Archives of oral biology · 2026
Silver diamine fluoride for dental caries: the good, the bad, and the ugly - insights from preclinical evidence.
СтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Ezhilarasan Devaraj
Аннотация
OBJECTIVE: Dental caries remains a major global public health problem, particularly in early childhood. Silver diamine fluoride (SDF) has gained attention as a cost-effective agent for arresting caries and enhancing remineralization. This narrative review highlights the anticariogenic benefits (the good), cytotoxic concerns (the bad), and tooth discoloration (the ugly) associated with SDF.
DESIGN: Relevant literature was identified through electronic searches of PubMed, Scopus, Embase, Google Scholar, Web of Science, and selected book chapters. Search terms included "silver diamine fluoride," "SDF," "SDF and anticaries," "SDF and cytotoxicity," and "SDF and tooth discoloration." Publications available up to November 30, 2025, were considered.
RESULTS: Experimental evidence demonstrates that SDF exhibits potent antibacterial and antifungal activity against key cariogenic microorganisms, leading to reduced biofilm formation and inhibition of enamel demineralization. Despite these advantages, SDF has notable limitations. In vitro studies report cytotoxic effects on pulp cells, gingival fibroblasts, epithelial cells, and deciduous tooth stem cells, mediated by oxidative stress and apoptosis. In addition, permanent black discoloration of treated lesions remains a major aesthetic concern.
CONCLUSION: From a "good" perspective, preclinical and clinical evidence shows that SDF demonstrates strong anticaries and antimicrobial efficacy by inhibiting cariogenic bacteria, reducing biofilm formation, and promoting dentin remineralization. From a "bad" perspective, it exhibits cytotoxic effects on oral cells at higher concentrations, necessitating cautious professional use. From an "ugly" perspective, clinically, tooth discoloration remains a key limitation. Hence, careful case selection, standardized protocols, and long-term in vivo studies are essential to optimize its safety, efficacy, and acceptance.
DESIGN: Relevant literature was identified through electronic searches of PubMed, Scopus, Embase, Google Scholar, Web of Science, and selected book chapters. Search terms included "silver diamine fluoride," "SDF," "SDF and anticaries," "SDF and cytotoxicity," and "SDF and tooth discoloration." Publications available up to November 30, 2025, were considered.
RESULTS: Experimental evidence demonstrates that SDF exhibits potent antibacterial and antifungal activity against key cariogenic microorganisms, leading to reduced biofilm formation and inhibition of enamel demineralization. Despite these advantages, SDF has notable limitations. In vitro studies report cytotoxic effects on pulp cells, gingival fibroblasts, epithelial cells, and deciduous tooth stem cells, mediated by oxidative stress and apoptosis. In addition, permanent black discoloration of treated lesions remains a major aesthetic concern.
CONCLUSION: From a "good" perspective, preclinical and clinical evidence shows that SDF demonstrates strong anticaries and antimicrobial efficacy by inhibiting cariogenic bacteria, reducing biofilm formation, and promoting dentin remineralization. From a "bad" perspective, it exhibits cytotoxic effects on oral cells at higher concentrations, necessitating cautious professional use. From an "ugly" perspective, clinically, tooth discoloration remains a key limitation. Hence, careful case selection, standardized protocols, and long-term in vivo studies are essential to optimize its safety, efficacy, and acceptance.