Enhanced Tooth Structure Via Silver Microwires Following Treatment with 38 Percent Silver Diamine Fluoride

Area of Science:

• Dental Science
• Materials Science
• Biomaterials

Background:

• The American Academy of Pediatric Dentistry recommends 38% silver diamine fluoride (SDF) for arresting pediatric dental caries.
• SDF treatment results in hardened lesions, suggesting structural changes in carious dentin.
• The precise mechanism behind SDF's hardening effect and structural reinforcement is not fully understood.

Purpose of the Study:

• To investigate the structural and chemical effects of silver diamine fluoride on native tooth structure.
• To elucidate the mechanism of carious dentin hardening following SDF application.

Main Methods:

• Analysis of extracted, SDF-treated primary teeth with cavitated lesions.
• High-resolution synchrotron X-ray microcomputer tomography.
• Field emission scanning electron microscopy and spectroscopy.

Main Results:

• Observed continuous, filamentous silver densities ('microwires') formed in situ within dentin lesions.
• Silver microwires ranged from 50 to 2,100 μm in length and 0.25 to 7.0 μm in diameter.
• Spectroscopy confirmed the microwires were predominantly silver, filling voids and permeating dentinal tubules.

Conclusions:

• SDF treatment leads to the formation of silver microwires that structurally reinforce carious dentin.
• This structural reinforcement, in addition to potential remineralization, contributes to lesion hardening and caries arrest.
• Silver diamine fluoride may exert antimicrobial effects through biochemical interactions and integration into tooth structure.