Effect of surface preparation and light curing on penetration of silver particles from 38% silver diamine fluoride in dentin of primary teeth: An in vitro evaluation.

PURPOSE: To evaluate the effect of light cure, as well as various dentin surface treatment approaches, on the penetration depth of silver precipitating from 38% silver diamine fluoride into primary dentin tubules. METHODS: The occlusal dentin surfaces of 42 non-carious primary molars were exposed and then sectioned into halves bucco-lingually. The halves from each tooth pair were randomly split in two mega-groups, and each mega-group was divided randomly as follows into six experimental groups: prepared by either carbide bur (G1, G2), ceramic bur (G3, G4), or erbium laser (G5, G6). SDF was then applied to all prepared surfaces, and finally even-numbered groups (G2, G4, G6) were light cured. One mega-group was assigned to quantitative evaluation of silver penetration depth along the axial wall, and the other mega-group was reserved for qualitative observation of relative silver distribution on the occlusal surface, both via scanning electron microscope. RESULTS: No significant difference was observed in silver penetration depth between light cure and non-light cure groups (P= 0.8908). There was a statistically significant association between tooth preparation method and depth of silver penetration (P< 0.000001); laser-treated groups had significantly deeper silver penetration (1,148.9 µm G5, 1160.4 µm G6) than carbide bur (P< 0.05; 184.7 µm G1, 301.8 µm G2) or ceramic bur (P< 0.05; 184.1 µm G3, 131.0 µm G4) groups. A significant difference (P< 0.05) was noted in percentage occlusal surface coverage of particles between laser (51.4% G5, 35.8% G6) and carbide groups (21.1% G1, 19.3% G2). Light cure had no significant effect on the depth of silver penetration from 38% SDF in the dentin of primary teeth. Laser preparation resulted in deeper silver penetration than carbide or ceramic bur. CLINICAL SIGNIFICANCE: Exposure of 38% silver diamine fluoride-treated dentin to light cure did not affect the depth of penetration of silver particles into the dentin tubules of primary teeth. Rather, tooth preparation approaches that reduce the smear layer, like laser ablation, resulted in the deepest penetration of silver into the tubules. Clinical application of these findings will depend on scenario and treatment aim.

Marginal adaptation and internal indentation resistance of a Class II bulk-fill resin-based composite.

PURPOSE: To compare the dentin bonded external marginal integrity and the internal surface indentation hardness of bulk-fill and conventional resin-based composite (RBC) placed in both bulk and increments. METHODS: 120 MO and DO cavities were prepared in 60 extracted human third molars. The teeth were randomly divided into four groups of 15 teeth per group to be restored as follows: BB (bulk-fill RBC, placed in a 4 mm bulk increment), BL (bulk-fill RBC, placed in 2 mm incremental layers), CB (conventional RBC, placed in a 4 mm bulk increment), and CL (conventional RBC, placed in 2 mm incremental layers). Marginal gaps were measured at mesial and distal dentin gingival cavosurfaces of each tooth using scanning electron microscopy of epoxy resin replicas and Knoop hardness (KHN) was measured at three different RBC depths (1.8, 2.8 and 3.8 mm). Statistical analyses included one-way ANOVA with post-hoc Tukey's HSD, and paired-sample t-test or a nonparametric Wilcoxon signed-rank test, as appropriate. RESULTS: There was no significant effect of RBC restoration type on external marginal gap at the distal surface or at the mesial surface among the four groups tested (P> 0.05 in each instance), while no significant difference in external marginal gap was found between the mesial and distal surfaces within groups (P> 0.05 in each instance). The mean RBC internal surface KHN at 1.8 mm depth was significantly greater than at 2.8 mm and 3.8 mm depths in all tested groups (P< 0.05 for all instances), with a similar mean internal hardness between all groups. The bulk-fill RBC restorations demonstrated similar marginal gap formation and Knoop hardness to conventional universal RBC restorations under the conditions of this study. CLINICAL SIGNIFICANCE: Bulk-fill resin-based composite (RBC), from the perspective of marginal adaptation and internal hardness, may be a suitable alternative to conventional RBC.

