RESUMO
Topical cariostatic agents have become a reasonable alternative for managing dental caries in young children. Silver diamine fluoride (SDF) is a practical topical approach to arrest caries and avoid extensive and risky dental treatment. However, the literature demonstrates a parental hesitation towards accepting SDF because of black unaesthetic tooth discolouration following application. The rapid oxidation of ionic silver darkens demineralised tooth structure permanently. In this regard, nano-metallic antimicrobials could augment or substitute for silver, and thereby enhance SDF aesthetic performance. Recently, biomedical research has drawn attention to selenium nanoparticles (SeNPs) due to their antimicrobial, antioxidant, and antiviral potencies. Various in vitro studies have examined the effect of SeNPs on the virulence of bacteria. This narrative review explores practical issues when using SDF and suggests future directions to develop it, focusing on antimicrobial metals. Several methods are described that could be followed to reduce the discolouration concern, including the use of nanoparticles of silver, of silver fluoride, or of selenium or other metals with antimicrobial actions. There could also be value in using remineralising agents other than fluoride, such as NPs of hydroxyapatite. There could be variations made to formulations in order to lower the levels of silver and fluoride in the SDF or even to replace one or both of the silver and fluoride components completely. Moreover, since oxidation processes appear central to the chemistry of the staining, adding SeNPs which have antioxidant actions could have an anti-staining benefit; SeNPs could be used for their antimicrobial actions as well. Future research should address the topic of selenium chemistry to optimise how SeNPs would be used with or in place of ionic silver. Incorporating other antimicrobial metals as nanoparticles should also be explored, taking into account the optimal physicochemical parameters for each of these.
RESUMO
OBJECTIVES: Dental caries managed through two main approaches: Treatment and prevention; one of the recently preventive measures is silver diamine fluoride (SDF), which proven to be a cost effective, minimally invasive, and handy. SDF also is a treatment that could be chosen for uncooperative patients to stop active caries. SDF has drawbacks, and one of these is staining, which may raise esthetic concerns. MATERIALS AND METHODS: This was a cross-sectional study, and the collected data were obtained from Saudi volunteers in Kingdom of Saudi Arabia. Questionnaire designed to obtain demographic data from participants and their opinion about the staining was shown in the photographs after using SDF on primary teeth. RESULTS: Of the 222 participants, when we asked their opinion about the staining, we found that the majority reject this type of treatment. In our analyses, there was statistically significant difference in acceptance ratings between male and female with SDF on posterior teeth (P > 0.05). CONCLUSION: The majority reject this type of treatment. There was a difference in acceptance to the treatment between anterior and posterior teeth. Dentist should provide informed consent form which includes clear photographs showing expected staining, especially when treating anterior teeth.