., Mlinkó, É., Szabó, B., Teutsch, B., Hegyi, P., Vág, J., Németh, O., Gerber, G., & Varga, G. (2024). Non-invasive strategies for remineralization and hypersensitivity management in molar-incisor hypomineralization—A systematic review and meta-analysis. Journal of Clinical Medicine, 13(23), 7154. https://doi.org/10.3390/jcm13237154
Gevert, M. V., Wambier, L. M., Ito, L. Y., de Souza, J. F., & Chibinski, A. C. R. (2024). Which are the clinical consequences of molar-incisor hypomineralization (MIH) in children and adolescents? Systematic review and meta-analysis. Clinical Oral Investigations, 28(7), 415. https://doi.org/10.1007/s00784-024-05800-5
Lygidakis, N. A., Garot, E., Somani, C., Taylor, G. D., Rouas, P., & Wong, F. S. L. (2022). Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): An updated European Academy of Paediatric Dentistry policy document. European Archives of Paediatric Dentistry, 23(1), 3–21. https://doi.org/10.1007/s40368-021-00668-5
Zhang, Y., et al. (2024). Association of molar-incisor hypomineralization with hypomineralized second primary molars: An updated systematic review with a meta-analysis and trial sequential analysis. Medical Principles and Practice. https://pubmed.ncbi.nlm.nih.gov/39186925/

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Silver Diamine Fluoride for Root Caries: Is It Effective?

Root caries is an increasing clinical concern in adults and older adults, particularly when gingival recession exposes root surfaces. Unlike enamel, exposed root dentin and cementum are more susceptible to acid-mediated demineralization.

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Management can be challenging when lesions occur in patients with multiple affected surfaces, limited access to dental care, reduced oral hygiene capacity, or medical and functional limitations.

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Silver diamine fluoride (SDF), particularly the 38% formulation, has emerged as a nonrestorative approach for arresting root caries. Its clinical value is based on the ability to inhibit caries progression without requiring conventional cavity preparation.
Current evidence supports SDF as an option for arresting root caries in permanent teeth, although the certainty of evidence and clinical recommendations vary according to the treatment alternative and patient circumstances.

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✅ Why Is Root Caries Difficult to Manage?
Root caries develops on exposed root surfaces after loss of periodontal coverage. Dentin and cementum have a higher organic content and are less mineralized than enamel, making them more vulnerable to demineralization.
Root caries management may be particularly challenging in older adults because lesions can occur in multiple teeth and may be associated with gingival recession, plaque accumulation, xerostomia, reduced manual dexterity, or difficulty maintaining oral hygiene.
Conventional restorative treatment remains appropriate when a lesion requires restoration because of structural loss, esthetic requirements, function, or other clinical considerations. However, a nonrestorative strategy can be useful when the primary objective is to arrest disease progression.

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✅ How Does SDF Work on Root Caries?
The anticaries effects of SDF are related primarily to its silver and fluoride components.
Silver has antimicrobial properties that can inhibit cariogenic microorganisms and interfere with bacterial activity within the carious lesion. Fluoride contributes to the formation and stabilization of fluoride-containing mineral phases and increases the resistance of dental hard tissues to subsequent acid attack.
For root caries, the objective is not to restore the original anatomy of the tooth. Instead, SDF is used to inactivate the carious lesion and prevent or reduce further progression.
Clinically, an arrested lesion generally becomes harder and darker after treatment. The permanent dark discoloration is an important consequence of SDF therapy and should be incorporated into informed consent.

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✅ What Does the Clinical Evidence Show?
Evidence from randomized clinical trials and systematic reviews supports the effectiveness of SDF for root caries in older adults.
A systematic review and meta-analysis evaluating SDF for exposed root surfaces included three controlled clinical trials involving 895 older adults. Compared with placebo, SDF significantly reduced the number of decayed or filled root surfaces at 24 months and at 30 months or longer. SDF also showed preventive effects comparable to chlorhexidine and fluoride varnish in the included studies.
A subsequent systematic review and meta-analysis published in 2021 similarly concluded that SDF was effective for the management of root caries in older adults, while emphasizing the limitations of the available evidence.

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✅ Evidence From a Recent Randomized Clinical Trial
More recent evidence further supports the caries-arresting effect of 38% SDF.
A 2026 randomized controlled trial included 186 community-dwelling older adults, with 323 root caries lesions assessed at baseline. At the 2-month follow-up, 165 participants with 286 lesions remained in the analysis.
The SDF group demonstrated substantially higher arrest rates than the control group:

▪️ Individual level: 81.2% with SDF vs. 21.3% with control
▪️ Lesion level: 84.9% with SDF vs. 20.7% with control
The study also found that SDF application, baseline lesion status, and absence of plaque on the lesion surface were positively associated with caries arrest.
Although the short follow-up limits conclusions regarding long-term effectiveness, these findings provide additional contemporary clinical evidence supporting 38% SDF for arresting root caries.