Pathogenesis, diagnosis and management of dentin hypersensitivity: an evidence-based overview for dental practitioners.

Though dentin hypersensitivity (DHS) is one of the most common complaints from patients in dental clinics, there are no universally accepted guidelines for differential diagnosis as well as selection of reliable treatment modalities for this condition. The neurosensory mechanisms underlying DHS remain unclear, but fluid movements within exposed dentinal tubules, i.e., the hydrodynamic theory, has been a widely accepted explanation for DHS pain. As several dental conditions have symptoms that mimic DHS at different stages of their progression, diagnosis and treatment of DHS are often confusing, especially for inexperienced dental practitioners. In this paper we provide an up-to-date review on risk factors that play a role in the development and chronicity of DHS and summarize the current principles and strategies for differential diagnosis and management of DHS in dental practices. We will outline the etiology, predisposing factors and the underlying putative mechanisms of DHS, and provide principles and indications for its diagnosis and management. Though desensitization remains to be the first choice for DHS for many dental practitioners and most of desensitizing agents reduce the symptoms of DHS by occluding patent dentinal tubules, the long-term outcome of such treatment is uncertain. With improved understanding of the underlying nociceptive mechanisms of DHS, it is expected that promising novel therapies will emerge and provide more effective relief for patients with DHS.

Fluoride Intake of Infants from Formula.

OBJECTIVE: This study aimed to assess fluoride intake in infants from formula reconstituted with water, with fluorosis risk in mind. STUDY DESIGN: Data on water source, formula brand/type, volume of formula consumption and infant weight were collected for infants at two-, four-, six-, nine- and twelve-month pediatrician well child visits. Identified formula brands and water types were reconstituted and analyzed for fluoride concentration. Patient body mass and volume consumed/day were used to estimate fluoride intake from reconstituted formula. Descriptive statistics, one-way analysis of variance and chi-square tests were utilized. RESULTS: All infants consumed formula reconstituted with minimally fluoridated water (0.0- 0.3 ppm). 4.4% of infants exceeded the recommended upper limit (UL) of 0.1mg/kg/day. Although mean daily fluoride consumption significantly differed among all groups, the proportion of infants at each visit milestone that exceeded daily fluoride intake of 0.1mg/kg/day was not statistically significantly different (p>0.05) for any age group. Predicted values calculated with optimally fluoridated water (0.7ppm) resulted in 36.8% of infants exceeding the UL. CONCLUSIONS: Optimally fluoridated water may increase fluorosis risk for patients younger than six months. Future investigation should include multiple sites and multi-year follow-up to assess actual fluorosis incidence.

Silver diamine fluoride and bond strength to enamel in vitro: A pilot study.

PURPOSE: To evaluate if pre-treatment with silver diamine fluoride (SDF) adversely affects the bond strength of orthodontic brackets to enamel. METHODS: 30 extracted non-carious permanent molar teeth were embedded in acrylic resin cylinders with buccal surfaces exposed and randomly divided equally into two groups. The experimental enamel surfaces were treated with 38% SDF applied for 1 minute between phosphoric acid etch and metal orthodontic bracket bonding with Transbond XT Light Cure Adhesive. Control groups were treated with 37% phosphoric acid etch followed by bonding. All samples were subjected to 500 thermocycles between 5°C and 55°C prior to shear load testing. Mean values and standard deviations of shear bond strengths for each group were analyzed using a general linear model at P< 0.05. Characteristics of bond failure were also recorded via Adhesive Remnant Index (ARI) and analyzed using an ordinal logistic regression at P< 0.05. RESULTS: No significant difference in shear bond strength to enamel was observed between the control and experimental groups (P= 0.65). Comparison of ARI did demonstrate a significant difference between the groups (P= 0.013); SDF significantly altered the characteristic of bond failure, resulting in more adhesive remaining bonded to enamel after failure. No silver staining of treated surfaces was observed. CLINICAL SIGNIFICANCE: The application of SDF to etched non-carious enamel in vitro prior to orthodontic bracket bonding does not adversely affect bond strength.

