Silver Diamine Fluoride (SDF) at 38% concentration has become an effective, safe, and minimally invasive alternative for the prevention and treatment of dental caries in pediatric patients.
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✅ 1. Scientific Basis
SDF combines the antibacterial properties of silver with the remineralizing effect of fluoride. Its mechanism of action includes:
° Bacterial inhibition: Silver ions denature bacterial proteins and enzymes, inhibiting their proliferation.
° Remineralization: Fluoride promotes the formation of fluorohydroxyapatite, strengthening enamel.
° Tubule occlusion: Helps reduce sensitivity and prevent further caries progression.
Recent studies have demonstrated the effectiveness of SDF in arresting active caries, with success rates exceeding 80% in primary dentition.
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° Active carious lesions in primary and young permanent teeth
° Children with high caries risk (e.g., severe early childhood caries)
° Patients with behavioral or medical challenges
Situations where conventional restorative treatment is not feasible
✅ 3. Contraindications
° Known allergy to silver, ammonium, or fluoride
° Oral ulcerative lesions, stomatitis, or mucositis
° Carious lesions with pulpal involvement or symptoms of irreversible pulpitis
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➤ Required materials:
° 38% SDF solution
° Disposable microbrushes
° Sterile gauze
° Gloves and eye protection
➤ Procedure:
1. Clinical assessment: Identify active carious lesions visually and radiographically if needed.
2. Isolation: Dry the affected area with gauze (rubber dam is not necessary).
3. Application: Use a microbrush to apply a small amount of SDF directly to the lesion for 1–3 minutes.
4. Drying: Allow the area to air dry; avoid rinsing immediately.
5. Follow-up: Reassess in 2–4 weeks to determine lesion arrest.
➤ Frequency:
° In high-risk patients or those with poor oral hygiene, reapplication is recommended every 6 months.
° In low-risk patients, annual application may be sufficient.
✅ 5. Side Effects and Aesthetic Considerations
The main side effect is permanent black staining of the treated lesion, indicating caries arrest. While safe, this discoloration can be esthetically undesirable, especially on anterior teeth. To mitigate this, potassium iodide may be applied immediately after SDF to reduce staining intensity.
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Parental acceptance of SDF depends on lesion location, the child’s behavior, and prior information provided. It is crucial to explain the benefits and possible esthetic outcomes to obtain informed consent.
✅ 7. Conclusions
38% SDF is a valuable tool in modern pediatric dentistry, offering an effective and non-invasive option for treating dental caries in children. Its simple, safe, and well-tolerated application is especially beneficial for vulnerable populations or those with limited access to care. Standardized protocols and proper parental education are essential to maximize its benefits.
📚 References
✔ Juarez Lopez, M. L. A., Marin Miranda, M., & Murrieta Pruneda, F. (2021). Silver Diamine Fluoride as a minimally invasive alternative in pediatric dental care: Narrative review. Revista de Odontopediatría Latinoamericana, 11(Suppl). https://doi.org/10.47990/alop.v11iSuplemento.482
✔ Sotillo, V., Limongi, I., Medina, A. C., & Martínez Vásquez, M. G. (2023). Silver Diamine Fluoride as therapy to inactivate cavitated caries lesions in primary teeth. Revista Científica CMDLT, 16. https://doi.org/10.55361/cmdlt.v16i1.71
✔ Pariona-Minaya, M. C. (2024). Use of Silver Diamine Fluoride for treating active carious lesions. Odontología Activa Revista Científica, 5(3). https://doi.org/10.31984/oactiva.v5i3.499
✔ Sabbagh, H., Othman, M., & Yaseen Abdulgader, A. A. (2020). Parental Acceptance of Silver Diamine Fluoride Application on Primary Dentition: a Systematic Review and Meta-analysis. BMC Oral Health, 20(227):1-12. https://www.siicsalud.com/dato/resiic.php/165298
✔ Chimbo Sánchez, K. D. (2024). Uses of Silver Diamine Fluoride and its application in pediatric dentistry. Systematic review. Repositorio Digital Uniandes. https://dspace.uniandes.edu.ec/handle/123456789/17914
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