IDRR APRIL -MAY -JUNE 2020 - Flipbook - Page 39
PEDODONTICS
it acted as reducing agent for silver fluoride and
second it prevented the new lesions from occurring.
This led to the decrease in 74% of existing lesion remain
unchanged
SDF was first investigated at Osaka university in 1969
as a part of PhD thesis where the researcher
combined the silver using its antimicrobial property
with high doses of fluoride that resulted in occluded
dentinal tubules and reduced dentinal hypersensitivity.
Soon after, “diammine silver fluoride” was granted
approval from the Central Pharmaceutical Council of
the Ministry of Health and Welfare of Japan as a
cariostatic agent and marketed under the name
Saforide. With lot of literature pouring in two facts
were established First, a concentration of 38% SDF was
found to be superior at arresting caries compared to
lower concentrations of 10 or 12% and Second, SDF
was superior at arresting dental caries and preventing
new caries compared fluoride varnish, interim
restorations and glass ionomer cements. SDF gained
clearance from the U.S. Food and Drug Administration
(FDA) as a Class II medical device in August2014. In
October 2016, the FDA awarded SDF the designation
of “breakthrough therapy” based on its arrest of
dental decay in children and adults, a first for an oral
health therapy.
Chemical Reaction of SDF on dentinal caries
1. (Ag (NH3)2 F) comes in comes in contact with
tooth mineral
Hydroxyapatite crystal (HA)(Ca10(PO4)6(OH)2)
2. This results in the formation of calcium fluoride
(CaF2) which forms the reservoir of fluoride
3. Along with this forms sliver phosphate (Ag3PO4)
that converts the lesion to dark colour
4. Both these byproducts help’s in hardening of the
decayed tissue
5. The reaction products between (Ag (NH3)2 F) and
organic components leads to enzymatic reaction
and causes formation of Dextran induced agglutination of cariogenic strains of streptococcus mutans
thereby reducing the antimicrobial activity
Antimicrobial action of SDF
Silver acts on bacteria by
1. Silver ions breakthrough the cell wall of the
bacteria
2. Attaches itself to DNA to stop replication
3. Disrupts the respiration of microbes
4. Silver possesses a potent inhibitory effect on the
activity of matrix metalloproteinases and cysteine
cathepsins.
5. Ionic silver deactivates nearly any macromolecule.
MICROSCOPICALLY
COMPOSITION & MECHANISM OF ACTION
Silver Diamine Fluoride also known as SDF is an
antibiotic liquid used to slow down the progression of
cavities and treat tooth sensitivity. The liquid is claimed
to be more stable than silver fluoride and can be kept
in a constant concentration due to the presence of
ammonia
This colourless topical medicament contains
• 25% (w/v) silver, 8% ammonia and 5% fluoride.
• 38% SDF can be bifurcated as 44,800ppm F &
253,870ppm Ag
• Silver acts as an antimicrobial, the
• Fluoride promotes remineralization, and the
• Ammonia stabilizes high concentrations in solution.
July-August-September 2019
1. An in vitro study found that principal components
of tooth tissue react with SDF and formed calcium
fluoride, which has caries protective effect.
2. This increases the mineral density of enamel
carious lesions
3. Another laboratory study reported SDF inhibits
demineralisation and preserve dentine collagen from
degradation in demineralised dentine.
4. SDF causes obturation of dentinal tubules, by
Increasing the resistance of peritubular dentine and
leads to micro-hardness of dentine carious lesions.
CLINICAL APPLICATIONS
•
•
Arrests smooth surface caries in anterior teeth
Prevents pit and fissure caries
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