Silver diamine fluoride, potassium iodide, and esthetic perception: An in vitro pilot study.

PURPOSE: To assess if there was a perceptible difference in staining of restorations in silver diamine fluoride (SDF)-treated teeth, with or without the subsequent application of potassium iodide (KI). METHODS: 20 extracted teeth with frank cavitated carious lesions were prepared with a spoon excavator to remove superficial soft carious dentin and then randomly divided into two groups of 10. The control group was treated with 38% SDF and then restored with glass-ionomer. The experimental group received similar treatment, with the additional step of KI applied before restoration. All teeth were subjected to 500 thermocycles between 5°C and 55°C, followed by storage in artificial saliva at 37°C for 30 days. Three blinded examiners evaluated all 20 teeth for intensity of staining on a scale from 0-5. Wilcoxon rank sum test compared average staining intensity between control and experimental groups of teeth as perceived by each examiner. RESULTS: No significant differences were found (P values: 0.93, 0.67, and 0.97). An aggregate comparison of staining perception between control and experimental groups by repeated measure analysis was done treating the outcome as Poisson distribution also finding no significant difference (P= 0.82). CLINICAL SIGNIFICANCE: The application of potassium iodide after silver diamine fluoride on caries-affected teeth may improve initial esthetic appearance, but after placement of a glass ionomer restoration, potassium iodide does not seem to result in any significant difference in staining.

Combination esthetic treatment of anterior teeth affected by idiopathic enamel hypoplasia: a case report.

The esthetic management of enamel dysplasia presents an opportunity for the practitioner to integrate expertise in diagnosis, biomaterials, and technique. In addition to considerations of appearance, careful attention must be paid to occlusal function and restorative material properties. This case report highlights a combined approach of conservative lithium disilicate indirect restorations and composite resin direct veneers to electively restore the anterior teeth of a patient diagnosed with idiopathic enamel hypoplasia.

Utilization of iTero digital impression unit for resin composite inlay.

Historically, traditional elastomeric impression techniques for indirect fixed procedures have presented challenges for the operator, laboratory, and patient. Recent digital impression unit technology offers a compelling alternative to elastomeric impressions. The iTero system applies parallel confocal imaging to create a virtual impression that can be easily captured, edited, and uploaded electronically to the dental laboratory. Computer-aided design/computer-aided manufacturing technology is applied to the virtual impression to create an unlimited number of identical polyurethane models. This case report is presented from the perspectives of the clinicians and the laboratory technician using an iTero system to treat a left mandibular second premolar with a resin composite inlay.

Survey of fluoride levels in vended water stations.

This study sought to measure the fluoride concentration of water derived from vended water stations (VWS) and to identify its clinical implications, especially with regard to caries prevention and fluorosis. VWS and corresponding tap water samples were collected from 34 unique postal zip codes; samples were analyzed in duplicate for fluoride concentration. Average fluoride concentration in VWS water was significantly lower than that of tap water (P < 0.001). Fluoride concentration in the VWS water ranged from <0.01 ppm to 0.04 ppm, with a mean concentration of 0.02 ppm (±0.02 ppm). Patients utilizing VWS as their primary source of drinking water may not be receiving optimal caries preventive benefits; thus dietary fluoride supplementation may be indicated. Conversely, to minimize the risk of fluorosis in infants consuming reconstituted infant formula, water from a VWS may be used.

The preventive effect of glass ionomer cement restorations on secondary caries formation: A systematic review and meta-analysis.

