Fluoride Leachate Profile of Silver Diamine Fluoride

Abstract

Recently, there has been a renewed interest in the use of silver diamine fluoride (SDF) in the management of caries especially in the high-risk groups. Clinical trials have shown SDF to be an easy to use, effective and safe topical agent with no significant adverse effects [1-4]. As a result, SDF is positioned as an efficient and equitable caries control agent that can be used to help meet the WHO Millenium oral health goals and fulfil the US Institute of Medicine’s criteria for 21st-Century medical care [1-4]. Nevertheless, the resulting black staining following topical application of SDF, as well as the fluoride concentration, potential toxicity and chemical stability of silver fluoride compounds have all been commonly reported as barriers for SDF use [1,5-7]. In an attempt to overcome the unsightly black stain, use of potassium iodide (KI) immediately following SDF application has been advocated [8]. However, to date, there is limited literature investigating the fluoride release from SDF, and to our knowledge, there are no reports investigating the effect of KI application on fluoride release [9]. Therefore, this study sought to compare the fluoride leachate profiles of 38% SDF, 38% SDF with Potassium Iodide (SDF+KI), 5% sodium fluoride varnish (NaF) and 0.32% fluoridated toothpaste (FTP). Furthermore, as fluoride release has been shown to vary depending on pH, a secondary objective of this study was to evaluate the fluoride leachate profiles of the aforementioned agents in neutral, acidic and basic artificial saliva to better reflect the oral environment.