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✅ Is SDF Recommended for Root Caries?
The current evidence-based recommendations are nuanced.
The American Dental Association (ADA) guideline on nonrestorative caries treatment identifies 38% SDF as a nonrestorative option for noncavitated and cavitated root caries lesions on permanent teeth.
However, the ADA guideline prioritizes 5,000 ppm fluoride toothpaste or gel used at least once daily over other nonrestorative options, including annual 38% SDF, because of the overall evidence assessment, feasibility, and clinical considerations. The recommendation for root-surface treatment is conditional and based on low-certainty evidence.
Therefore, SDF should not be interpreted as the universally preferred treatment for every root caries lesion. Its value is particularly relevant when a nonrestorative, minimally invasive approach is appropriate.

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✅ Advantages of SDF for Root Caries
Several characteristics make SDF clinically attractive for selected patients:

▪️ Nonrestorative application: no conventional cavity preparation is required to arrest the lesion.
▪️ Minimal invasiveness: treatment can be performed without rotary instrumentation.
▪️ Caries-arresting activity: clinical studies demonstrate significant arrest of root caries compared with placebo.
▪️ Potential usefulness in older adults: particularly when multiple root lesions or treatment limitations are present.
▪️ Simple topical application: the procedure requires relatively limited clinical resources.
▪️ Potential public-health value: SDF may facilitate disease control in populations with barriers to conventional restorative treatment.
These advantages should be considered within a comprehensive caries-management strategy rather than as a replacement for oral hygiene measures, fluoride exposure, dietary management, or restorative treatment when clinically indicated.

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✅ Limitations of SDF for Root Caries
The principal limitation is permanent dark discoloration of the treated carious lesion. This can be particularly relevant when lesions are located on visible root surfaces.
SDF also does not restore lost tooth structure. An arrested lesion may remain cavitated, and the patient may still require restorative treatment when structural integrity, plaque control, function, food impaction, or esthetics are concerns.
Another limitation is the heterogeneity of the available evidence, including differences in lesion characteristics, application protocols, follow-up periods, and patient populations. The ADA therefore assigns a conditional recommendation with low certainty for nonrestorative management of root caries using SDF.
Importantly, evidence from root caries studies should not automatically be extrapolated to every form of dental caries or to every clinical situation.

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💬 Discussion
The available evidence indicates that 38% silver diamine fluoride is effective in arresting root caries, particularly in older adults. Both earlier systematic reviews and more recent randomized clinical evidence demonstrate a substantially greater likelihood of lesion arrest with SDF than with placebo or control treatment.
Nevertheless, effectiveness should be interpreted in the context of the treatment objective. SDF is primarily a disease-arresting intervention, not a restorative procedure. It can stabilize a carious root surface but does not reconstruct missing dental tissue.
The 2026 randomized trial also highlights the importance of plaque control. The absence of plaque on the lesion surface was positively associated with caries arrest, reinforcing that SDF should be integrated into broader preventive and behavioral management rather than used as an isolated intervention.
Current guidelines consequently position SDF as one component of nonrestorative root-caries management rather than a universal substitute for high-concentration fluoride toothpaste, preventive care, or restorations when indicated.

🎯 Clinical Recommendations
1. Consider 38% SDF for active root caries in permanent teeth when a nonrestorative approach is clinically appropriate.
2. Prioritize comprehensive caries management, including plaque control, appropriate fluoride exposure, dietary counseling, and management of contributing risk factors.
3. Discuss permanent discoloration before treatment, particularly for lesions on visible root surfaces, and obtain appropriate informed consent.
4. Do not regard SDF as a restorative substitute when substantial structural rehabilitation, function, esthetics, or plaque-retentive cavitation requires restoration.
5. Monitor treated lesions clinically for changes in hardness, activity, plaque accumulation, and progression.
6. Use patient-specific decision-making. The ADA currently gives a conditional recommendation with low-certainty evidence for SDF on root surfaces, while prioritizing daily 5,000 ppm fluoride toothpaste or gel as the preferred nonrestorative strategy when feasible.


✍️ Conclusion
Silver diamine fluoride, particularly 38% SDF, has demonstrated clinically significant caries-arresting activity on exposed root surfaces. Evidence from systematic reviews and a recent randomized clinical trial supports its use as a nonrestorative option, especially in older adults and patients for whom conventional restorative treatment may be difficult or undesirable.
However, SDF does not restore lost tooth structure and produces permanent dark staining of treated carious lesions. Its use should therefore be based on lesion characteristics, patient preferences, caries risk, plaque control, functional and esthetic considerations, and the feasibility of alternative preventive or restorative treatments.

📚 References

✔ American Dental Association. (2018). Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. Journal of the American Dental Association, 149(10), 837–849.e19. https://doi.org/10.1016/j.adaj.2018.07.002
✔ Fontana, M., & Weyant, R. J. (2025). Silver diamine fluoride for caries management: An executive summary of the clinical practice guideline. Journal of the California Dental Association, 53(1), Article 2588948. https://doi.org/10.1080/19424396.2025.2588948
✔ Grandjean, M.-L., Maccarone, N. R., McKenna, G., Müller, F., & Srinivasan, M. (2021). Silver diamine fluoride (SDF) in the management of root caries in elders: A systematic review and meta-analysis. Swiss Dental Journal, 131(5), 417–424. https://doi.org/10.61872/sdj-2021-05-02
✔ Zhang, W., McGrath, C., Lo, E. C. M., & Li, J. Y. (2016). Silver diamine fluoride: A systematic review of clinical trials. Journal of Dental Research, 95(5), 512–519. https://doi.org/10.1177/0022034516630671

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