OBJECTIVE: The objective is to compare the preventive effect on secondary caries of glass ionomer cement (GIC) restorations with amalgam or resin-composite restorations. METHODS: Two independent researchers conducted a systematic search of English publications in PubMed, Web of Science, Cochrane and Scopus. They selected randomized clinical trials comparing secondary caries incidences around GIC restorations (conventional GIC or resin-modified GIC) with amalgam or resin-composite restorations. Meta-analysis of the secondary-caries incidences with risk ratio (RR) and 95% confidence interval (95% CI) as the effect measure was performed. RESULTS: This review included 64 studies. These studies included 8310 GIC restorations and 5857 amalgam or resin-composite restorations with a follow-up period from 1 to 10 years. Twenty-one studies with 4807 restorations on primary teeth and thirty-eight studies with 4885 restorations on permanent teeth were eligible for meta-analysis. The GIC restorations had a lower secondary caries incidence compared with amalgam restorations in both primary dentition [RR= 0.55, 95% CI:0.41-0.72] and permanent dentition [RR= 0.20, 95% CI:0.11-0.38]. GIC restorations showed similar secondary caries incidence compared with resin-composite restorations in primary dentition [RR= 0.92, 95% CI:0.77-1.10] and permanent dentition [RR= 0.77, 95% CI:0.39-1.51]. Conventional GIC restorations showed similar secondary caries incidence compared with resin-modified GIC-restored teeth in both primary dentition [RR= 1.12, 95% CI:0.67-1.87] and permanent dentition [RR= 1.63, 95% CI:0.34-7.84]. CONCLUSIONS: GIC restorations showed a superior preventive effect against secondary caries compared to amalgam restorations, and a similar preventive effect against secondary caries compared to resin-composite restorations in both primary and permanent teeth. [PROSPERO Registration ID: CRD42022380959].

Calibration of equipment for analysis of drinking water fluoride: a comparison study.

Current American Dental Association evidence-based recommendations for prescription of dietary fluoride supplements are based in part on the fluoride concentration of a pediatric patient's drinking water. With these recommendations in mind, this study compared the relative accuracy of fluoride concentration analysis when a common apparatus is calibrated with different combinations of standard values. Fluoride solutions in increments of 0.1 ppm, from a range of 0.1 to 1.0 ppm fluoride, as well as 2.0 and 4.0 ppm, were gravimetrically prepared and fluoride concentration measured in pentad, using a fluoride ion-specific electrode and millivolt meter. Fluoride concentrations of these solutions were recorded after calibration with the following 3 different combinations of standard fluoride solutions: 0.1 ppm and 0.5 ppm, 0.1 ppm and 1.0 ppm, 0.5 ppm and 1.0 ppm. Statistical analysis showed significant differences in the fluoride content of water samples obtained with different two-standard fluoride solutions. Among the two-standard fluoride solutions tested, using 0.5 ppm and 1.0 ppm as two-standard fluoride solutions provided the most accurate fluoride measurement of water samples containing fluoride in the range of 0.1 ppm to 4.0 ppm. This information should be valuable to dental clinics or laboratories in fluoride analysis of drinking water samples.

Effect of shift to virtual teaching on active learning: A snapshot.

PURPOSE: Active learning engages students via interaction for deeper understanding and retention. A global pandemic resulted in an abrupt mid-semester transition from in-person to virtual learning. This study examined student reporting on active learning before and after this transition. METHODS: First-year DDS candidates took an anonymous survey, reflecting on three Spring (January-April) 2020 courses (lecture-style, small-group case-based, and pre-clinical). Survey questions included: (1) basic demographics, (2) reporting frequency (1-Never, 2-Rarely, 3-Sometimes, 4-Often, 5-Always) of active learning elements from a pre-set list before/after the shift to online learning, and (3) Likert-style questions regarding effects on active learning and learning environment preference. RESULTS: The traditional lecture course manifested two active learning activities in the category Sometimes prior to the transition to virtual; one of those activities (question and answer) experienced the most significant difference (p < 0.0001) in frequency change. The small group, case-based course incorporated nine activities in-person in the category Sometimes; although small significant differences (p ≤ 0.05) in frequency were noted for five of those activities between virtual and in-person, these differences may have not have made a difference in practice. The pre-clinical course incorporated four activities in the category Sometimes pre-transition, with no significant differences detected in frequency. Students slightly leaned toward preferring in-person for the small-group and pre-clinical courses, but had no preference for the traditional lecture course. CONCLUSIONS: Course structure may correlate more with student experience of the frequency of active learning activities and preference for in-person versus virtual environment than the environment itself.

