Silver-based compounds in dentistry: Multifaceted applications, cellular antibacterial mechanisms, and safety considerations.

Silver-based compounds represent a promising strategy against oral biofilm-related diseases. This review systematically examines their evolution from simple salts to advanced delivery platforms, including silver diamine fluoride (SDF), nano-silver fluoride (NSF), silver nanoparticles (AgNPs), and emerging silver-organic complexes. The antibacterial action, common to all forms, stems from bioavailable Ag+ ions that attack multiple bacterial targets, disrupting cell membranes, metabolic pathways, and DNA, while inducing oxidative stress. Clinically, SDF and NSF effectively arrest caries, whereas AgNPs are primarily integrated into restorative materials, endodontic systems, and periodontal delivery platforms to inhibit dysbiotic biofilm formation. However, therapeutic success is highly formulation-dependent, facing challenges such as rapid Ag+ inactivation in saliva, esthetic concerns, and nanoparticle agglomeration. Safety profiles reveal a narrow therapeutic window, with risks of argyria from chronic accumulation, highlighting the critical importance of controlled release kinetics. Future translation hinges on the rational design of smart delivery systems, particularly ligand-engineered silver-organic complexes, which offer precise control over Ag+ release for sustained, localized efficacy with improved safety. Advancing these compounds from broad-spectrum antimicrobials to precision therapeutic platforms holds significant potential for improving outcomes in caries management, periodontal therapy, endodontics, and restorative dentistry.