Minimizing tooth discoloration caused by topical silver diamine fluoride application: A systematic review

The objective of this systematic review is to examine the methods used to minimize discoloration of the carious lesions after topical silver diamine fluoride (SDF) application.

Two independent researchers conducted a search of English literature published up to 30th April 2024 in three databases (PubMed, Scopus, and Web of Science). They screened titles and abstracts, excluding conference proceedings, books, reviews and publications unrelated to SDF. They included only original research on methods to minimize SDF-induced discoloration. The publications lacking comparative color change data were excluded. Full texts of the included articles were then analyzed. The Cochrane guidelines for clinical trials and the guidelines for in-vitro studies on dental materials were used for the risk of bias assessment.

The systematic review included 33 publications from 1,283 identified publications (26 laboratory studies and 7 clinical studies). Thirteen laboratory studies and five clinical studies were rated as having 'low risk'. Three main methods to minimize discoloration were identified: masking with restoration, using chemicals, and substituting silver with nano-silver. Nine studies used resin composite or glass ionomer cement to mask the SDF-induced discoloration. Twenty-nine studies used chemicals to reduce SDF-induced discoloration. These chemicals included precipitating agents like potassium iodide, oxidizing agents like hydrogen peroxide, and chelating agents like glutathione. Seven publications used chemicals (potassium iodide or glutathione) before restoration and six of them found improved masking effect. Four studies substituted silver ions with silver nanoparticles which did not discolor carious lesion.

Masking with restoration, using chemicals, and substituting silver ions with nano-silver particles have been reported to address the discoloring effects of SDF therapy. However, most are laboratory studies, and more clinical trials are needed to confirm their effectiveness in reducing SDF-induced discoloration.

SDF effectively arrests caries, but it discolors carious lesions. This review summarizes the methods and their outcomes for reducing SDF-induced discoloration. This study is supported by the General Research Fund of Research Grant Council No. 17,100,222.