Junior faculty perspectives on the academic environment: A call for development and onboarding.

BACKGROUND: One challenge in dental education is new faculty members can be hired with limited teaching experience or understanding of pedagogy. Recent publications document increasing initiatives of faculty development in US and Canadian dental schools. This study evaluates full-time faculty perspectives of their develop and academic environment. METHODS: A 33-item questionnaire distributed to senior administrators and forwarded to faculty, collected data on demographics and satisfaction, utilizing a 5-item Likert scale, multiple choice, and binary yes/no questions. Responses were descriptively and statistically analyzed utilizing an analysis of variance, chi-square, and two-sample t-test. RESULTS: There were 183 faculty respondents (37.7% male/62.3% female), age ranges were 20-29 (2.2%), 30-39 (53.5%), and 41-49(44.3). Respondents reported race/ethnicity: Caucasian (60.7%), Asian (19.1%), Hispanic (12.6%), Black/African American (5.5%), two or more races (2.2%), and Native American 0%. Length of employment was significantly associated with primary responsibility (p = 0.0023), recent publications (p < 0.0011), and short-term intent to remain in academia (p = 0.046). There was a statistically significant difference between age and satisfaction with professional development (p = 0.0411), achieving career objectives (p = 0.0151), well-being (p = 0.0492), access to resources for scholarly interests (p = 0.0114), communication (p = 0.0058), and assessment training (p = 0.0249). Non-Caucasian faculty reported greater dissatisfaction with being treated respectfully (p = 0.0302), departmental commitment to diversity and inclusion (p = 0.0075), and departmental cooperation/teamwork (p = 0.0323). CONCLUSIONS: A significant number of junior faculty have interest in academic dental careers. Institutions should invest in improving onboarding and professional development. Improve the early experiences of faculty, and foster diversity and inclusion and faculty well-being.

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis.

OBJECTIVE: To investigate the effectiveness of glass ionomer cement (GIC) restorations on preventing new caries in primary or permanent dentitions compared with other types of restorations. DATA: Randomized controlled clinical trials evaluating caries experience increment or caries incidence in patients with GIC restorations, including conventional GIC (CGIC) and resin-modified GIC (RMGIC) restorations, were included. SOURCES: A systematic search of publications in English was conducted in PubMed/Medline, Web of Science, Cochrane, and Scopus databases. STUDY SELECTION/RESULTS: This review included 10 studies reporting caries preventive effect of GIC restorations and selected 5 studies for meta-analysis. Patients with GIC restorations showed lower caries incidence compared with other restorations in primary and permanent dentition [RR=0.67, 95% CI:0.55-0.82, p < 0.0001]. Patients with CGIC restorations showed lower caries incidence compared with amalgam restorations [RR=0.57, 95% CI:0.43-0.76, p = 0.0001] and RMGIC restorations [RR=0.70, 95% CI:0.56-0.87, p = 0.002], but no statistical difference with composite resin restorations [RR=0.73, 95% CI:0.51-1.04, p = 0.08] in primary dentition. Patients with RMGIC restorations showed no statistical differences of caries incidence compared with composite resin restorations in primary and permanent dentition [RR=0.83, 95% CI:0.56-1.22, p = 0.33]. CONCLUSIONS: GIC restorations presented a better preventive effect on new caries than other restorations did in primary and permanent dentitions. CGIC restorations presented a better caries preventive effect on new caries than RMGIC and amalgam restorations in primary dentitions did. RMGIC restorations showed similar preventing effect on new caries with composite resin restorations in primary and permanent dentitions. CLINICAL SIGNIFICANCE: This review affirmed the potential of GIC in preventing new caries development in the dentition.

Cytotoxicity Analysis of Human Dental Pulp Stem Cells After Silver Diamine Fluoride Application.

Purpose: The purpose of this study was to evaluate the cytotoxicity of silver diamine fluoride (SDF) to human dental pulp stem cells (hDPSC). Methods: hDPSC were exposed to dilutions of 38 percent SDF ( 10-3, 10-4, and 10-5) and incubated for 24 hours. Cell viability was assessed with colorimetric detection assay at 24 hours. Fresh media was used as a negative control, and 0.1% sodium dodecyl sulfate was used as a positive control. Three independent experiments were performed in triplicate. Cell viability data were analyzed using analysis of variance and Tukey's multiple comparison test. Results: Cells exposed to dilution of 38 percent SDF 10-3 had an average cell viability of 17.0±3.5 (standard deviation) percent. Cells exposed to SDF 10-4 and 10-5 had an average cell viability of 101±2.5 percent and 94±4.4 percent, respectively. Dilution of 10-3 had significantly lower cell viability than the negative control (P<0.001). Dilution of 10-4 and 10-5 SDF had significantly higher cell viability than the positive control (P<0.001) and cells treated with a dilution of 10-3 (P<0.001). Conclusions: Thirty-eight percent silver diamine fluoride was cytotoxic to human dental pulp stem cells at a dilution of 10-3, but not at 10-4 and 10-5. In light of the cytotoxicity of SDF to hDPSC, this in vitro study supports the concern that exposure of the full concentration of 38 percent SDF to the pulp should be avoided.

Factors affecting dental students' postgraduate plans: A multi-site study.

PURPOSE: This multi-site study examined dental students' postgraduate plans and factors affecting them, perceptions of pathways with the best future, and whether those postgraduate plans changed during dental school. METHODS: An online survey was made available to all four dental classes (2018, 2019, 2020, and 2021) and advanced standing/international dental students at eight US dental schools. The survey questionnaire consisted of two parts: (1) 14 questions pertaining to demographic information and (2) 11 questions pertaining to career path choices and possible influencing factors. RESULTS: Overall response rate was approximately 38.4% (1459/3800). For those responding 34.0% planned to enroll in a general dentistry residency, followed by associate dentist in a private practice (31.4%), and specialty residency (17.6%). Quality of life, to increase knowledge/clinical skills, and intellectual satisfaction were most often rated extremely important factors; Influence of family members in dentistry and prestigious specialty received the most responses of not important. General dentistry was perceived to have the best future in terms of overall impact on the profession, potential for positive impact on patient's quality of life, and personal quality of life; oral and maxillofacial surgery was believed to have the best future in terms of salary. Students changed their postgraduate plan during dental school 43.0% of the time, with race (p = 0.006) and year of progress toward degree (p < 0.001) being significant associations. CONCLUSIONS: General dentistry remains the most popular pathway. Many dental students change their plans during dental school; a better understanding of these trends and contributing factors may aid development of practice readiness curricula.

Hand-held water fluoride analysis: An accessible caries prevention tool for dental professionals.

This study sought to compare the relative accuracy of a commercially available hand-held water fluoride analysis unit with a standard laboratory bench-top fluoride-specific electrode/millivoltmeter apparatus, with the goal of identifying possible practical applications of the hand-held unit for preventive dentistry. The units analyzed identical gravimetrically prepared fluoride solutions ranging from 0.1 to 4.0 ppm. The average difference between the measurements from the hand-held unit and the nominal values of the fluoride solutions was 0.011 ppm (SD = 0.068), and the average difference between the hand-held unit's measurements and the bench-top unit's measurements was 0.030 ppm (SD = 0.115). T-test analysis demonstrated no statistical difference between measurements from the hand-held unit with either the nominal values of the fluoride solutions or the bench-top unit's measurements. Results indicate that the hand-held water fluoride analysis unit has an appropriate level of accuracy for the measurement of fluoride levels in drinking water samples by dental professionals.

Fluoride varnish: the top choice for professionally applied fluoride.

Although various modes of delivery for professionally applied fluoride exist, one form has emerged that combines caries prevention efficacy with safety and versatility. The American Dental Association Council on Scientific Affairs recommends fluoride varnish as the only professionally applied fluoride for moderate to high risk patients of all age groups. In addition to demonstrating effectiveness equivalent to fluoride gels, fluoride varnish provides improved safety and acceptability. Furthermore, fluoride varnish has shown promise in preventing dental caries in special groups, such as orthodontic patients and the elderly.

Evaluating the substantivity of silver diamine fluoride in a dentin model.

OBJECTIVES: The goal of endodontic therapy is to prevent apical periodontitis. This is achieved by biomechanical preparation, microbial control using endodontic irrigants, and complete obturation of the canal space. In order to prevent possible post-obturation complications and for an added antimicrobial effect, substantivity is a desired characteristic of endodontic irrigants. Currently the most commonly used endodontic irrigant that produces an antibacterial substantivity effect is chlorohexidine (CHX). Silver diamine fluoride (SDF) is a topically applied agent for managing dental caries and has shown to stop caries lesion progression. The objective of this study was to compare the antimicrobial substantivity effect of 3.8% SDF against other commonly used endodontic irrigants such as 2% CHX and 6.25% Sodium hypochlorite (NaOCl). MATERIAL AND METHODS: Using a diffusion disc assay we determined the antimicrobial activities of 38%, 3.8%, 0.38%, and 0.038% of SDF against the bacterium Enterococcus faecalis OG1RF. Subsequently, we compared the levels of colonization of E. faecalis by scanning electron microscopy (SEM) at 1.5- and 3-week time intervals on dentin pretreated with 3.8% SDF, 6.25% NaOCl, 2% CHX or sterile phosphate buffered saline (PBS). RESULTS: The diffusion disc assay demonstrated that 38% and 3.8% of SDF inhibited the growth of E. faecalis. Moreover, the substantivity of 3.8% SDF (p < 0.01) was comparable to 2% CHX (p < 0.01) and it is significantly greater than 6.25% of NaOCl compared to the PBS treated samples after 1.5 and 3 weeks of incubation. CONCLUSIONS: In this study, we demonstrate that SDF possesses antimicrobial properties against the opportunistic pathogen E. faecalis. Moreover, using a dentin model we show the substantivity of 3.8% SDF is significantly greater than 6.25% NaOCl, but is comparable to 2% CHX.

Clinical Instructions for Using Silver Diamine Fluoride (SDF) in Dental Caries Management.

Manufacturer instructions for 38% silver diamine fluoride (SDF) are limited to current FDA clearance for tooth desensitization. There is a need for instructions to provide best-practice recommendations for off-label use of SDF for caries prevention and arrest. METHODS: The authors considered existing clinical approaches to the use of 38% SDF at pH 10 for the prevention and arrest of active dental caries, in light of the best current evidence. Application of SDF, with or without subsequent direct restoration, is included. The content was reviewed by stakeholders including but not limited to those listed on the consensus statement (Appendix A, below). RESULTS: 38% SDF for the prevention and arrest of active caries lesions, as well as compatibility with common direct restorative materials, such as glass-ionomer cement and resin composite, has a foundation in the scientific literature. A practical decision-flow diagram and accompanying best practices for treatment of caries lesions, based on clinical access and intention to restore, were developed based on available evidence and expert clinical observation when no evidence was available. CONCLUSIONS: Based on the best available evidence, a logical approach can be adopted regarding the practical use of 38% SDF for caries prevention and arrest. PRACTICAL IMPLICATIONS: SDF used as per these instructions for prevention on high-risk tooth surfaces and arrest of active caries lesions has a place in the practitioner's dental caries management armamentarium. When SDF is applied to active lesions, it can be used with or without subsequent restoration, depending on clinical context, expert judgment, and patient input.